What Is Hypoglycemia? Understanding the Causes and Symptoms

Hypoglycemia, often referred to as low blood sugar, occurs when the level of glucose in the blood drops below normal levels. Glucose, a simple sugar, is the primary source of energy for the body's cells. Understanding the causes, symptoms, and management of hypoglycemia is essential, especially for individuals with diabetes but also for others who may experience it.

What Exactly Is Hypoglycemia?

Simply put, hypoglycemia happens when your blood glucose falls too low. For people with diabetes, this typically means a level below 70 mg/dL (3.9 mmol/L), although this can vary based on individual targets set by their healthcare provider. While it's most common in people managing diabetes, certain other medical conditions and lifestyle factors can also cause hypoglycemia.

Common Causes of Hypoglycemia

Understanding what can trigger low blood sugar is crucial for prevention. Several factors can contribute to hypoglycemia:

• Diabetes Medications: The most frequent cause of hypoglycemia is the use of insulin or certain oral diabetes medications like sulfonylureas (e.g., glipizide, glyburide) that stimulate the pancreas to release more insulin. Taking too much medication or not eating enough after taking medication can lower blood sugar levels drastically.

• Skipping Meals or Eating Too Little: Insufficient food intake or delaying meals can lead to a drop in blood glucose. The body relies on regular carbohydrate intake to maintain adequate glucose levels.

• Increased Physical Activity: Exercise increases glucose uptake by the muscles. Without sufficient carbohydrate intake before, during, or after physical activity, blood sugar can plummet.

• Alcohol Consumption: Alcohol can interfere with the liver's ability to release stored glucose into the bloodstream, particularly if consumed on an empty stomach.

• Other Medical Conditions: In rare cases, hypoglycemia can result from underlying medical conditions, such as liver or kidney disease, hormone deficiencies (e.g., adrenal insufficiency), or certain tumors that produce insulin.

• Gastric Bypass Surgery: Changes to the digestive system following gastric bypass can affect glucose absorption and insulin sensitivity, potentially causing hypoglycemia.

Recognizing the Symptoms of Hypoglycemia

Identifying the signs and symptoms of low blood sugar is key to treating it promptly. Symptoms can vary from person to person, but common ones include:

• Shakiness and Trembling: Uncontrolled shaking, particularly in the hands.

• Sweating: Sudden onset of perspiration, even in cool environments.

• Dizziness or Lightheadedness: Feeling faint or unsteady.

• Hunger: An overwhelming urge to eat.

• Irritability or Anxiety: Sudden mood changes, including increased frustration or worry.

• Confusion: Difficulty concentrating or thinking clearly.

• Rapid Heartbeat: A racing or pounding sensation in the chest.

• Blurred Vision: Temporary changes in eyesight.

• Headache: A throbbing or persistent pain in the head.

• Weakness or Fatigue: Feeling unusually tired or lacking energy.

In severe cases, hypoglycemia can lead to loss of consciousness, seizures, or coma. It's important to recognize early warning signs and take action promptly.

Diagnosing Hypoglycemia

Diagnosis often involves monitoring blood glucose levels using a blood glucose meter, especially during symptomatic episodes. In some cases, a doctor may recommend a continuous glucose monitor (CGM) for more detailed tracking. Diagnostic tests can also help determine the underlying cause of recurrent low blood sugar events.

Managing Hypoglycemia

The primary goal of managing hypoglycemia is to quickly raise blood glucose levels to a safe range. The Unexpected Factors Affecting Your Blood Glucose Bg Levels

• The 15-15 Rule: For mild to moderate hypoglycemia, consume 15 grams of fast-acting carbohydrates (such as glucose tablets, fruit juice, or regular soda). Wait 15 minutes and then recheck your blood glucose. If it's still below 70 mg/dL, repeat the process. Simple Ways To Regulate Your Blood Sugar Starting Today

• Glucagon Injection: For severe hypoglycemia, when the person is unable to swallow or is unconscious, a glucagon injection can be administered. Glucagon stimulates the liver to release stored glucose. Family members and caregivers of people at risk for severe low blood sugar should be trained on how to administer glucagon. The 8 Best Foods For Long Term Blood Sugar Control

• Medical Alert Identification: Wear a medical ID bracelet or necklace indicating that you have diabetes and are at risk for hypoglycemia. This can help first responders provide appropriate treatment in an emergency.

• Preventive Strategies: Work with your healthcare team to adjust medications, meal plans, and exercise routines to minimize the risk of future hypoglycemic episodes. Regular blood glucose monitoring and consistent meal timing are essential.

Preventive Measures for Hypoglycemia

Preventing hypoglycemia is often easier than treating it. Here are some key strategies:

• Consistent Meal Timing: Eat regular meals and snacks, and avoid skipping meals.
• Carbohydrate Counting: Learn how to count carbohydrates accurately to match your insulin dose or medication regimen.
• Blood Glucose Monitoring: Check your blood glucose levels regularly, especially before meals, after exercise, and before bedtime.
• Medication Management: Work closely with your healthcare provider to ensure your medications are appropriately dosed and timed.
• Alcohol Awareness: Consume alcohol in moderation and always with food. Be aware of the potential impact of alcohol on blood glucose levels.
• Exercise Precautions: Adjust your insulin or medication dosage or increase carbohydrate intake before, during, and after exercise, as needed.

Hypoglycemia in People Without Diabetes

While less common, hypoglycemia can occur in people who do not have diabetes (referred to as non-diabetic hypoglycemia). This can be due to reactive hypoglycemia (occurring within a few hours after eating a high-carbohydrate meal) or fasting hypoglycemia (occurring after a period of fasting). Identifying the underlying cause often requires medical evaluation.

Continuous Glucose Monitoring (CGM) and Hypoglycemia

Continuous Glucose Monitoring (CGM) systems have revolutionized diabetes management and are extremely helpful in preventing and detecting hypoglycemia. These devices continuously track glucose levels throughout the day and night, providing real-time data and alerts when glucose levels are dropping or are too low. CGM systems can significantly improve glycemic control and reduce the risk of hypoglycemic events.

The Impact of Hypoglycemia on Daily Life

Recurrent hypoglycemia can have a significant impact on quality of life, affecting work, school, and daily activities. Fear of low blood sugar can lead to anxiety and avoidance behaviors. Proper education, proactive management strategies, and support from healthcare professionals can help individuals with hypoglycemia live full and active lives.

Key Risk Factors for Hypoglycemia

Several factors increase the risk of developing hypoglycemia:

Risk Factor	Description
Insulin Therapy	Taking insulin to manage diabetes. Risk increases with higher doses and variable timing.
Sulfonylureas	Using sulfonylurea medications like glipizide and glyburide.
Kidney Disease	Impaired kidney function affects insulin metabolism and glucose regulation.
Liver Disease	Compromised liver function hinders glucose storage and release.
Elderly Age	Older adults are more vulnerable due to reduced kidney function, cognitive impairment, and multiple medications.

When to Seek Medical Attention

While mild hypoglycemia can often be managed at home, it's important to seek medical attention if:

• You experience frequent or severe hypoglycemic episodes.
• You are unable to identify the cause of your low blood sugar.
• You have unexplained hypoglycemia without diabetes.
• You develop symptoms of hypoglycemia despite following your diabetes management plan.

A healthcare provider can help determine the underlying cause of your hypoglycemia and adjust your treatment plan accordingly.

Conclusion: Empowering Yourself with Knowledge

Understanding hypoglycemia, its causes, symptoms, and management strategies is crucial for individuals with diabetes and anyone who may experience low blood sugar. By being proactive and informed, you can effectively prevent, recognize, and treat hypoglycemic episodes, empowering yourself to live a healthier and more balanced life. Consult with your healthcare team for personalized guidance and support.

By Catherine Madaffari, M.D.