Table of Content
What Is Hypoglycemia?
Hypoglycemia occurs when blood sugar levels drop below 70 mg/dL or 3.9 mmol/L. The severity of hypoglycemia isn’t determined by how low the blood sugar level is, but by the symptoms.
Mild Hypoglycemia
Mild hypoglycemia can be self-treated. Symptoms include cold sweat, trembling, blurred vision, racing heartbeat, and hunger. These symptoms can be alleviated by consuming an appropriate amount of carbohydrates.
Severe Hypoglycemia
People experiencing severe hypoglycemia need assistance and it cannot be self-treated. Symptoms include confusion or trouble concentrating, drowsiness, and coma.
What Are the Symptoms of Hypoglycemia?
Symptoms of a glycemic episode include trembling, sweating, rapid heartbeat, and difficulty breathing. These are related to the autonomic nervous system.
This is followed by symptoms related to the central nervous system lacking glucose supply, such as dizziness and blurred vision. As a result, if a person with diabetes experiences the symptoms mentioned above, it’s best to promptly measure the blood sugar to confirm if it’s a case of hypoglycemia.
Relationship Between Hypoglycemia and Dementia
Hypoglycemia can also cause cognitive impairment, increasing the risk of developing dementia. People with diabetes who have often experienced hypoglycemia might set easier blood sugar level targets to avoid hypoglycemia. However, this can significantly reduce the effectiveness of blood sugar control, indirectly increasing the risk of dementia.
Causes of Hypoglycemia
Diet
There are several dietary habits that can lead to hypoglycemia, including:
- eating at irregular times
- eating late
- deliberately reducing carb intake
- having inconsistent portions of carbs
- and drinking alcohol with an empty stomach.
Exercise
Physical activity helps improve insulin sensitivity. High-intensity exercise requires more glucose to fuel your muscles, resulting in an immediate or 12-24 hour blood sugar-lowering effect. Without consuming carbs after exercise, symptoms of hypoglycemia are likely to occur.
Medication
Effective use of medication along with a properly planned diet is essential to preventing hypoglycemia. Causes of hypoglycemia related to medication include:
- taking excessive doses of insulin
- not eating after insulin injection
- reducing food intake without adjusting insulin doses or other oral medications that induce insulin secretion.
Others
This often happens to people with diabetes who are just starting medication. The body may not adapt quickly enough when insulin is administered, causing a sudden drop in blood sugar (e.g., from 350 mg/dL to 220 mg/dL or 19.4 mmol/L to 12.2 mmol/L). This can lead to “pseudo-hypoglycemia” where people experience symptoms similar to hypoglycemia. In this case, sitting down to rest and drinking water can help alleviate the symptoms.
How to Treat Hypoglycemia?
Self-Manageable
When the symptoms are still self-manageable, you can follow the 15-15 rule.
Firstly, consume 15g of sugar. After 15 minutes, measure your blood sugar level again.
If it hasn’t reached 70 mg/dL (3.9 mmol/L) , consume another 15g of sugar to ensure that your blood sugar reaches 70 mg/dL (3.9 mmol/L) and above.
Requiring Assistance
If you have glucagon, usually used as an emergency medicine to treat severe hypoglycemia, inject it or ask close friends or family members to rub honey or syrup inside the cheek against the buccal mucosa. This will help increase the blood sugar level. If the blood sugar levels are still low, seek medical attention immediately.
The best way to raise blood sugar quickly is to consume glucose or processed carbs. Consuming high-fat or low-GI foods like chocolate, ice cream, and milk isn’t as effective in terms of alleviating hypoglycemia symptoms since these foods raise blood sugar more slowly than processed sugar.
Note: 15g of sugar = 3 sugar cubes = 120ml of fruit juice = 150ml of sugar soft drink.
How to Prevent Hypoglycemia
It is essential to start with diet, exercise, and medication in order to effectively prevent hypoglycemia. In addition, monitoring blood sugar levels help you understand the reasons behind your blood sugar fluctuations. You can then make dietary or medication adjustments after discussing with your healthcare providers. Analyzing the causes after a hypoglycemic episode helps avoid similar situations in the future.
Diet
Having regular, consistent meals not only stabilizes blood sugar levels but also reduces the chances of having hypoglycemia. If you’re traveling or engaging in physical activities, you can carry candy or biscuits for emergencies.
Exercise
Before high-intensity or prolonged exercise, and before bedtime on the same day, monitor your blood sugar levels. Based on the readings, you can then decide whether to have extra carbs.
Medication
Know your medication. Check whether your current medications pose a risk of hypoglycemia and follow the healthcare providers’ instructions for timely medication use. If hypoglycemia occurs more than three times a week, consult your doctor in advance. It’s also recommended to not stop medication on your own.
How to Prevent Nocturnal Hypoglycemia?
If you’re worried about having nocturnal hypoglycemia, try measuring your blood sugar before going to bed. If the blood sugar level is below 110 mg/dL (6.1 mmol/L), you can have a small snack or other foods with sugar, such as a cup of milk. If your bedtime blood sugar is consistently low, talk to your healthcare providers whether to reduce your medication dosage or adjust dinner diet recipes.
Many healthcare professionals now encourage people with diabetes to use continuous glucose monitoring (CGM) to identify abnormal blood sugar fluctuations at night. If you have experienced nocturnal hypoglycemia, consider using a CGM.
By knowing more about your body and developing healthy habits, you can easily prevent severe hypoglycemia.
Sources
- Zoungas, S., et al., Severe hypoglycemia and risks of vascular events and death. N Engl J Med, 2010. 363(15): p. 1410-8.
- Whitmer, R.A., et al., Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA, 2009. 301(15): p.1565-72
- Hypoglycemia (Low Blood Glucose)
