About Diabetes » Managing Complications » Hypoglycemia

Hypoglycemia

Hypoglycemia occurs when your blood sugar drops too low, causing you to feel weak, shaky, irritable or confused. As a general rule, a blood glucose reading lower than 70 mg/dL is considered too low.¹ Talk to your doctor about what blood sugar level constitutes low blood glucose, or "hypoglycemia," for you. The key is to identify the symptoms early and to treat it before it gets worse.

Symptoms of Hypoglycemia

For many people, the warning signs of hypoglycemia are unmistakable and can include:²

sweatiness
irritability
blurred vision or seeing spots
nausea
shakiness
passing out
fainting
cold
clammy skin
confusion
nervousness
weakness
rapid heart beat
numb lips and tongue

Recognizing low blood sugar can sometimes be tricky. Some people have low blood sugar without any warning signs, or you may have symptoms of low blood sugar without hypoglycemia. Blood sugar that drops quickly within a short period of time may cause symptoms of hypoglycemia even though blood sugar levels are in the normal range.

That's why, if you think you may be experiencing hypoglycemia, it's important to test your blood sugar. If a test confirms that your blood sugar is low, it is very important to treat it immediately.

Treating Hypoglycemia

Low blood sugar should be treated immediately by eating foods that will increase your blood sugar quickly.

Follow the "15-15" rule:³

Eat 15 grams of carbohydrates, then wait 15 minutes and test your blood sugar again.
If you are still low, eat 15 more grams of carbohydrates, then wait 15 minutes and test.
If the results are still low, call your doctor and have someone take you to the emergency room.

Be careful not to overtreat hypoglycemia, or your blood sugar could go too high.

Foods that provide about 15 grams of fast-acting carbs:

glucose gel or tablets (as directed)
4 oz. fruit juice
6 oz. regular (not diet) soft drink
1 tablespoon honey
3-4 teaspoons granulated sugar
2 tablespoons raisins
8 hard candies

Always carry one of these foods with you. Low blood sugar can happen very quickly, so you should be prepared to act quickly to correct it.

In addition, if you don't expect to have a meal within 30 minutes after you've experienced low blood sugar, you may need to follow up with a snack, such as half a sandwich and a glass of milk.

Finally, call a member of your healthcare team if:

You have started a new diabetes medication or think your medication may need to be changed.
You have three or four low blood sugars within one week.
You have low blood sugar twice or more in 24 hours.
You have low blood sugar the same time every day for several days in a row.
Your low blood sugar was severe enough that someone needed to help you, or it dipped below 50 mg/dL.

Ask your doctor if there are other situations in which they'd like to be notified.

Identifying Causes of Hypoglycemia and Preventing Future Lows

Knowing what caused a blood sugar low may help you avoid hypoglycemia in the future. Ask yourself:

Have you not followed your meal plan? Have you not eaten enough food or delayed a meal?
Have you exercised more than usual without a snack?
Have you taken too much medication or changed the time you take your medication?
Do you have too much stress in your life?
Are you possibly experiencing side effects of other medications?
Have you been drinking alcohol, especially without food?

To help you understand why your blood sugar was low, ask yourself these questions, and then discuss your answers with your healthcare team.

Food

Did you eat everything on your meal plan?
Was your meal or snack delayed?
Did you skip a meal?

Exercise

Did you exercise without eating a meal or snack first?
Did you exert yourself for a long time without eating a snack?
Did you exercise when your blood sugar was too low?

Medication

Did you take more insulin or diabetes pills than the dose prescribed by your doctor?
Were you off schedule in taking your insulin or diabetes pills?

Stress

Were you under more stress than normal?

If Hypoglycemia Goes Untreated

If untreated, low blood sugar can cause serious health problems. A person with untreated hypoglycemia might faint or lose consciousness or experience seizures, requiring help from others.

People who are unconscious or unable to eat should be given an immediate injection of glucagon, a substance that makes the liver release sugar into your bloodstream.⁴ Glucagon is available by prescription. Your diabetes educator can show your family and friends how to prepare and inject glucagon.

If you have a severe reaction and do not have glucagon, someone needs to call your local emergency number. Immediate help is very important for anyone who is having seizures or who has passed out. In addition, it's important that you wear a medical ID tag, to assist others in knowing how to help if you are in an emergency.

¹ Centers for Disease Control and Prevention. "Having Problems with Low Blood Glucose." Available at: http://www.cdc.gov/diabetes/pubs/tcyd/ktrack.htm#problems. Accessed February 14, 2008.
² American Diabetes Association, "Signs and Symptoms." Available at: http://diabetes.org/signs.jsp. Accessed February 5, 2008.
³ American Diabetes Association, "Treating Mild Hypoglycemia." Available at: http://diabetes.org/treating.jsp. Accessed February 5, 2008.
⁴ American Diabetes Association, "Preventing and Treating Severe Hypoglycemia." Available at: http://diabetes.org/preventing.jsp. Accessed February 5, 2008.