What Causes Low Blood Sugar (Hypoglycemia) and How to Treat It

Hypoglycemia, or low blood sugar, is a condition where your blood glucose levels drop below what's healthy for you. While often associated with diabetes, hypoglycemia can affect anyone. Understanding the causes and knowing how to treat it is crucial for maintaining your health and preventing serious complications. This article will delve into the various reasons behind low blood sugar and provide practical steps you can take to manage and treat it.

Understanding Blood Sugar Basics

Before diving into the causes of hypoglycemia, let’s briefly recap how blood sugar works. When you eat, your body breaks down carbohydrates into glucose, which is your primary energy source. Insulin, a hormone produced by the pancreas, helps glucose enter your cells. When your blood sugar levels drop too low, your body releases glucagon, another hormone that signals your liver to release stored glucose, thus raising your blood sugar. Hypoglycemia occurs when this intricate balance is disrupted. How To Achieve Blood Sugar Balance For Better Energy And Health

Causes of Low Blood Sugar (Hypoglycemia)

Hypoglycemia has several potential causes, broadly categorized into diabetes-related and non-diabetes-related factors.

Diabetes-Related Causes

For individuals with diabetes, especially those taking insulin or certain oral medications, hypoglycemia is a common concern. Here’s why:

• Excessive Insulin Dose: Taking too much insulin relative to food intake can lead to a rapid drop in blood sugar. Insulin injections need to be carefully coordinated with meals to match carbohydrate intake.
• Missed or Delayed Meals: Skipping meals or delaying them, especially after taking insulin, can result in hypoglycemia. Insulin continues to lower blood sugar even if there's not enough glucose available from food.
• Strenuous Exercise: Physical activity increases insulin sensitivity and glucose uptake by muscles. If you don't adjust your insulin dose or eat extra carbohydrates before or during exercise, your blood sugar might plummet.
• Alcohol Consumption: Alcohol can interfere with the liver’s ability to release glucose, particularly when consumed on an empty stomach. This effect is more pronounced in individuals using insulin.
• Medication Interactions: Certain medications, such as sulfonylureas, stimulate insulin release, which can potentially lead to hypoglycemia if not carefully managed.

Non-Diabetes-Related Causes

Hypoglycemia can also occur in individuals without diabetes, although less frequently. Common non-diabetes-related causes include:

• Reactive Hypoglycemia (Postprandial Hypoglycemia): This type occurs within a few hours after eating, often after a high-carbohydrate meal. The body releases an excessive amount of insulin in response to the meal, causing a rapid drop in blood sugar.
• Fasting Hypoglycemia: This type happens when you haven’t eaten for several hours. Possible causes include:
  • Certain Medications: Some medications not typically used for diabetes, like quinine or salicylates, can sometimes cause hypoglycemia.
  • Excessive Alcohol Consumption: As mentioned earlier, alcohol can impair glucose release from the liver, especially after prolonged drinking or on an empty stomach.
  • Critical Illness: Severe liver, kidney, or heart failure can interfere with glucose metabolism and lead to hypoglycemia.
  • Hormone Deficiencies: Conditions affecting the adrenal glands or pituitary gland can impair hormone production necessary for regulating blood sugar.
  • Insulinoma: This is a rare tumor in the pancreas that produces excessive insulin, leading to recurrent hypoglycemia.
  • Non-Islet Cell Tumor Hypoglycemia: These tumors produce insulin-like substances and are extremely rare.
• Dietary Causes:
  • Extreme Calorie Restriction: Severely limiting calorie intake, especially when combined with intense exercise, can deplete glucose stores and trigger hypoglycemia.

Symptoms of Low Blood Sugar

Recognizing the symptoms of hypoglycemia is crucial for timely intervention. Symptoms vary from person to person and can range from mild to severe:

• Mild to Moderate Symptoms:
  • Shakiness or Trembling
  • Sweating
  • Rapid Heartbeat or Palpitations
  • Anxiety or Nervousness
  • Irritability or Mood Changes
  • Confusion or Difficulty Concentrating
  • Dizziness or Lightheadedness
  • Hunger
  • Blurred Vision
  • Tingling or Numbness in the Lips, Tongue, or Cheeks
• Severe Symptoms:
  • Incoordination
  • Slurred Speech
  • Difficulty Walking
  • Seizures
  • Loss of Consciousness

Note: Some people may experience hypoglycemia unawareness, where they don't recognize the early warning signs, increasing the risk of severe episodes. Regular blood sugar monitoring is particularly important in these cases.

Diagnosing Hypoglycemia

Diagnosis usually involves measuring your blood glucose level when you’re experiencing symptoms. Your Guide To Normal Blood Sugar Levels A Complete Chart For Adults

• Blood Glucose Monitoring: A blood glucose meter provides an immediate reading of your blood sugar level. A value below 70 mg/dL (3.9 mmol/L) is generally considered low.
• Continuous Glucose Monitoring (CGM): A CGM device continuously tracks your glucose levels, providing a more complete picture of how your blood sugar fluctuates throughout the day.
• Mixed-Meal Tolerance Test: Used in cases of suspected reactive hypoglycemia, this test measures blood sugar levels over several hours after consuming a specific meal.
• Fasting Blood Glucose Test: Helps determine if fasting is causing hypoglycemia.
• Medical History and Physical Exam: Evaluating medical history and conducting a physical exam helps rule out other potential causes of your symptoms.

How to Treat Low Blood Sugar (Hypoglycemia)

The primary goal of treating hypoglycemia is to rapidly raise blood sugar levels to normal.

The 15-15 Rule

For individuals with diabetes experiencing mild to moderate hypoglycemia, the 15-15 rule is a simple yet effective guideline: Blood Sugar Support Supplements What Does The Research Actually Say

1. Check Your Blood Sugar: Confirm that your blood sugar is indeed low (below 70 mg/dL or 3.9 mmol/L).
2. Consume 15 Grams of Fast-Acting Carbohydrates: Examples include:
   • 4 ounces (120 ml) of juice (not diet)
   • 4 ounces (120 ml) of regular soda (not diet)
   • 1 tablespoon of honey or syrup
   • Glucose tablets (follow the package instructions)
   • Hard candies (check the packaging for carb content)
3. Wait 15 Minutes: Give the carbohydrate source time to raise your blood sugar.
4. Recheck Your Blood Sugar: If it’s still low, repeat the process until your blood sugar is above 70 mg/dL (3.9 mmol/L).
5. Eat a Snack or Meal: Once your blood sugar is back in the normal range, eat a snack or meal containing both carbohydrates and protein to stabilize it and prevent a recurrence. Good choices include crackers with peanut butter, cheese and fruit, or a small sandwich.

Treatment for Severe Hypoglycemia

Severe hypoglycemia requires immediate medical intervention, especially if the person is unconscious or unable to swallow.

• Glucagon Injection: Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It’s available as an injection and should be administered if the person is unable to take glucose orally. Family members, caregivers, and close friends of individuals at risk of severe hypoglycemia should be trained on how to administer glucagon.
• Emergency Medical Services: Call emergency services (911) immediately. While waiting for help, ensure the person is lying on their side to prevent choking.
• Intravenous Glucose: In a hospital setting, healthcare professionals may administer glucose directly into the bloodstream through an IV.

Prevention of Hypoglycemia

Preventing hypoglycemia is crucial for maintaining consistent blood sugar control and overall well-being. Strategies include:

• Regular Blood Sugar Monitoring: Frequent monitoring, especially before meals, after meals, before exercise, and at bedtime, helps you understand how your blood sugar responds to various factors.
• Meal Planning and Timing: Consistently eating regular meals and snacks, spaced evenly throughout the day, helps maintain stable blood sugar levels. Avoid skipping meals or delaying them for extended periods.
• Carbohydrate Counting: Learning to accurately count carbohydrates in your meals allows you to match your insulin dose to your food intake, minimizing the risk of hypoglycemia.
• Insulin Adjustment: Work closely with your healthcare provider to adjust your insulin doses based on your blood sugar levels, activity levels, and other relevant factors.
• Exercise Management: Discuss with your healthcare team how to adjust your insulin dose or carbohydrate intake before, during, and after exercise to prevent hypoglycemia.
• Alcohol Awareness: If you consume alcohol, do so in moderation and always with food. Monitor your blood sugar levels carefully and be aware of the delayed effects of alcohol on blood sugar.
• Medical Identification: Wear a medical alert bracelet or carry a card that identifies you as having diabetes and includes information about emergency contacts and treatment protocols.
• Education and Training: Participating in diabetes education programs helps you better understand your condition and develop effective strategies for preventing and managing hypoglycemia.

When to See a Doctor

Consult your healthcare provider if you experience frequent or severe episodes of hypoglycemia, especially if you are unsure of the cause. Additional signs to seek medical attention:

• Recurring Hypoglycemia Unawareness: Not recognizing low blood sugar symptoms is dangerous and needs medical evaluation.
• Difficulty Managing Hypoglycemia: If you’re struggling to prevent or treat your low blood sugar despite following recommended guidelines.
• Suspected Non-Diabetes-Related Hypoglycemia: If you’re not diabetic but experiencing symptoms of hypoglycemia, it's important to determine the underlying cause.

Key Takeaways

Key Area	Summary
Causes of Hypoglycemia	Can be diabetes-related (insulin overdose, missed meals) or non-diabetes-related (reactive hypoglycemia, fasting, medications).
Symptoms to Recognize	Ranges from mild (shakiness, sweating) to severe (seizures, loss of consciousness); hypoglycemia unawareness is a critical concern.
Treatment Strategies	Follow the 15-15 rule for mild cases; use glucagon for severe situations; immediate medical attention is necessary for unconscious individuals.
Preventive Measures	Includes regular blood sugar monitoring, planned meals, carb counting, and careful insulin adjustments.

Conclusion

Hypoglycemia is a potentially serious condition that requires understanding, proactive management, and timely treatment. Whether you have diabetes or not, being aware of the causes, recognizing the symptoms, and knowing how to respond can help you maintain stable blood sugar levels and protect your health. Always consult with your healthcare provider for personalized advice and management strategies. If you experience any symptoms that are worrying you, seeking the appropriate medical advice is paramount for maintaining your health and well-being.

By Shon E. Meek, M.D., Ph.D.