As an endocrinologist, most of my patients are worried about high blood glucose levels. But patients can also have low blood glucose levels, or hypoglycemia, where levels are lower than normal — less than 70mg/dL or 3.9 mmol/L. This is can be caused by medications, lack of food, or too much exercise.

Hypoglycemia is uncommon in people who do not have diabetes, though some might feel like they have low glucose levels, even if they don’t. This is called relative hypoglycemia or pseudohypoglycemia, where glucose levels are above 70mg/dL but patients feel symptoms.

This can happen within hours of eating a high-calorie meal or when patients haven’t eaten for many hours. In patients with uncontrolled diabetes this can happen when they are used to higher glucose levels and these levels start coming down to normal range with treatment.

Some common symptoms of hypoglycemia are:

•Cold sweats

• Shaking

• Dizziness

• Feeling hungry or anxious

If your glucose level is really low and does not get treated, more severe symptoms can develop:

• Headache

• Blurring of vision

• Weakness

• Difficulty walking

• Confusion

• Passing out

Aside from medications for diabetes, other causes of hypoglycemia include:

•Liver or kidney disease

• Alcohol intake, especially drinking a lot over a few days

• Eating disorders with lack of calories

Problems of the pancreas, an organ in the body that makes the hormone insulin, which lowers blood glucose levels

• Side effects of weight loss surgery

• Certain medications (antibiotics, blood pressure medications)

To be diagnosed with hypoglycemia, a patient must meet certain conditions. You must:

1. Have symptoms

2. Have a low blood glucose level when you have the symptoms, checked with a fingerstick and a glucometer or a blood test, and

3. Feel better after you eat something that raises your blood glucose level to normal.

Immediate treatment for hypoglycemia involves both raising the blood glucose and treating the cause. The fastest way is to eat or drink about 15 to 20 grams of quick sources of sugar such as:

• ½ cup of juice or regular soda (not sugar-free)

• 1 tablespoon of sugar

• 1 tablespoon of honey or corn syrup

• 6 to 8 hard candies