Signs of Hypoglycemia (Low Blood Sugar) Everyone with Diabetes Should Know

Hypoglycemia, or low blood sugar, is a common and potentially dangerous complication for people with diabetes. It occurs when the level of glucose in the blood drops too low, usually below 70 mg/dL. Recognizing the signs and symptoms of hypoglycemia is crucial for prompt treatment and preventing severe health consequences. This article provides a detailed guide on the various signs of hypoglycemia and emphasizes why every person with diabetes must be well-informed about them.

Why Recognizing Hypoglycemia is Critical

For individuals managing diabetes, maintaining a stable blood sugar level is a constant balancing act. Medications like insulin or sulfonylureas can sometimes lead to an excess of insulin in the bloodstream relative to the amount of glucose available. Additionally, factors like skipping meals, strenuous exercise, or alcohol consumption can contribute to hypoglycemia.

Here's why recognizing the signs is vital:

• Prevention of Severe Events: Untreated hypoglycemia can escalate quickly, leading to seizures, loss of consciousness, and, in rare cases, even coma or death.
• Improved Diabetes Management: Recognizing early signs allows for prompt correction, helping individuals better manage their blood sugar levels over the long term.
• Enhanced Quality of Life: By being aware of the symptoms, individuals can take proactive steps to avoid severe episodes, leading to increased confidence and a better quality of life.

Examples of Situations Leading to Hypoglycemia:

| Scenario | Contributing Factors | | --------------------------------- | ---------------------------------------------------------------------------------- | | Missed or Delayed Meal | Insufficient carbohydrate intake to match insulin dosage. | | Unplanned Exercise | Increased glucose utilization without adjusting insulin or carbohydrate intake. | | Excessive Insulin Dosage | Taking too much insulin relative to food intake or activity level. | | Alcohol Consumption | Alcohol can impair the liver's ability to release glucose, leading to hypoglycemia. |

Early Signs and Symptoms of Hypoglycemia

The body reacts in various ways when blood sugar levels drop too low. These reactions serve as warning signals that need immediate attention. Early signs and symptoms are typically mild to moderate and can often be managed with prompt action. Here are the common early indicators of hypoglycemia:

1. Shakiness

One of the earliest signs is feeling shaky or trembling. This occurs because the body releases adrenaline and other hormones in response to low blood sugar, preparing for a "fight or flight" situation.

2. Sweating

Excessive sweating, even when the temperature is cool, is another common sign. This is again due to the release of adrenaline.

3. Dizziness or Lightheadedness

Low blood sugar can impair brain function, leading to feelings of dizziness or lightheadedness. The brain relies on a constant supply of glucose for energy, and a drop in glucose levels can disrupt its normal function.

4. Hunger

An intense feeling of hunger, often accompanied by stomach rumbling, is a frequent symptom. The body sends signals to stimulate glucose intake. A1C Test Explained What Your Number Really Means For Diabetes

5. Irritability or Anxiety

Mood changes, such as irritability, anxiety, or nervousness, can occur as low blood sugar affects brain chemistry.

6. Rapid Heartbeat

A faster-than-normal heartbeat, also known as palpitations, can be experienced as the body tries to compensate for the lack of glucose by increasing blood flow to vital organs.

Table Summarizing Early Signs

| Symptom | Physiological Explanation | Action to Take | | ----------------------- | ---------------------------------------------------------- | ------------------------------------------------------------------- | | Shakiness | Adrenaline release due to low glucose levels | Check blood sugar; consume fast-acting carbohydrates | | Sweating | Adrenaline release | Check blood sugar; consume fast-acting carbohydrates | | Dizziness | Impaired brain function due to low glucose | Check blood sugar; sit down to avoid falls; consume carbohydrates | | Hunger | Body signaling the need for glucose | Check blood sugar; eat a snack containing carbohydrates | | Irritability/Anxiety | Brain chemistry changes due to low glucose | Check blood sugar; consume carbohydrates; rest and calm down | | Rapid Heartbeat | Body compensating for low glucose by increasing blood flow | Check blood sugar; consume carbohydrates; monitor heart rate |

Late Signs and Symptoms of Hypoglycemia

If early symptoms are ignored or go unnoticed, hypoglycemia can progress to more severe stages. Late signs and symptoms indicate a more critical state and require immediate intervention, often involving assistance from others.

1. Confusion or Difficulty Concentrating

As brain function deteriorates further, confusion, disorientation, and difficulty concentrating become apparent. The individual may struggle to think clearly or follow simple instructions.

2. Blurred Vision

Visual disturbances, such as blurred or double vision, can occur as low blood sugar affects the nerves and muscles controlling eye function.

3. Slurred Speech

Difficulty speaking clearly, often resembling intoxication, is another serious symptom. The muscles controlling speech may not function properly due to lack of glucose.

4. Coordination Problems

Loss of coordination, clumsiness, or difficulty walking can indicate severe hypoglycemia. The nervous system's ability to control muscle movements is compromised.

5. Seizures or Convulsions

In extreme cases, hypoglycemia can lead to seizures or convulsions, where the individual experiences uncontrolled muscle contractions and loss of consciousness.

6. Loss of Consciousness

The most severe outcome of untreated hypoglycemia is loss of consciousness. This is a medical emergency and requires immediate medical attention.

Data on Hypoglycemia-Related Hospitalizations

According to a study published in Diabetes Care, severe hypoglycemia is a significant cause of hospitalizations among individuals with diabetes. The study found that approximately 10% of individuals with type 1 diabetes and 5% with type 2 diabetes experience at least one episode of severe hypoglycemia requiring hospitalization each year. What Is Glucose And Why Is It Critical For Persons With Diabetes

Hypoglycemia Unawareness

Some people with diabetes may develop hypoglycemia unawareness, a condition where they no longer experience the early warning signs of low blood sugar. This is especially common in individuals who have had diabetes for many years or who frequently experience hypoglycemic episodes.

Risks of Hypoglycemia Unawareness:

• Delayed Treatment: Without early warning signs, individuals may not realize they have low blood sugar until it reaches a critical stage.
• Increased Risk of Severe Events: The risk of seizures, loss of consciousness, and other severe outcomes is significantly higher in those with hypoglycemia unawareness.
• Impact on Quality of Life: Constant worry about unexpected severe hypoglycemic episodes can lead to anxiety and reduced quality of life.

Strategies for Managing Hypoglycemia Unawareness:

1. Frequent Blood Sugar Monitoring: Regularly check blood sugar levels, especially before meals, bedtime, and exercise.
2. Continuous Glucose Monitoring (CGM): CGMs can provide real-time glucose readings and alerts for impending hypoglycemia.
3. Adjusting Treatment Plan: Work with a healthcare provider to adjust medication dosages or insulin timing to reduce the frequency of hypoglycemic episodes.
4. Hypoglycemia Awareness Training: Participate in training programs designed to help recognize subtle symptoms of hypoglycemia.

What to Do When Hypoglycemia is Suspected

When any of the signs of hypoglycemia are recognized, immediate action is necessary.

1. Check Blood Sugar Levels

If possible, use a blood glucose meter to check blood sugar levels immediately. A reading below 70 mg/dL indicates hypoglycemia.

2. Consume Fast-Acting Carbohydrates

If blood sugar levels are low or if a meter is not available, consume 15-20 grams of fast-acting carbohydrates. Examples include: What To Do During A Severe Hypoglycemia Low Blood Sugar Event

• 4 ounces (120 ml) of fruit juice
• 4 ounces (120 ml) of regular (non-diet) soda
• 1 tablespoon of honey or syrup
• Glucose tablets or gel (follow package instructions)

3. Wait 15 Minutes and Recheck

After consuming carbohydrates, wait 15 minutes and recheck blood sugar levels. If levels are still below 70 mg/dL, repeat the carbohydrate intake.

4. Follow with a Longer-Acting Carbohydrate

Once blood sugar levels are above 70 mg/dL, consume a snack or meal containing both carbohydrates and protein to help stabilize blood sugar levels and prevent a recurrence of hypoglycemia. Examples include:

• A slice of whole-wheat bread with peanut butter
• A small apple with cheese
• A handful of nuts and a small piece of fruit

5. Seek Medical Assistance if Necessary

If the individual is unable to take carbohydrates orally due to confusion, loss of consciousness, or seizures, glucagon should be administered (if available and if trained to do so). Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. Call emergency services immediately.

Table Summarizing Immediate Actions

| Action | Rationale | When to Perform | | -------------------------- | -------------------------------------------------------- | -------------------------------------------------------------------------- | | Check Blood Sugar | Confirm hypoglycemia | Whenever symptoms are suspected | | Consume Fast-Acting Carbs | Rapidly raise blood glucose levels | If blood sugar is below 70 mg/dL or if testing is not possible | | Wait 15 Minutes & Recheck | Allow time for carbohydrates to raise glucose levels | After consuming fast-acting carbs | | Consume Longer-Acting Snack | Stabilize glucose levels | Once blood sugar is above 70 mg/dL | | Administer Glucagon | Raise glucose levels when oral intake is not possible | If the individual is unable to take carbohydrates orally | | Seek Medical Assistance | For severe cases (loss of consciousness, seizures, etc.) | Immediately after administering glucagon or if no improvement is observed |

Preventing Hypoglycemia

Preventing hypoglycemia involves careful management of diabetes through regular monitoring, medication management, and lifestyle adjustments.

1. Regular Blood Sugar Monitoring

Monitor blood sugar levels regularly, especially before meals, after meals, before exercise, and at bedtime. This helps identify patterns and potential triggers for hypoglycemia.

2. Medication Management

Follow the prescribed medication regimen carefully and understand how medications affect blood sugar levels. Work with a healthcare provider to adjust dosages as needed.

3. Meal Planning

Eat regular, balanced meals and snacks at consistent times each day. Avoid skipping meals or significantly delaying food intake. Ensure each meal includes a balance of carbohydrates, protein, and healthy fats.

4. Exercise Planning

Plan exercise routines carefully, and adjust insulin dosages or carbohydrate intake as needed. Monitor blood sugar levels before, during, and after exercise.

5. Alcohol Consumption

Consume alcohol in moderation and with food. Be aware that alcohol can lower blood sugar levels, especially when consumed on an empty stomach.

6. Educate Family and Friends

Educate family members, friends, and coworkers about the signs of hypoglycemia and how to assist in case of an emergency. Ensure they know how to administer glucagon if necessary.

Final Thoughts

Recognizing the signs of hypoglycemia is a crucial skill for anyone with diabetes. Understanding both the early and late symptoms, as well as the factors that can trigger low blood sugar, allows for prompt and effective management. By being vigilant and proactive, individuals with diabetes can minimize the risk of severe hypoglycemic episodes and maintain a healthy, active lifestyle. Always consult with a healthcare provider for personalized advice and guidance on managing diabetes and preventing hypoglycemia.

By Pankaj Shah, M.D.