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Guide to Understanding and Managing Hypoglycemia (Low Blood Sugar)

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Hypoglycemia is a prevalent condition that leads to a range of symptoms that affect your physical health. Recognising hypoglycemia causes and signs are important because if left untreated, it can pose serious health risks. In this informative article, we are going to discuss the causes, symptoms, and effective preventive strategies for hypoglycemia.

What is hypoglycemia (low blood sugar)?

Hypoglycemia, commonly known as low blood sugar, occurs when the concentration of glucose in your bloodstream drops below normal levels.

Glucose serves as the primary energy source for your body, especially the brain. Insufficient glucose can affect various organ systems within your body. It is typically observed when your blood glucose levels fall below 70 milligrams per deciliter (mg/dL). However, the specific target range of hypoglycemia levels can vary based on factors such as age, overall health, and the presence or absence of diabetes. If you have type 1 diabetes, you may frequently experience low blood sugar levels.

How common is hypoglycemia?

The term hypoglycemia is most commonly associated with diabetes, particularly when you are using insulin or other anti-diabetic medications. In people with diabetes, it's a relatively frequent occurrence, with studies suggesting that up to one in three individuals with diabetes experience hypoglycemia. In a study based on Type II Diabetes patients in India, the prevalence of hypoglycemia was about 57%. However, it can also affect those without diabetes. The prevalence varies based on the underlying causes of hypoglycemia.

What are the signs and symptoms of hypoglycemia (low blood sugar)?

There are several common symptoms of hypoglycemia that you can observe:

  • One of the early symptoms of hypoglycemia is trembling or shaking, particularly in your hands. This is a result of your body's stress response to low blood sugar.
  • Experiencing excessive sweating, even in cool conditions
  • Low blood sugar can impact your mood, leading to irritability, mood swings and anxiety.
  • You will often report feeling tired and lethargic.
  • Insufficient glucose reaching your brain can cause dizziness or lightheadedness, creating a sense of unsteadiness.
  • Your body may respond to low blood sugar by signalling hunger, even if you have recently eaten.
  • Blurred or impaired vision can occur due to the impact of low blood sugar on the function of your eyes.
  • You may experience headaches as a symptom of low blood sugar.
  • In severe cases, hypoglycemia can lead to difficulty speaking, confusion, and coordination problems, resembling the effects of intoxication.
  • In extreme cases, untreated hypoglycemia can lead to loss of consciousness.

When do hypoglycemia symptoms appear?

The onset of hypoglycemia symptoms can vary depending on the underlying causes and the severity of the low blood sugar. Here's a list of scenarios when you may notice hypoglycemia symptoms:

  • If you have diabetes, symptoms may manifest relatively soon after meals. This happens because excessive insulin is released in response to a meal, causing a rapid drop in blood sugar levels.
  • Exercise can lead to increased glucose uptake by your muscles leading to hypoglycemia.
  • In some cases, hypoglycemia may occur many hours after eating. This delayed reaction can catch you off guard leading to low blood sugar symptoms.
  • If you have diabetes, hypoglycemia can occur during the night, which can affect your sleep. This phenomenon is known as nocturnal hypoglycemia and can lead to symptoms such as night sweats, nightmares, or morning headaches.
  • Consuming alcohol, especially on an empty stomach or in excess, can lead to hypoglycemia. It inhibits glucose production (gluconeogenesis) and release from your liver. This disrupts your normal liver function, impairing its ability to maintain blood sugar levels. Symptoms may appear while drinking or several hours later.
  • Certain medications, particularly those used to treat diabetes (such as insulin or sulfonylureas), can cause hypoglycemia. Symptoms may occur within a few hours of taking the medication, and their onset can be influenced by factors like dosage and individual response.

What are the complications of low blood sugar?

Common complications associated with hypoglycemia are as follows:

  • Low hypoglycemia levels can influence your endocrine system, potentially contributing to hormonal imbalances.
  • hypoglycemia, especially when severe, can trigger seizures in susceptible individuals.
  • Prolonged hypoglycemia can potentially lead to cognitive impairment.
  • Repeated episodes of low blood sugar may contribute to cardiovascular problems, increasing the risk of heart disease and related complications.
  • Severe hypoglycemia has been associated with an increased risk of death.

What causes hypoglycemia (low blood sugar) in people with diabetes?

The primary cause of hypoglycemia in people with diabetes is because of an imbalance between insulin, medication, food intake, and physical activity. The main hypoglycemia causes include:

  • Insulin Overdose or Mismatch: Taking too much insulin or certain diabetes medications can lead to excessive glucose removal from your bloodstream, causing hypoglycemia.
  • Skipped or Delayed Meals: Missing meals or having a delay between meals can disrupt the balance between your insulin levels and available glucose, resulting in low blood sugar.
  • Inadequate Carbohydrate Intake: Consuming insufficient carbohydrates, which are your body's primary source of glucose, can contribute to hypoglycemia.
  • Intense Physical Activity: Strenuous exercise without adjusting insulin doses or carbohydrate intake can lead to low blood sugar during or after physical activity.
  • Impaired Glucagon Response: If you are a diabetes patient, your body's ability to release glucagon ( a hormone that raises your blood sugar ) is often impaired, making it challenging to counteract low blood sugar effectively.

What causes hypoglycemia in people without diabetes?

Hypoglycemia without diabetes is typically observed in two forms: Reactive hypoglycemia and Fasting hypoglycemia.

Reactive hypoglycemia

Reactive hypoglycemia is a condition characterised by episodes of low blood sugar that typically occur 2-5 hours after you eat, especially due to meals that are rich in carbohydrates. It is also known as postprandial hypoglycemia. Unlike fasting hypoglycemia, reactive hypoglycemia manifests relatively soon after meals. The exact cause is not fully understood, but it is believed to involve an exaggerated release of insulin in response to your consumption of simple carbohydrates like white bread, white rice, potatoes etc.

Common symptoms of reactive hypoglycemia include shakiness, sweating, irritability, confusion, and dizziness. These symptoms are a result of the rapid drop in your blood glucose levels following the initial surge of insulin.

Fasting hypoglycemia

Fasting hypoglycemia refers to the occurrence of low blood sugar levels after an extended period without eating, typically during fasting or prolonged periods between meals. Unlike reactive hypoglycemia, which occurs after meals, fasting hypoglycemia is characterised by a decline in your blood glucose levels during periods of food deprivation. Several factors can contribute to this condition:

  • Impaired Glucose Production: In a fasting state, your body relies on glucose production from stored glycogen in the liver. Conditions that hinder this process, such as liver diseases or certain enzyme deficiencies such as glucose-6-phosphatase, can lead to fasting hypoglycemia.
  • Non-islet cell tumor hypoglycemia (NICTH): It is a rare condition where tumours outside your pancreatic islets produce substances that lead to hypoglycemia. These substances increase insulin-like activity, causing excessive glucose uptake. NICTH is often associated with large, fast-growing tumours and can result in severe, recurrent low blood sugar episodes.
  • Adrenal Insufficiency: Adrenal insufficiency can cause hypoglycemia due to inadequate production of cortisol, a hormone that promotes glucose release from your liver. Insufficient cortisol levels impair your body's ability to maintain blood sugar, leading to lower glucose levels and hypoglycemic episodes.
  • Tumours: Pancreatic tumors, particularly insulinomas, cause hypoglycemia by overproducing insulin. Insulin is responsible for facilitating glucose uptake by your cells, but excessive insulin secretion from these tumours leads to a rapid and unregulated decrease in your blood sugar levels. This continuous release of insulin, even in the absence of dietary glucose, results in recurrent and potentially severe hypoglycaemic episodes.
  • Antibiotic use: Certain antibiotics, such as quinolones and sulfonamides, may rarely cause hypoglycemia as a side effect. They can interfere with insulin release or action, lowering your blood sugar levels.

How is hypoglycemia diagnosed in people with diabetes?

In clinical settings, Whipple's triad—symptoms consistent with hypoglycemia, a low blood glucose reading, and symptom relief upon glucose administration— are 3 criteria used for hypoglycemia diagnosis:

  • Recognising hypoglycemic symptoms like shakiness, sweating, irritability, and confusion.
  • Regular blood glucose monitoring using a glucometer to detect low blood sugar levels. A reading below the target range indicates hypoglycemia.
  • CGM systems provide real-time glucose readings throughout the day, offering a comprehensive view of your blood sugar trends and potential hypoglycaemic episodes.
  • Haemoglobin A1c (HbA1c) tests measure your average blood glucose levels over several months, providing insights into overall glycaemic control. Consistently low levels may indicate a higher risk of hypoglycemia.

How is hypoglycemia diagnosed in people without diabetes?

Diagnosis for hypoglycemia for non-diabetics involves:

  • Fasting Tests: Supervised fasting tests are conducted to observe how your blood sugar levels respond during periods of no food intake.
  • Hormone and Metabolic Panel: Measures insulin, cortisol, and other hormone levels, and assesses your liver and kidney function, helping identify potential contributors to hypoglycemia.
  • Imaging Studies: Utilises imaging, such as CT scans, to detect tumors or abnormalities in organs like your pancreas.
  • Mixed meal tolerance test (MMTT): It evaluates your insulin production in response to consuming a liquid meal beverage containing fats, proteins, and sugar to check if your pancreas is working properly.

How is hypoglycemia (low blood sugar) treated?

The treatment of hypoglycemia, whether you have diabetes or not, focuses on raising blood sugar levels promptly to relieve your symptoms. Common methods of hypoglycemia treatment include:

  1. The 15-15 rule: It is a widely recognised guideline for mild to moderate hypoglycemia treatment if you have diabetes. Here's how it works:
    • Consume 15 Grams of Carbohydrates: Choose a rapidly absorbed source of carbohydrates, such as:
      • 4 ounces (about 120 ml) of fruit juice or regular soda,
      • 3 to 4 glucose tablets
      • 1 tablespoon of honey or sugar.
    • Wait for 15 Minutes: After consuming the carbohydrates, wait for about 15 minutes to allow your body to raise blood sugar levels.
    • Recheck Blood Glucose Levels: After the 15-minute wait, recheck blood glucose levels. If they remain below the target range, repeat the process by consuming another 15 grams of carbohydrates and waiting for an additional 15 minutes.
  2. Adjusting Medications: If you have diabetes, adjusting the dosage or timing of insulin or other hypoglycemia medications can work. However, you should always consult the doctor before doing the same.

How is severe hypoglycemia treated?

Severe hypoglycemia is a medical emergency that requires immediate intervention to raise your blood sugar levels and prevent serious complications. The primary treatment for severe hypoglycemia involves the administration of glucose through various means:

  • Glucagon Injection: Glucagon is a hormone that stimulates your liver to release stored glucose into your blood. A glucagon injection is often used when you cannot consume oral carbohydrates and are unconscious or unable to cooperate. Family members, caregivers, or the affected person themselves (if able) can administer the injection. Glucagon also comes in the form of powders or dry nasal sprays.
  • Intravenous (IV) Dextrose: In a hospital or emergency setting, intravenous administration of dextrose (sugar) may be necessary for rapid and reliable sugar elevation in your blood. This is especially important if glucagon injection is not effective or unavailable.

The options for treating severe hypoglycemia are restricted to intravenous dextrose, injectable glucagon, nasal glucagon, and liquid glucagon. These interventions are the only current standards for addressing critically low blood sugar levels.

How can I prevent low blood sugar?

You can prevent low blood sugar by following the below discussed recommendations:

  • Consume a well-balanced diet that includes a mix of carbohydrates, proteins, and healthy fats. Opt for complex carbohydrates, such as whole grains and vegetables, to provide a steady release of glucose into the bloodstream.
  • Stick to a consistent meal schedule, including regular snacks if needed, to maintain a stable blood sugar level. Skipping meals can lead to drops in blood glucose.
  • If you're on hypoglycemia treatments and taking medications that lower blood sugar, take them as directed by your doctor, and communicate any concerns or issues promptly.
  • Carry a fast-acting source of glucose, such as glucose tablets or gel, to address sudden drops in blood sugar. Make sure your friends and family are aware of the symptoms and know how to assist if needed.
  • Regularly check your blood sugar levels. This enables you to detect any fluctuations early on and take appropriate action.

By incorporating these strategies into your daily routine, you can significantly reduce the risk of experiencing low blood sugar episodes. Always personalise these general recommendations with guidance from your doctor, as your needs may vary.

What can I expect if I have hypoglycemia episodes?

The prognosis of hypoglycemia varies based on severity and cause. Mild cases often respond to lifestyle adjustments. Severe or recurring episodes, especially in diabetes, may lead to complications. Timely recognition, proper management, and adherence to treatment plans are essential for a positive outcome. Uncontrolled or undetected hypoglycemia can pose serious risks, including cognitive impairment, coma, or even death.

When should I see my healthcare provider about hypoglycemia?

Consult your healthcare provider promptly if you experience recurrent or severe hypoglycemia symptoms, such as mental confusion, dizziness, or fainting. Seek medical attention if your blood sugar levels remain low despite corrective measures, or if you require assistance to manage hypoglycaemic episodes. Regular appointments with a doctor and taking the suggested will help you determine the underlying causes and risk factors of your hypoglycemia. You will also know if your condition is evolving or if you have to adjust your hypoglycemia treatments or diet.

What’s the difference between hypoglycemia and hyperglycaemia?

hypoglycemia is low blood sugar whereas hyperglycaemia is high blood sugar.

Conclusion

To summarise, understanding the various aspects of hypoglycemia is vital for both individuals with diabetes and those without. Recognising its symptoms, prompt diagnosis and addressing low blood sugar with appropriate interventions like the 15-15 rule, and keeping in touch with doctors regularly, form the cornerstone of effective management of hypoglycemia. By tailoring strategies to your needs, adopting healthy lifestyle habits, and identifying underlying causes, you can easily minimise the risks associated with hypoglycemia. If you are experiencing frequent symptoms, do not delay and book an at-home HbA1c blood test with Metropolis Healthcare to check if you are suffering from low blood sugar. Our state-of-the-art lab facilities and expert phlebotomists make sure you receive prompt, precise and pocket-friendly diagnostic services like no other. Book your test today!

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