Don't ignore the signs of hypoglycemia - learn how to recognize the symptoms and understand the causes and levels. Our comprehensive guide offers expert insights

Hypoglycemia

Humza Khizer

Overview

Hypoglycemia is a medical condition characterized by low blood sugar levels, typically below 70 mg/dL.

Blood sugar serves as the primary source of energy for the body cells. Normal blood sugar levels are essential for proper body function and <a href="https://merisehat.pk/article/insulin-dose-and-timings">insulin </a>is the hormone that helps regulate blood sugar levels. It allows glucose to enter cells where it can either be used for energy or stored for later use.

At a scientific level, hypoglycemia occurs when the balance between glucose production and utilization in the body is disrupted. Low blood sugar levels can be dangerous particularly because it leaves the brain starving for glucose. This means the brain cells cannot function properly, leading to a range of symptoms such as confusion, dizziness, and even loss of consciousness. 

Hypoglycemia is difficult to accurately determine in a population as symptoms are often attributed to hypoglycemia without confirmation of low blood sugar levels.

A study conducted in Brazil found that hypoglycemic events occurred in a significant percentage of patients with <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">type 1 and type 2 diabetes</a>, including nocturnal, asymptomatic, and severe hypoglycemic events<a href="#accordion">[1]</a>. 

Hypoglycemia can be caused by certain medications and therapies for diabetes. Insulin-producing tumors are a rare but important cause of hypoglycemia. Reactive hypoglycemia is more commonly reported in women aged 25-35 years, while insulinoma is typically diagnosed in patients in their early 40s, but can occur at any age<a href="#accordion">[1]</a>.

Another study revealed that 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes who take insulin reported low blood sugar at least once within 4 weeks. Individuals with type 2 diabetes who take oral diabetes medications, such as meglitinide or sulfonylurea, are also at a higher risk for hypoglycemia<a href="#accordion">[2]</a>. 

In rare cases, someone without diabetes can also experience hypoglycemia<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

Low blood sugar can be classified into different types based on the severity and timing of symptoms<a href="#accordion">[3]</a> <a href="#accordion">[7]</a>: 
&nbsp;

<ol>
	<li>Nighttime Low Slood Sugar: This type of low blood sugar occurs during sleep and can be caused by a variety of factors, including taking too much insulin, drinking alcohol before bedtime, or having an active day. Symptoms include sweating, shaking, confusion, or nightmares. 
	It is important to monitor blood sugar levels regularly and to have a snack before bedtime if at risk for nighttime low blood sugar. 
	&nbsp;</li>
	<li>Severe Low Blood Sugar: This type of low blood sugar occurs when blood glucose levels drop below 54 mg/dL, and can be life-threatening if not treated promptly. Symptoms include weakness, difficulty walking, confusion, seizures, or loss of consciousness. </li>
</ol>

Severe low blood sugar can be caused by skipping meals, taking too much insulin, or engaging in excessive physical activity. Treatment involves consuming a fast-acting source of glucose, such as fruit juice or candy, followed by a longer-acting source of carbohydrates. In some cases, a glucagon injection may be needed to quickly raise blood sugar levels. 
&nbsp;

<ol start="3">
	<li>Reactive Hypoglycemia: This occurs when the blood sugar levels drop rapidly after eating a meal high in carbohydrates. It&#39;s often seen in people who have had gastric bypass surgery or who have other conditions that affect their digestion. 
	&nbsp;</li>
	<li>Fasting Hypoglycemia: This type of hypoglycemia occurs when a person hasn&rsquo;t eaten for a while, such as when they&rsquo;re sleeping or fasting for a medical test. It can be caused by a variety of conditions, including diabetes, liver disease, and certain medications. 
	&nbsp;</li>
</ol>

Signs and Symptoms

Some common signs and symptoms of hypoglycemia include: 
&nbsp;

<ul>
	<li>Shakiness or trembling, often accompanied by sweating and feeling cold</li>
	<li>Dizziness or lightheadedness</li>
	<li>Confusion or difficulty concentrating</li>
	<li>Irritability or mood changes</li>
	<li>Hunger or nausea</li>
	<li>Headache</li>
	<li>Blurred vision</li>
	<li>Weakness or fatigue</li>
	<li>Seizures or unconsciousness 
	&nbsp;</li>
</ul>

Note: Symptoms of hypoglycemia vary from person to person. It&rsquo;s also possible that you may not experience any symptoms at all. That&rsquo;s why it is important to monitor blood sugar levels regularly, especially if you&rsquo;re diabetic or have any other medical conditions that can affect sugar levels. 
&nbsp;

Causes

The most common causes of hypoglycemia include: 
&nbsp;

Diabetes Medication: These drugs, especially insulin, are designed to lower blood sugar levels.&nbsp; If the dosage is too high or it&rsquo;s administered or taken at the wrong time, then blood sugar levels can drop too low. 
&nbsp;

Not Eating Enough: Skipping meals or not eating enough can lead to hypoglycemia, especially if the person is also taking diabetes medication. 
&nbsp;

Excessive Alcohol Consumption: Alcohol causes hypoglycemia because it interferes with the liver&#39;s ability to produce glucose. 
&nbsp;

Increased Physical Activity: Exercise can lower blood sugar levels, especially if the individual is diabetic. 
&nbsp;

Medical Conditions: Certain medical conditions, such as liver or kidney disease, can affect the body&#39;s ability to regulate blood sugar levels and lead to hypoglycemia. Some rare genetic conditions, such as glycogen storage disease or von Gierke disease, can also lead to hypoglycemia. 
&nbsp;

Hormonal Imbalances: Hormonal imbalances, such as those caused by an overactive thyroid gland, can also lead to hypoglycemia. 
&nbsp;

&nbsp;
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A fasting blood glucose test may be used to screen for hypoglycemia in individuals who are at risk, such as those with diabetes or a family history of the condition. 
&nbsp;

<h5>Neonatal Hypoglycemia Screening&nbsp;</h5>

It is normal for an infant to experience a brief moment of low blood sugar during the first 2 hours of life. Also, they&rsquo;re usually asymptomatic during this period. It is not important to perform a routine glucose screening test for these infants.

However, infants who are at risk of pathologic hypoglycemia due to the following reasons need to be screened:

<ul>
	<li>Premature (&lt;37 weeks gestation)</li>
	<li>Large for gestational age</li>
	<li>Small for gestational age</li>
	<li>Born to a diabetic mother or mother with gestational diabetes 
	&nbsp;</li>
</ul>

Moreover, infants who exhibit the following symptoms should also be screened for hypoglycemia:

<ul>
	<li>High-pitched cry</li>
	<li>Poor sucking ability or refusal to feed</li>
	<li>Tremors, irritability</li>
	<li>Hypothermia or temperature instability</li>
	<li>Exaggerated Moro reflex</li>
	<li>Apnea, cyanosis, tachypnea</li>
	<li>Lethargy, hypotonia 
	&nbsp;</li>
</ul>

Diagnosis

Tests, including a glucose tolerance test or continuous glucose monitoring, help evaluate the patient&#39;s blood glucose levels over a period. 

The doctor may also evaluate the patient&#39;s diet, medication use, and exercise habits to identify any factors contributing to hypoglycemia.

The doctor may also perform a Whipple&#39;s triad, which involves observing the patient&#39;s symptoms during an episode of low blood sugar, measuring low blood sugar levels during the episode, and observing the resolution of symptoms after the patient receives treatment for low blood sugar. 
&nbsp;

Treatment

Immediate Treatment For Hypoglycemia Symptoms

<ul>
	<li>Eat or drink 15-20 g of fast-acting carbohydrates such as glucose tablets or gel, fruit juice, regular soda, honey, or sugary candy.</li>
	<li>Recheck blood sugar levels 15 minutes after treatment. If it&rsquo;s still under 70 mg/dL, consume a healthy snack that includes 15-20 g of fast-acting carbs. Then check the blood sugar level again. Repeat these steps until the blood sugar level is above 70 mg/dL. 
	&nbsp;</li>
</ul>

Emergency Treatment For Severe Hypoglycemia

Severe hypoglycemia requires assistance from another person for recovery. Generally, diabetics who use insulin have a glucagon kit available for emergencies and their family and friends should know where it is and how to use it. For instance, if the person is unable to eat, they would need a glucagon injection to recover.

NOTE: If the person is unconscious, do not attempt to give them food or drink. Also, if there is no glucagon kit or you are unsure of how to use it, seek emergency medical help. 
&nbsp;

Treatment Of Underlying Conditions Causing Hypoglycemia

Identifying and treating the underlying cause is important to prevent recurring episodes. This may involve:

<ul>
	<li>Nutrition counseling by a registered dietitian to review eating habits and food planning </li>
	<li>Changing the dose of medications that cause hypoglycemia. The doctor may stop some of them entirely if they feel that the patient&rsquo;s quality of life is affected drastically. </li>
	<li>Surgery to remove the tumor in the pancreas if that&rsquo;s causing hypoglycemia. In some cases, partial removal of the pancreas may be necessary.<a href="#accordion">[5]</a> 
	&nbsp;</li>
</ul>

Prolonged severe hypoglycemia can be life-threatening and lead to various complications, including:

<ul>
	<li>Multiple organ failure</li>
	<li>Cardiac arrhythmias</li>
	<li>Cardiac arrest</li>
	<li>Permanent brain damage</li>
	<li>Coma</li>
	<li>Death 
	&nbsp;</li>
</ul>

NOTE: People with low blood sugar should avoid operating heavy equipment, such as driving a vehicle, as it can be dangerous and increase the risk of accidents. 
&nbsp;

The risk factors of hypoglycemia include: 
&nbsp;

<ul>
	<li>Poorly controlled diabetes.</li>
	<li>Skipping meals or fasting.</li>
	<li>Excessive use of alcohol.</li>
	<li>Hormone deficiencies, such as growth hormone deficiency or adrenal insufficiency.</li>
	<li>Medical conditions, such as liver disease, kidney disease, or insulinoma. 
	&nbsp;</li>
</ul>

Several preventative measures can be taken to reduce the risk of hypoglycemia: 
&nbsp;

Regular Blood Glucose Monitoring: This helps individuals with diabetes or other health issues that can cause hypoglycemia to identify and address low blood sugar levels before the condition becomes severe.

Also, exercise can lower blood sugar levels. So, it&#39;s important to monitor blood sugar levels before, during, and after exercise and to adjust medication and food intake as needed. 
&nbsp;

Proper Medication Management: It is important to take medications as prescribed by the doctor and to inform the practitioner of any symptoms or side effects as they occur. 
&nbsp;

Balanced Meals And Snacks: Eating balanced meals and snacks that include complex carbohydrates, proteins, and healthy fats help regulate blood sugar levels. 
&nbsp;

Avoid Skipping Meals: This is particularly for those individuals who are at risk of developing hypoglycemia. 
&nbsp;

Quit Alcohol: Alcohol may make hypoglycemia more likely and hence it is important to quit this habit. 
&nbsp;

Key Points

<ul>
	<li>Hypoglycemia is a medical condition characterized by low blood sugar levels, typically below 70 mg/dL.</li>
	<li>It is most commonly associated with diabetes but can also occur in people without diabetes.</li>
	<li>Symptoms of hypoglycemia can range from mild to severe, including sweating, shakiness, confusion, and loss of consciousness.&nbsp;</li>
	<li>The most common cause of hypoglycemia in people with diabetes is taking too much insulin or other blood sugar-lowering medication.</li>
	<li>Severe hypoglycemia is life-threatening and requires emergency medical attention.</li>
	<li>Continuous glucose monitoring devices can help diabetic people track their blood sugar levels and reduce the risk of hypoglycemia. 
	&nbsp;</li>
</ul>

[1] Osama Hamdy MD. Hypoglycemia. Practice Essentials, Background, Pathophysiology.

[2] Hypoglycemia. Cleveland Clinic.

[3] Low blood sugar (hypoglycemia). Centers for Disease Control and Prevention.

[4] Endocrine Society. Hypoglycemia. Endocrine Society.

[5] Hypoglycemia. Mayo Clinic.

[6] Ly TT, Nicholas JA, Retterath A, Lim EM, Davis EA, Jones TW. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial. JAMA. 2013 Sep 25;310(12):1240-7. doi: 10.1001/jama.2013.277818. PMID: 24065010.