Hypoglycemia: Signs, Symptoms, and Complications (2024)

Hypoglycemia occurs when your blood sugar (glucose) levels fall below what is considered normal.It is also called low blood sugar. The condition can be related to diabetes treatment, but it can also have other causes.

Glucose is the primary energy source for your body. When your blood glucose levels are too low, you may experience symptoms like shakiness, a fast heartbeat, anxiety, and hunger. If your blood sugar gets dangerously low, you may have symptoms like confusion, vision difficulties, behavioral changes, seizures, or even loss of consciousness.

Hypoglycemia is common in people with diabetes, though it tends to occur more often in people with type 1 diabetes. The true incidence is not known because mild hypoglycemia often goes unnoticed.

This article explores the symptoms, causes, and complications of hypoglycemia. It will also help you understand when you should see a healthcare provider for hypoglycemia.

Understanding Blood Sugar (Glucose)

Glucose comes from the foods we eat and serves as a source of energy for the body. Your body uses a hormone called insulin to move glucose into your cells where it can be used. When you have diabetes, your body doesn't make enough insulin, so the glucose remains in your blood.

Your body breaks carbohydrates down into sugars. When you have diabetes, these sugars can build up in your blood, leading to hyperglycemia or high blood sugar.

Taking insulin can help prevent high blood pressure, but it can also cause your blood sugar to become too low. Low blood sugar can also occur when you skip meals, eat too little, or exercise without changing how much you eat or adjusting your medication.

Hypoglycemia Symptoms

Hypoglycemia symptoms may occur when your blood glucose is 70 milligrams per deciliter (mg/dL) or below. The symptoms tend to follow a pattern that you'll probably very quickly learn to recognize if you have diabetes.

Frequent Symptoms

Common symptoms include:

• Shakiness
• Hunger
• Fast heartbeat
• Anxiety or panic
• Tingling feeling around your mouth
• Sweating
• Headache
• Tiredness
• Inability to concentrate
• Dilated pupils
• Irritability
• Restlessness
• Nausea
• Dizziness
• Weakness
• Loss of muscle control

Severe Symptoms

When your blood sugar becomes dangerously low—less than 54 mg/dL, as defined by the American Diabetes Association (ADA), which regards this parameter as severe or "level 2" hypoglycemia—you may have any of these symptoms as well:

• Confusion
• Behavioral changes
• Slurred speech
• Clumsy movements, as if you're intoxicated
• Blurry or double vision
• Seizures
• Loss ofconsciousness

Nocturnal Symptoms

During the night, you may have hypoglycemic episodes and not be aware of them. This is especially common with type 1 diabetes and a bit less common with type 2 diabetes.

Your body produces two hormones,glucagon and epinephrine, that help keep yourblood sugar at normal levels. During sleep, glucagon production decreases. Added to this, type 1 diabetes tends to disrupt glucagon production and glucagon decreases with every episode as well.

Symptoms of nocturnal hypoglycemia include:

• Night sweats
• Nightmares
• Talking or shouting in your sleep
• Restlessness
• Headache
• Not feeling well-rested when you wake up
• A glucose level that's higher than normal in the morning

To help prevent nocturnal hypoglycemic episodes, try eating a bedtime snack that's high in complex carbohydrates such as granola, oatmeal, or dried fruit. Keep your eating plan, exercise routine, and medication consistent in the afternoon and evening as well.

Also, be careful not to overdose on your insulin in the evening, which can lead to hypoglycemia.

Hypoglycemia Unawareness

When you have diabetes and you have repeated episodes of hypoglycemia, your brain can become less able to recognize that you're hypoglycemic because your body stops showing symptoms. This is known as hypoglycemic unawareness and it often happens at night while you're sleeping.

It's more common in type 1 diabetes than in type 2. Your blood sugar levels can become dangerously low if this continues, leading to a coma or even death.

What Causes Hypoglycemia?

Hypoglycemia has numerous causes, which are different depending on whether you have type 1 diabetes, type 2 diabetes, or don't have diabetes.

Type 1 Diabetes

Hypoglycemia is common in type 1 diabetes. It usually happens when you take more insulin than your body needs to process your food, but other things can cause it, too, including:

• Not timing your insulin dose correctly around meals
• Not monitoring your blood sugar closely when exercising or drinking alcohol
• Hot, humid weather
• Changes in your schedule, such as when traveling
• Being at a high altitude
• Puberty
• Menstrual periods

Because you can't control some of those factors, it's especially important to pay attention to the ones you can control.

Type 2 Diabetes

Hypoglycemia is less common in type 2 diabetes than in type 1. It's often caused by:

• Medications: This includes taking too much medication, including insulin.
• Food: Eating too few carbohydrates compared to your insulin is a factor.
  
• Drinking carbohydrates: Your body absorbs carbs from liquids faster than from solids, so your insulin timing may prove difficult.
• Physical activity: Exercise lowers your insulin needs.

Note that newer insulins and diabetes medications are less likely to result in hypoglycemia.

No Diabetes

Non-diabetic hypoglycemia can be caused by many things, including:

• Some medications (beta-blockers, some antibiotics, heart arrhythmia medications)
• Alcohol consumption
• Underlying kidney, liver, or metabolic illness
• Undereating
• Hormonal deficiencies
• A rare pancreatic tumor (insulinoma) causing insulin overproduction
• Recent bariatric surgery
• Insulin autoimmune syndrome
• Reactive hypoglycemia

How Is Hypoglycemia Diagnosed?

Hypoglycemia is diagnosed with a blood sugar level test. If your blood sugar is below 70 mg/dL, you have hypoglycemia.

If you don't have diabetes, your healthcare provider will diagnose hypoglycemia with a blood test. You will have to fast overnight before the test. Some tests require you to do a longer fast in a hospital setting.

How to Test Your Blood Sugar at Home

You can test your blood sugar at home with a glucose meter. To test your blood, wash your hands and insert a test strip into your meter. Using the needle included with the test kit, prick the end of a fingertip. Place the blood droplet on the test strip. The meter will read the blood sugar level from the test strip and display it on a screen.

What Are the Complications of Hypoglycemia?

If hypoglycemia remains untreated, it can lead to any of the severe symptoms mentioned above, such as seizures, unconsciousness, and, eventually, death. This is why it's critical to treat low blood sugar immediately, no matter the cause.

Hypoglycemia can also be a contributing factor in:

• Falls
• Motor vehicle accidents
• Other injury-causing accidents

How Is Hypoglycemia Treated?

Hypoglycemia can usually be treated at home by eating a small snack containing 15 carbohydrates. Check your blood sugar 15 minutes after eating the snack, and repeat if it is not above 70mg/dL.

You can also take glucose tablets instead of eating a snack.

If your hypoglycemia is severe, you may need a glucagon injection. If you have diabetes, you should always keep a glucagon kit on hand in case your blood sugar becomes dangerously low. The glucagon should be injected into an arm, thigh, or buttocks. Glucagon is also available as a dry nasal spray, which is administered into a nostril.

Treatment if You Pass Out

Severe hypoglycemia can lead to loss of consciousness. If this happens, someone else will need to administer the glucagon injection. Make sure your friends and family members know where you keep your glucagon kit and that they understand how to administer the injection if you lose consciousness.

How Is Hypoglycemia Prevented?

You can prevent low blood sugar by monitoring your blood sugar as recommended by your healthcare provider and making sure you have 15g carbohydrate snacks on hand if your blood sugar begins to trend low.

Make sure you are eating on a regular schedule and that you are eating consistent amounts. Don't skip meals or snacks and be sure to take your medication as directed.Avoid alcohol or drink in moderation and only with a meal or snack.

If you are more physically active than usual, you may need to add snacks or adjust your medication. It is especially important to continue monitoring your glucose on days when you are more active than usual.

If you have hypoglycemia often, it's a good idea to keep records of what you eat and how much exercise you've been getting. This can help you spot patterns so you can avoid becoming hypoglycemic in the future.

When to See a Healthcare Provider

When to get medical help for hypoglycemia depends on whether you have diabetes.

If You Don't Have Diabetes

If you don't have diabetes and you have symptoms of hypoglycemia, you should see your healthcare provider right away, even if you're able to get your symptoms to subside.

Being hypoglycemic means something else is going on and you need to find out what that is. Then, you can get treatment before your hypoglycemia becomes life-threatening.

If you still have symptoms after treating your low blood sugar with the above measures, go to the emergency room immediately.

If You Have Diabetes

If you have diabetes, you'll most likely deal with hypoglycemia on occasion. If your blood sugar is below 70 mg/dl, try one of the remedies detailed above or take glucose tablets as directed by the package.

As long as your blood sugar goes back to normal, you can resume your regular activities. However, if you've treated your hypoglycemia and your blood sugar remains low and/or you still have symptoms, contact your healthcare provider as soon as possible.

Get emergency help for severe symptoms such as:

• Behavioral changes
• Confusion
• Visual changes
• Slurred speech
• Seizures
• Unconsciousness

Summary

Hypoglycemia, also called low blood sugar, is a potentially life-threatening condition where glucose levels in your blood become lower than what is considered normal. It often occurs as a result of diabetes treatment, but other conditions can cause it, too.

If you have symptoms of hypoglycemia or your blood sugar is less than 70mg/dL, try eating a snack containing 15 grams of carbohydrate. If your symptoms do not improve, repeat every 15 minutes until you feel better or your blood glucose is above 70mg/dL.

See your healthcare provider if you don't have diabetes and you have symptoms of hypoglycemia, or if you have diabetes and you frequently experience low blood sugar or have low blood sugar overnight.