Recognizing Low Blood Sugar Symptoms (Hypoglycemia) and What to Do Fast

Hypoglycemia, or low blood sugar, is a condition that occurs when the level of glucose (sugar) in your blood drops below normal. It's most commonly associated with diabetes treatment, particularly when taking insulin or certain oral medications, but can also occur in people without diabetes under certain circumstances. Recognizing the symptoms of hypoglycemia and acting quickly is crucial to prevent severe complications like seizures, loss of consciousness, or even brain damage. This article will delve into the signs of low blood sugar, explain the causes, and provide a step-by-step guide on what to do when you or someone around you experiences a hypoglycemic episode.

Understanding Hypoglycemia: Why It Happens

Blood glucose, the body’s primary source of energy, fuels your brain and muscles. When glucose levels drop too low, these organs don't function correctly, leading to various symptoms. The reasons for hypoglycemia vary:

• Excessive Insulin or Medication Dosage: The most common cause for diabetics is too much insulin or oral medications designed to lower blood sugar.
• Skipping Meals or Eating Too Little: Insufficient carbohydrate intake compared to medication dosage can cause blood sugar to plummet.
• Increased Physical Activity: Exercise uses up glucose stores. Without adjusting medication or increasing food intake, intense or prolonged activity can cause hypoglycemia.
• Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, especially when consumed without food.
• Underlying Medical Conditions: In rare cases, kidney disorders, liver disease, tumors, or hormonal deficiencies may cause low blood sugar.

It’s important to distinguish between reactive hypoglycemia, which occurs within a few hours after eating (often after a high-carb meal), and fasting hypoglycemia, which develops after not eating for a prolonged period. These two types have different underlying causes and require specific medical evaluation.

Recognizing the Signs: What Are the Symptoms of Low Blood Sugar?

The symptoms of hypoglycemia can vary from person to person and may also depend on how quickly blood sugar levels drop. Symptoms often begin mildly and can worsen rapidly if left untreated. Early recognition is key. Here's a comprehensive breakdown of common symptoms:

Mild to Moderate Symptoms:

• Shakiness or Trembling: A feeling of inner shakiness, even without visible tremors.
• Sweating: Unexplained, excessive sweating, particularly in the absence of physical activity or a hot environment.
• Anxiety or Nervousness: Feelings of unease, worry, or agitation.
• Irritability or Confusion: Sudden mood changes, being easily angered, or difficulty concentrating.
• Rapid Heartbeat (Palpitations): A sensation of your heart racing or pounding.
• Dizziness or Lightheadedness: Feeling faint, unsteady, or like the room is spinning.
• Hunger: An intense craving for food, often accompanied by stomach rumbling.
• Tingling or Numbness: Often felt around the mouth, fingers, or toes.
• Blurred Vision: Difficulty focusing or seeing clearly.

Severe Symptoms:

• Difficulty Concentrating: Significant impairment in thinking clearly or making decisions.
• Slurred Speech: Difficulty articulating words.
• Confusion or Disorientation: Being unable to recognize people or places, or difficulty answering simple questions.
• Seizures: Uncontrolled muscle spasms and loss of consciousness.
• Loss of Consciousness (Passing Out): Unresponsiveness to stimuli.
• Coma: A prolonged state of unconsciousness.

It’s vital to be aware of these symptoms, particularly if you are at risk for hypoglycemia, and to communicate them clearly to others. If you have diabetes, educating your family, friends, and colleagues on how to recognize and respond to a hypoglycemic emergency can be lifesaving. Consider wearing a medical identification bracelet or carrying a card that identifies you as having diabetes and provides emergency contact information.

What to Do When Hypoglycemia Strikes: A Step-by-Step Guide

Responding quickly and effectively to a hypoglycemic episode can prevent serious consequences. Here’s a detailed guide on what to do: A Beginner S Guide To Effective Diabetes Management And A1C Goals

Step 1: Recognize the Symptoms and Check Blood Sugar (If Possible)

If you suspect low blood sugar, immediately check your blood glucose level with a blood glucose meter if you have one available. A reading below 70 mg/dL (3.9 mmol/L) generally indicates hypoglycemia. However, even without a meter, if you experience symptoms consistent with low blood sugar, proceed with treatment.

Step 2: The "15-15 Rule"

The "15-15 rule" is the cornerstone of treating mild to moderate hypoglycemia:

• Consume 15 Grams of Fast-Acting Carbohydrates: Choose one of the following options:
  • 4 ounces (120 ml) of regular soda (not diet)
  • 4 ounces (120 ml) of fruit juice (such as apple or orange juice)
  • 1 tablespoon of honey or corn syrup
  • 3-4 glucose tablets (check the packaging for the amount to equal 15 grams)
  • 1 tube of glucose gel
  • Hard candies: Typically 3-4 pieces, but read the label to ensure you're consuming roughly 15 grams of carbohydrates
• Wait 15 Minutes: Allow the carbohydrates to be absorbed into your bloodstream.
• Recheck Blood Sugar: After 15 minutes, check your blood glucose level again.
• Repeat If Necessary: If your blood sugar is still below 70 mg/dL (3.9 mmol/L), repeat the 15-15 rule.

Important Considerations:

• Avoid Fatty Foods: Foods high in fat (like chocolate bars, ice cream, or peanut butter) can slow down the absorption of glucose, delaying the rise in blood sugar.
• Complex Carbohydrates are Not Ideal: While complex carbs (like bread or crackers) are healthy, they take longer to raise blood sugar, making them less effective for treating acute hypoglycemia.

Step 3: Follow-Up with a Meal or Snack

Once your blood sugar has returned to a safe range (above 70 mg/dL or 3.9 mmol/L), it's essential to eat a meal or snack containing both carbohydrates and protein to help stabilize your blood sugar and prevent another drop. Good options include:

• A piece of whole-wheat bread with peanut butter
• Crackers with cheese
• A small sandwich with lean protein

Step 4: When to Seek Emergency Medical Attention

If someone is experiencing severe hypoglycemia, characterized by:

• Unconsciousness
• Seizures
• Inability to Swallow
• Significant Confusion

Do the following IMMEDIATELY:

• Do NOT attempt to give them food or fluids by mouth: This could cause choking.
• Administer Glucagon (If Available): If you have been prescribed glucagon, a hormone that raises blood sugar levels, and you have been trained on how to administer it, inject it according to the instructions. Glucagon comes in various forms, including an injectable solution and a nasal spray.
• Call Emergency Services (911 in the US): Even if glucagon is administered and the person regains consciousness, it's still essential to seek immediate medical attention, as the effects of glucagon are temporary, and they may require further treatment in a hospital.
• Position the Person on Their Side: If the person is unconscious but breathing, place them in the recovery position (on their side) to prevent them from choking on vomit.

Table: Quick Guide for Treating Hypoglycemia

| Symptom Level | Action | Follow-Up | | :---------------- | :------------------------------------------------------------- | :------------------------------------------------------------ | | Mild to Moderate | 15-15 Rule: 15g of fast-acting carbs, wait 15 mins, recheck blood sugar | Meal or snack with carbs and protein once blood sugar is stable | | Severe (Unconscious/Seizure) | Do NOT give food/drink, administer glucagon (if available), call 911 | Emergency medical evaluation | Hyperglycemia Explained 7 Warning Signs Your Blood Sugar Is Too High

Preventing Hypoglycemia: Long-Term Strategies

While knowing how to treat hypoglycemia is crucial, preventing it in the first place is even better. Here are some key strategies: Top 7 Factors Affecting Blood Sugar That Aren T Food

• Regular Blood Sugar Monitoring: If you have diabetes, regularly check your blood sugar levels, as directed by your healthcare provider. This allows you to identify patterns and make adjustments to your medication or lifestyle as needed.
• Consistent Meal Schedules: Eat meals and snacks at regular times each day to avoid prolonged periods without food.
• Carbohydrate Counting: Work with a registered dietitian or diabetes educator to learn how to accurately count carbohydrates in your meals and snacks. This can help you match your insulin dosage to your food intake.
• Adjust Insulin Doses for Exercise: If you exercise regularly, discuss with your doctor how to adjust your insulin doses to prevent hypoglycemia. You may need to reduce your insulin before, during, or after exercise, or increase your carbohydrate intake.
• Carry a Fast-Acting Carb Source: Always have a source of fast-acting carbohydrates with you in case of a hypoglycemic episode. Glucose tablets, juice boxes, or hard candies are convenient options.
• Limit Alcohol Consumption: If you drink alcohol, do so in moderation and always with food. Be aware that alcohol can lower blood sugar levels, especially when consumed without food.
• Communicate with Your Healthcare Team: Regularly discuss your blood sugar control with your doctor, diabetes educator, or registered dietitian. They can help you identify and address any factors that may be contributing to hypoglycemia.
• Educate Family and Friends: Make sure your family, friends, and coworkers know how to recognize and treat hypoglycemia. Show them where you keep your glucagon kit and how to administer it in an emergency.

Hypoglycemia in People Without Diabetes: Non-Diabetic Hypoglycemia

While less common, hypoglycemia can occur in people without diabetes. This is often referred to as non-diabetic hypoglycemia, and it can be caused by various factors:

• Reactive Hypoglycemia: Occurs a few hours after eating, often after a meal high in carbohydrates. It's thought to be caused by an exaggerated insulin response to the rapid rise in blood sugar after eating.
• Fasting Hypoglycemia: Occurs after not eating for a prolonged period. It can be caused by underlying medical conditions such as tumors, liver disease, or kidney disease.
• Medications: Certain medications, such as quinine (used to treat malaria) or pentamidine (used to treat pneumonia), can cause hypoglycemia.
• Alcohol Consumption: As mentioned earlier, alcohol can interfere with the liver's ability to release glucose into the bloodstream.
• Hormonal Deficiencies: Conditions that affect hormone production, such as adrenal insufficiency or growth hormone deficiency, can cause hypoglycemia.

If you experience frequent symptoms of hypoglycemia but do not have diabetes, it's essential to consult a doctor to determine the underlying cause and receive appropriate treatment. Your doctor may recommend blood tests, a mixed-meal tolerance test, or other diagnostic procedures to evaluate your blood sugar control and identify any contributing factors.

Conclusion: Be Prepared and Take Action

Recognizing low blood sugar symptoms and knowing what to do fast is a critical skill, especially for individuals with diabetes and their caregivers. However, awareness of hypoglycemia is also important for people without diabetes, as certain situations and medical conditions can lead to this condition. By understanding the causes, recognizing the symptoms, and following the step-by-step guide outlined in this article, you can confidently manage hypoglycemic episodes and prevent potentially severe complications. Remember, early recognition and prompt treatment are the keys to staying safe. Don’t hesitate to seek medical advice if you have concerns about your blood sugar levels or experience frequent hypoglycemic episodes. Knowledge empowers you to take control of your health and protect yourself and those around you.

By Nitin N. Katariya, M.D.