Hypoglycemia

Low blood sugar, or hypoglycemia occurs when blood sugar levels drop lower than where they should be. Some people may refer to this as a diabetic episode or an insulin reaction. Generally, a blood sugar level of less than 70 mg/dL is considered hypoglycemia.

Hypoglycemia generally occurs in people with diabetes that take insulin, sulfonylureas, or meglitinides. Less commonly, it can happen in other people with diabetes, and even in people that don’t have diabetes.

When treating diabetes, there can sometimes be a fine line between keeping blood sugars in a safe and low range versus making them TOO low TOO often. If your diabetes is being treated with one of the drugs previously mentioned, there’s a chance that you may get hypoglycemia once in a while. Maybe you skipped a meal, consumed less carbohydrates than normal, drank alcohol, or were more active. Although it’s important to treat this low blood sugar properly and come up with steps to prevent it in the future, there may be no need change your medication regimen. However, if it’s happening frequently, making you fearful or nervous, is severe in nature, or you’re eating and drinking excessively to prevent it – talk to your provider as a change in regimen may be necessary.

Some common symptoms of hypoglycemia include:

• Shakiness

• Lack of coordination

• Sweating

• Blurred or impaired vision

• Nervousness or anxiety

• Weakness

• Irritability

• Confusion

• Fast heart rate

• Hunger

If hypoglycemia is severe, other symptoms can include seizures, convulsions and/or unconsciousness. It can also lead to accidents and falls. Once you learn what symptoms happen to you, they’re generally going to stay the same. If you always get sweaty when you’re low, that’s your cue in the future that something is possibly wrong. Some people say it’s actually a loved one or co-worker that will notice signs of hypoglycemia before they do. I’ve heard from many people that when they are being argumentative or difficult their significant other will tell them to check their blood sugars. What’s said with a low blood sugar doesn’t count, right?

If you are having symptoms of hypoglycemia, check your blood sugars if possible to verify whether your level is <70. Unfortunately, symptoms of low blood sugars are somewhat generic, so it may be difficult to know if it’s a low blood sugar or something else. If your blood sugar is actually low, the goal is to treat it as quickly as possible. All the healthy eating rules are thrown out the window and blood sugars should be raised by consuming simple sugar. Don’t go overboard though – we’re talking about 15 grams of sugar, not 150! Some examples include:

• 3-4 glucose tablets

• Prepackaged liquids or gels (check instructions for amounts)

• 4 ounces (1/2 cup) regular soda or juice (not diet!)

• 1 Tablespoon honey or sugar

• 15g carbohydrates worth of jellybeans, gumdrops or other candies that can be chewed relatively quickly

Notice that these ideal examples contain just sugar, not fat or protein. Fat can potentially slow down the digestion of the carbohydrates so your blood sugars don’t rise as quickly as possible. Protein, particularly in people with type 2 diabetes, seems to make the body secrete insulin, which in this case is the exact opposite of what we want to happen. Again, these are ideal examples so try to make them accessible. However, sometimes you have to improvise if such options are not available. If that is the case, feel free to grab whatever you have to that contains carbohydrates- glass of milk, donut, bread, whatever.

After consuming carbohydrates, wait 15 minutes and then check your blood sugars again. If it’s still low, go through the process again. Afterwards, consume a balanced meal or snack to keep your blood sugars where they belong. Some people feel better as soon as their blood sugars go up, other people feel crumby for several hours or even for the rest of the day. Judging by your symptoms alone might not be the best way to determine if your blood sugars are back to normal or not.

I think most people that have had a low blood sugar are guilty of overtreating their low blood sugar, meaning they pig out or go crazy to compensate. I can’t tell you how many people go from a blood sugar of 50 to 250 because they went overboard with the carbs. It’s tempting to drink the whole bottle of orange juice or treat yourself to a dessert you normally avoid. Maybe low blood sugars make you really nervous and you feel the need to really drive your blood sugars up. However, especially if you're treating your diabetes with insulin, you’ll never get off the crazy blood sugar roller coaster with this habit. Stick to the plan as much as possible and talk to your provider or Certified Diabetes Care and Education Specialist if you need help.

Hypoglycemia can be a scary part of having diabetes. Treat it like an emergency situation as it can lead to some serious stuff like a trip to the hospital, or if left untreated, potentially death. In terms of long-term issues, the evidenced is mixed. For some age groups, a history of severe hypoglycemia appears to increase the risk of dementia, but in other age groups this does not seem to be the case. Another thing we know is, hypoglycemia can cause more hypoglycemia (weird, right?). Your body has counterregulatory hormones like epinephrine to help increase blood sugars when they go too low. If you’re having frequent hypoglycemic episodes these hormones don’t work as well. Luckily this vicious low blood sugar cycle can be stopped by keeping blood sugars in a higher range for even a short period of time.