Hypoglycemia, also referred to as low blood sugar, occurs when someone doesn’t have enough glucose in their blood. This is most common in people with diabetes since their ability to regulate blood sugar is impaired, but this can happen to anyone. If left untreated, hypoglycemia can result in severe consequences, such as seizures or unconsciousness, so it’s important to know the warning signs and appropriate ways to handle it.
The following information refers to general hypoglycemia monitoring and regulation, but your diabetes management team may have different guidelines for you to follow.
Symptoms
For most people with diabetes < 70 mg/dL is considered hypoglycemic, while someone without diabetes may not notice symptoms until getting to <55 mg/dL. Every individual may also have a unique response to low blood sugar, but some common initial early warning signs include:
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Lack of energy
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Shakiness
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Looking pale
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Sweating
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Hunger or nausea
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Headache or difficulty concentrating
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Irritability or anxiety
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Sweating
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Irregular/fast heartbeat
If untreated, some more severe signs of hypoglycemia include:
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Confusion
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Blurry vision
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Muscle weakness or loss of coordination
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Drowsiness
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Difficulty speaking or slurring your words
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Loss of consciousness
If you’re regularly having symptoms of severe hypoglycemia, make sure to discuss that with your provider as they may want to change part of your diabetes management plan.
If you’re prone to experiencing nighttime lows, you may find that you have more nightmares, damp sheets or pajamas due to excessive sweating, or more tiredness/confusion when you wake up.
When you’re experiencing low blood sugar symptoms, stop what you’re doing and test your glucose. If it’s low, you’ll want to implement the “15-15 Rule” and take 15 grams of simple sugar, wait 15 minutes, and then recheck your glucose. If you’re still under 70 mg/dL, you would repeat this process.
15 grams of a simple sugar could be:
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4 glucose tablets or 1 tube of glucose gel
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1/2 can of regular soda
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1/2 cup of fruit juice
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6 Lifesaver candies
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1 cup of skim milk
Once your glucose is above 70 mg/dL again, the last step is to have a snack with some carbs and protein to help stabilize your blood sugar. This could be something like Greek yogurt, 3 graham crackers with peanut butter, a small orange and a handful of nuts, or a 1/2 of a peanut butter & jelly sandwich.
After any hypoglycemic event, the goal is to try to understand why you had that low blood sugar in the first place so you can learn how to avoid it in the future. For many people, achieving more stable glucose values through diet and lifestyle interventions helps to reduce the frequency of these lows.
Reactive Hypoglycemia
Sometimes low blood sugar occurs in response to a meal. This commonly happens when you eat larger portions of sugary foods or refined carbs (such as flour-based foods). That influx of easy-to-digest sugar causes the pancreas to overcompensate by secreting too much insulin. While this insulin helps to respond to the initial spike from the sugars in that meal, the over-secretion of insulin leads to a significant drop after the meal. This will be reflected in the CGM data by an initial spike followed by a rapid drop where your ending glucose is much lower than it was before you started the meal.
Often the best way to prevent that post-meal drop is to avoid the initial glucose spike in the first place. More tips on minimizing a glucose spike will be discussed in Chapter 3 - Healthy Eating.
Next: Diabetic Ketoacidosis