Halting Hypoglycemia

You feel weak and lethargic right after eating a meal. You are diabetic. You could also be hypoglycemic.

Hypoglycemia is a condition your blood sugar level (glucose) is less than normal. Glucose is your body’s main energy source. Hypoglycemia goes hand in hand with diabetes treatment. But other drugs and a variety of medical conditions can cause low blood sugar in people who don’t have diabetes.

Treatment often involves getting your blood sugar back to normal either with high sugar foods or drinks or with medication. Long term treatment involves identifying the cause of hypoglycemia.

Some symptoms of hypoglycemia include an irregular or fast heartbeat, pale skin, fatigue, shakiness, anxiety, sweating, hunger, irritability, and tingling or numbness of the lips, tongue or cheek. If hypoglycemia worsens, some other signs include confusion, abnormal behavior or both, such as inability to complete routine tasks; visual disturbances, such as blurred vision; seizures; and loss of consciousness.

Hypoglycemia occurs when your blood sugar is too low and there are several causes for this, the most common being a side effect of drugs used to treat diabetes.

When you eat, the body breaks down carbohydrates such as bread, pasta and rice into various sugar molecules including glucose.

Glucose, the main energy source for your body, enters the cells of most of your tissues with the help of insulin, a hormone secreted by your pancreas. Insulin enables the glucose to enter the cells and provide the fuel your cells need. Extra glucose is stored in your liver and muscles in the form of glycogen.

If you haven’t eaten for several hours and your blood sugar level drops, another hormone from your pancreas signals your liver to break down the stored glycogen and release glucose into your bloodstream. This helps keep your blood sugar level in the normal range until you eat again.

If you have diabetes, you might not make enough insulin (type 1 diabetes) or your body may not be responsive to it (type 2 diabetes). As a result, glucose tends to build up in the bloodstream and reach scary high levels. You may need to take insulin or other drugs to lower blood sugar levels.

But too much insulin or other diabetes medications may cause your blood sugar level to fall too low, causing hypoglycemia. Hypoglycemia occurs when you eat less than usual after taking diabetes medication or if you exercise more than you normally do.

Hypoglycemia without diabetes is rare. Causes can include medications, excessive alcohol drinking, some critical illnesses, insulin overproduction, and hormone deficiencies.

Hypoglycemia occurs usually when you haven’t eaten, but not always. Sometimes hypoglycemia can occur when you have eaten foods high in sugar because your body produces more insulin than is needed.

This type of hypoglycemia called reactive hypoglycemia or postprandial hypoglycemia can occur in people who have had stomach bypass surgery. It can also occur in people who haven’t had this surgery.

Untreated hypoglycemia can lead to seizure, loss of consciousness, and even death. Hypoglycemia can contribute to dizziness and weakness, falls, injuries, motor vehicle accidents, and greater risk of dementia in older adults.

Over time, repeated episodes of hypoglycemia can lead to hypoglycemia unawareness. This means the brain and body no longer produces signs of hypoglycemia such as shakiness or irregular heartbeat. This raises the risk of severe, life-threatening hypoglycemia.

If you have diabetes, recurring episodes of hypoglycemia and hypoglycemia unawareness, your doctor might modify your treatment, raise your blood sugar level goals, and recommend blood glucose awareness training.

If you have diabetes, these episodes of low blood sugar levels can be uncomfortable and frightening. Fear of hypoglycemia can cause you to take less insulin to ensure that your blood sugar level doesn’t fall too low. Talk to your doctor about your fear and never switch your diabetes medication without speaking with your physician.

A continuous blood glucose monitor (CGM) is one way to monitor your blood glucose level. A CGM has a tiny wire that’s inserted under the skin that can send blood glucose readings to a receiver.

If blood sugar levels drop too low, some CGM models will alert you with an alarm. Some insulin pumps are now integrated with CGMs and can shut off insulin delivery when the blood sugar levels are dropping too quickly to help prevent hypoglycemia.

If you don’t have diabetes, eating frequent small meals throughout the day is a stopgap measure to help prevent your blood sugar levels from dipping too low. However, this is not a long-term strategy.

If you use insulin or another diabetes medication to lower your blood sugar, and you have signs and symptoms of hypoglycemia, test your blood sugar levels with a blood glucose meter. If the result shows a blood sugar level under 70 mg/dl, then treat accordingly.

If you have symptoms of hypoglycemia then you should eat or drink 15 to 20 grams of fast-acting carbohydrates (sugary foods without protein or fat that can easily be converted to sugar in the body like fruit juice or soft drinks); recheck blood sugar levels 15 minutes after treatment to see if above 70 mg/dl. If not, then repeat eating 15 to 20 grams of fast-acting carbs. Once blood sugar levels are normal, have a snack or meal to stabilize it and replenish your glycogen stores.

Your hypoglycemia is considered severe if you need help from someone in order to recover from it. If you can’t eat, you might need glucagon injection or intravenous glucose. In general, people who are treated for diabetes should have a glucagon kit for emergencies. Family and friends should know where the kit is and how to use it just in case.