Hypoglycemia occurs when blood sugar levels drop below a normal range. Quick action, like consuming fast-acting sugars, is essential to prevent complications. Understanding the causes, symptoms and treatments can help you manage hypoglycemia effectively.
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What Is Hypoglycemia?
Hypoglycemia occurs when blood sugar (glucose) levels drop below the standard range. Since glucose is the body’s primary energy source, low levels can lead to serious health issues. Doctors typically consider a blood sugar reading below 70 mg/dL (milligrams per deciliter) to be hypoglycemia. Still, this number may vary based on individual circumstances. It’s especially common in people with diabetes, particularly those using insulin or other diabetes medications.
When blood sugar dips too low, doctors recommend immediate action, such as consuming a high-sugar food or drink or taking medication to raise glucose levels. While diabetes treatment is the most common cause, hypoglycemia can also result from other factors. These include fasting, not consuming enough carbohydrates, increasing physical activity, drinking too much alcohol and being sick. Identifying and addressing the root cause is essential for long-term management.
Types of Hypoglycemia
There are two types of hypoglycemia, according to the U.S. Centers for Disease Control and Prevention: nighttime hypoglycemia and severe hypoglycemia.
Nighttime hypoglycemia occurs during sleep. It is often triggered by physical activity, excess insulin or alcohol consumption, especially when done shortly before sleeping. While some may wake up due to symptoms like sweating or shaking, relying on a continuous glucose monitor (CGM) is safer for alerting you to dangerously low levels.
Severe hypoglycemia happens when blood sugar drops below 54 mg/dL, causing symptoms like weakness, confusion, trouble walking or even seizures. Severe cases may result in fainting and require assistance for treatment. Proper blood sugar management is key to preventing these episodes.
Symptoms of Low Blood Sugar
Recognizing the symptoms of hypoglycemia is crucial, as low blood sugar can lead to serious health issues if left untreated. Symptoms can range from mild shakiness to severe confusion or unconsciousness. Knowing when to seek medical help can prevent complications and help ensure proper management.
Mild to moderate symptoms of hypoglycemia
Confusion
Dizziness
Fast or irregular heartbeat
Fatigue
Headache
Hunger
Irritability
Nausea
Pale Skin
Shakiness
Sweating
Tingling of the lips, tongue or che
Severe symptoms of hypoglycemia
Blurred vision
Confusion
Fainting
Loss of coordination
Nightmares
Seizures
Slurred speech
Seek immediate medical attention if you experience symptoms of hypoglycemia but don’t have diabetes. If you do have diabetes, but symptoms persist despite treatment, you should also seek medical attention. Emergency care may be necessary if you experience severe symptoms or lose consciousness.
“While hypoglycemia occurs most often in patients with diabetes, it can also occur in patients who do not have diabetes. It can be easily diagnosed but must be rapidly treated to avoid long-term consequences.”
Severe low blood sugar, if left untreated, can cause serious problems like seizures, coma or even death. If it happens often, your body may adjust to the symptoms. This means you might not notice the warning signs until your blood glucose level is very low due to “hypoglycemia unawareness.”
Some people might skip taking their diabetes medication because they’re afraid of developing low blood sugar. However, this can be dangerous, as it may lead to consistently high blood sugar levels.
Rather than skipping medication, people can often manage their hypoglycemic episodes safely with precautionary measures. Prompt treatment and proper monitoring of your symptoms, such as with a glucose monitor, can help manage hypoglycemia.
What Causes Hypoglycemia?
Common triggers for hypoglycemia, or low blood sugar, include medications, insufficient carbohydrate intake, increased physical activity, alcohol consumption and illness. Recognizing these triggers can help individuals take preventive measures and respond appropriately when blood sugar levels drop.
Examples of Hypoglycemia Causes
Alcohol
Drinking alcohol without enough food can interfere with blood sugar regulation. This increases the risk of severe hypoglycemia.
Carbohydrate intake
Not eating enough carbs, skipping meals or delaying eating can result in low blood sugar.
Illness
Being sick may reduce food intake, lowering blood sugar levels.
Increased Physical activity
Increased physical activity can lower blood glucose for hours after exercise, even overnight.
Medications
Insulin and the diabetes pills sulfonylureas and meglitinides can lower blood glucose. Accidentally taking too much insulin or injecting it into muscle may also cause hypoglycemia.
Medications That May Cause Hypoglycemia
Some medications can make low blood sugar worse, especially for people with diabetes. Diabetes medications used to control blood sugar levels, like insulin and sulfonylureas, can increase the risk of low blood sugar. Other non-diabetes medications can also cause low blood sugar, especially when taken together or in high amounts.
Common Medications That May Cause Hypoglycemia:
Beta-blockers such as Tenormin (atenolol) or an overdose of Inderal/Hemangeol (propranolol)
Certain antibiotics, including Zymaxid (gatifloxacin) and Levaquin (levofloxacin)
Glinides such as Starlix (nateglinide) and Prandin (repaglinide)
Heart arrhythmia drugs, including quinidine and quinine
Insulin
Metformin and sulfonylureas, when used together
NSAIDs such as ibuprofen or indomethacin, especially in large doses
Sulfonylureas, including Glucotrol (glipizide), Amaryl (glimepiride) and Glynase (glyburide)
Thiazolidinediones such as Actos (pioglitazone) and Avandia (rosiglitazone) when used with sulfonylureas
If you take any drugs in these classes, understanding their potential side effects is essential for safe medication management and hypoglycemia prevention.
Case Study: Drug-Induced Hypoglycemia
Hypoglycemia is a serious side effect of certain medications. It can happen when people take drugs that lower their blood sugar levels more than expected. A 2023 study in Expert Opinion on Drug Safety used U.S. Food and Drug Administration data to find which drugs are most frequently linked to this condition.
At the time of the study, there were over 11 million reports of adverse events in the FDA Adverse Event Reporting System (FAERS) database. The study found that about 28,000 of the reports related to hypoglycemia. The diabetes medication metformin was involved in nearly 7,000 cases, more than any other drug. Other drugs like penamecillin, nikethamide and sotagliflozin also had links to hypoglycemia, even if their labels didn’t warn about it.
Monitoring for low blood sugar is crucial for people taking these medications, even those not labeled for this risk. Awareness can help prevent serious health issues related to hypoglycemia.
Medications Associated with Hypoglycemia
Doctors can use several different medications to treat low blood sugar. In general, however, the first line of treatment is to consume a fast-acting carbohydrate.
Drugs Used to Treat Hypoglycemia
Glucagon
Available in injectable or nasal powder forms, glucagon can treat severe hypoglycemia when a person is unconscious or unable to ingest sugar orally. It works by prompting the liver to release stored glucose into the bloodstream.
Dextrose
For more severe cases or emergencies (such as coma), doctors can administer intravenous dextrose in health care settings to quickly raise blood sugar levels.
Diazoxide
Used in cases of hyperinsulinism — a genetic disorder in which pancreatic cells secrete an excess of insulin — diazoxide inhibits insulin release from the pancreas to increase blood glucose levels.
Octreotide
Doctors can use octreotide to treat type 2 diabetes in cases of hypoglycemia caused by ingesting certain medications called sulfonylureas. It works by inhibiting insulin secretion.
If you experience an episode of dangerously low blood sugar, you should eat or drink a fast-acting carbohydrate. This could include something sugary, like juice or glucose tablets. After 15 minutes, recheck your blood sugar. If it’s still low, have more sugary food or drink until your levels increase.
Remember that some foods high in carbohydrates, such as rice and bread, may not necessarily be fast-acting. This means your body is unlikely to digest them quickly enough to help in an emergency. Your doctor can help you plan the best diet for your situation.
In severe cases, or if you can’t eat, you may need a glucagon injection or intravenous glucose and should seek emergency help.
Don’t try to give an unconscious person food or drink. If you don’t have a glucagon kit or don’t know how to use it, call 911 for emergency medical help.
Prevention and Lifestyle Considerations
Treating and preventing recurrent hypoglycemia involves addressing the underlying cause. This may include adjusting or stopping medications that trigger low blood sugar, nutrition counseling or treating pancreatic tumors through surgery or medication. These approaches lower the risk of hypoglycemia and help stabilize blood sugar levels.
Treat the Underlying Cause of Low Blood Sugar
Dietary changes
Consider lowering your consumption of sugary foods and beverages — except when you experience a dangerously low blood sugar episode. In that case, a high-sugar snack may help. But in general, try to opt for whole grains and lean protein instead of sugary snacks or processed foods. Drinking less alcohol and not mixing it with sugary drinks like fruit juice may also help.
Exercise
Activities like short sprints, high-intensity intervals and resistance exercises can help prevent low blood sugar during exercise. This means you might not need to eat as many carbs to maintain your blood sugar levels during exercise.
Monitoring
Using a continuous glucose monitor (CGM) or regularly monitoring your blood sugar is important. This is crucial before and after meals, before exercise and before going to bed. After addressing a low blood sugar incident, write down its specifics to accurately share them with your doctor.
Carry foods to treat low blood sugar
Carrying fast-acting carbs is essential for treating hypoglycemia quickly. In emergencies, opt for items like four ounces of juice, non-diet soda, a tablespoon of sugar or honey, hard candies, glucose tablets or glucose gel to raise blood sugar rapidly. Foods high in fat or fiber are less effective because they slow sugar absorption.
It’s crucial to inform friends, family and coworkers about your hypoglycemia. They need to recognize symptoms, know how to test your blood sugar and be prepared to act, especially if you can’t. If you have a glucagon kit, ensure they know where it’s stored and how to use it in an emergency.
Editor Lindsay Donaldson contributed to this article.
Please seek the advice of a medical professional before making health care decisions.
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“While hypoglycemia occurs most often in patients with diabetes, it can also occur in patients who do not have diabetes. It can be easily diagnosed but must be rapidly treated to avoid long-term consequences.”