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
If your blood glucose level is still less than 70mg/dL after 15 minutes, eat another 15 to 20 grams of a quick source of sugar. Repeat every 15 minutes until the blood glucose is above 70 mg/dL and then eat a small or snack to stabilize your sugar levels. Resist the urge to eat too much or too quickly or the next problem will be a very high glucose level.
Hypoglycemia is considered severe if you need assistance. If you are not feeling well ask for help immediately. If you are helping someone who is unconscious, don’t try to give the person food or drink. Rubbing table sugar along the gums and inside the cheeks might help temporarily, but still seek emergency medical assistance right away.
I always tell my patients with diabetes that high glucose levels are bad, but low levels are worse. Remember the warning signs and be ready to take action if necessary. It is also more prudent to avoid having a low blood glucose than having to treat one. Be careful to take your medications properly and eat a balanced diet.
Hypoglycemic episodes can be very stressful and serious if you become unconscious and fall or get into an accident. Patients with too many hypoglycemic episodes may get used to having them and no longer have any symptoms. This is called hypoglycemic unawareness and can be very dangerous because you no longer have any warning that you need to take action.
If you are having episodes of hypoglycemia, let your doctor know. Medications can be changed or adjusted. If you do not have diabetes, additional tests might be ordered to look for other possible causes.