Hypoglycemia

Hypoglycemia is a state of low blood sugar prevalent among diabetic individuals, particularly Type 1 diabetes, but can occur in those without diabetes. Whenever you experience hypoglycemic symptoms, you must ingest sweet food to prevent the condition from aggravating to severe hypoglycemia.

What is hypoglycemia?

Hypoglycemia develops when the level of blood glucose drops below 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L) in diabetic people and below 55 mg/dL or 3.1 mmol/L for non-diabetics. Quick intervention, eating or drinking sugary food, is crucial to prevent potentially fatal consequences.

Symptoms

Signs of hypoglycemia include:

• Pale skin and lips
• Shakiness, fatigue
• Sweating
• Nausea, hunger
• Dizziness, headache, anxiety
• Difficulty concentrating
• Fast heart rhythm
• Numbness of the lips, tongue, or cheek.

If your condition aggravates, you may lose coordination and the ability to do daily tasks and experience blurred vision and slurred speech. At night, you may have a night of restless sleep or sleep terror, sweat profusely, and wake up unrefreshed and disoriented.

Causes

For people with diabetes

For people with diabetes, these circumstances can lead to hypoglycemia. 

• Excessive insulin administration, use of the wrong insulin type, or injection route into the muscle instead of fat tissue
• Overdosing on oral diabetes medications
• Engaging in more physical activity than usual
• Consuming alcohol on an empty stomach
• Disrupting meal patterns by eating meals late or skipping meals altogether
• Unbalanced meals.

For people without diabetes

For people without diabetes, Non-diabetes-related hypoglycemia is of two types: reactive hypoglycemia and fasting hypoglycemia.

• Reactive hypoglycemia typically occurs approximately 2 - 4 hours after eating a meal of simple carbohydrates, which are rapidly broken down and absorbed, such as white rice, potatoes, white bread, cake, and pastries.
  Reactive hypoglycemia can result from bariatric surgery, especially gastric bypass surgery, which causes rapid absorption of sugars, leading to excessive insulin production and subsequent hypoglycemia.
• Fasting hypoglycemia. Usually, the body has glucose storage as glycogen, so fasting does not cause hypoglycemia. Under certain circumstances fasting can lead to hypoglycemia as follows:
• Excessive alcohol consumption: Alcohol interferes with gluconeogenesis, a process whereby the body produces new glucose. Prolonged and heavy alcohol consumption and inadequate food intake can deplete stored glucose (glycogen) and disrupt blood sugar regulation.
• Critical illness: Conditions like end-stage liver disease, sepsis, starvation, or kidney failure can deplete stored glucose faster than the body can generate new glucose from food.
• Adrenal insufficiency: It can cause insufficient cortisol production, contributing to episodes of hypoglycemia.
• Non-islet cell tumor hypoglycemia (NICTH): NICTH tumors release excess insulin-like growth factor 2 (IGF-2), a hormone with insulin-like effects, causing low blood sugar. 
• Insulinoma: Insulinoma is a tumor in the pancreas that produces excessive insulin, causing hypoglycemia commonly occurring in the early morning.
• Certain medications: Medications such as beta-blockers and certain antibiotics can induce hypoglycemia.

When to see a doctor

Seek medical help immediately if:

• You don't have diabetes but have the aforementioned symptoms.
• You have diabetes and treatment such as drinking juice or regular soft drinks, eating candy, or taking glucose tablets cannot improve the symptoms of hypoglycemia.
• You have diabetes or a history of hypoglycemia and have severe symptoms of hypoglycemia or lose consciousness. This is an emergency situation.

Complications

Prolonged hypoglycemia can lead to cardiac arrest, heart arrhythmias, organ failure, permanent brain damage, coma, or even death.

Diagnosis

Measurements of blood sugar with a glucometer of blood obtained by pricking a fingertip allow rapid bedside diagnosis. The glucometer can be pre-programmed to alert you when low blood sugar is likely to happen, such as while sleeping or driving.

Diagnosis in non-diabetic people is to check their blood sugar levels every 2-3 hours. Imaging tests may be necessary to rule out tumors as a cause of the condition. The doctor may order a mixed-meal tolerance test (MMTT) if reactive hypoglycemia is in question. They will consume a special drink to raise their blood glucose, stimulating the pancreas to secrete more insulin. The blood glucose will be measured serially over the next five hours.

Treatment

Mild or moderate hypoglycemia

For mild or moderate hypoglycemia, you can follow the “15-15 rule” recommended by the American Diabetes Association.

• Consume 15 grams of sweet food or fast-acting carbohydrates.
• Wait 15 minutes and check your glucose level.
• If your glucose level remains below 70 mg/dL, consume an additional 15 grams of sweets or fast-acting carbohydrates.
• Repeat this process until your glucose level reaches a minimum of 70 mg/dL.

Here are several examples of food options that provide approximately 15 grams of fast-acting carbohydrates:

• Half of a banana.
• Half a cup of fruit juice or a regular soft drink.
• One tablespoon of sugar, honey, or syrup.
• One tube of instant glucose gel (follow the instructions provided).
• 3 to 4 glucose tablets (follow the instructions provided).

If you cannot check your glucose level, continue the 15-15 rule until your condition improves.

Severe hypoglycemia

If someone has severe hypoglycemia and becomes unconscious or confused, do not give them food because they can choke. Administer glucagon available in the form of dry nasal spray or injection to stimulate your liver to release stored glucose, elevating blood sugar. Follow the instructions of the injectable or nasal glucagon kit. Within 5-15 minutes, they will become conscious and may feel nauseous. Roll them onto their sides if they are in the supine position to prevent aspiration.

Prevention

• Adhere to your prescribed medication, diet, and exercise regimen as directed by your doctor.
• Check your blood sugar regularly with a continuous glucose monitor (CGM), including before and after meals, before and after exercise, and before bedtime.
• Have snacks on hand.
• Keep records of low blood sugar episodes, noting the details, such as the time, recent food intake, exercise, symptoms experienced, and glucose levels. Sharing this information with your healthcare provider can assist in adjusting your management plan to minimize future episodes of low blood sugar.
• Educate people around you about hypoglycemia and severe hypoglycemia and how to use emergency glucagon to ameliorate severe hypoglycemia.

Hypoglycemia is common among individuals with diabetes; if left untreated can pose life-threatening risks. It is crucial to acquaint yourself with warning signs of low blood sugar and regularly monitor your blood sugar levels to prevent severe episodes.