Hypoglycemia

What is Hypoglycemia

Hypoglycemia is when the sugar (glucose) level in your blood is too low. Signs of low blood sugar may include:

  • Feeling:
    • Hungry.
    • Worried or nervous (anxious).
    • Sweaty and clammy.
    • Confused.
    • Dizzy.
    • Sleepy.
    • Sick to your stomach (nauseous).
  • Having:
    • A fast heartbeat.
    • A headache.
    • A change in your vision.
    • Tingling or no feeling (numbness) around your mouth, lips, or tongue.
    • Jerky movements that you cannot control (seizure).
  • Having trouble with:
    • Moving (coordination).
    • Sleeping.
    • Passing out (fainting).
    • Getting upset easily (irritability).

Low blood sugar can happen to people who have diabetes and people who do not have diabetes. Low blood sugar can happen quickly, and it can be an emergency.

4 Interesting Facts of Hypoglycemia

  1. Presents similarly in neonates and infants, with nonspecific manifestations such as tachypnea, tachycardia, lethargy, fussiness, and poor feeding
  2. Diagnoses are difficult to differentiate on clinical grounds alone; ancillary studies (eg, serum glucose) are required to aid in differentiation
  3. Diagnose hypoglycemia by serum glucose level
  4. Plasma glucose level defining hypoglycemia is not rigorously agreed on in the first 72 hours of life; levels below about 45 mg/dL are generally considered abnormal, especially when accompanied by symptoms of hypoglycemia; by 72 hours of life, normal glucose levels reach 60 to 100 mg/dL
  5. Most likely scenario is a patient with type 1 diabetes receiving hyperbaric oxygen therapy (Related: Diabetes mellitus type 1 in adults)Less likely in a diving setting, since people with diabetes are screened out of scuba certification unless disease is very well-controlled
  6. Can also occur in patients with type 2 diabetes taking oral hypoglycemic drugs and fasting too long between meals and in people without diabetes after fasting several hours (Related: Diabetes mellitus type 2 in adults)
  7. As with nitrogen narcosis, can present with confusion or unconsciousness
  8. Unlike nitrogen narcosis, does not resolve with return to normal-pressure environment
  9. Differentiated on basis of history of diabetes and/or fasting, failure to resolve in normal-pressure environment, and blood glucose analysis (in hyperbaric facility setting)

Treating low blood sugar

Low blood sugar is often treated by eating or drinking something sugary right away. If you can think clearly and swallow safely, follow the 15:15 rule:

  • Take 15 grams of a fast-acting carb (carbohydrate). Some fast-acting carbs are:
    • 1 tube of glucose gel.
    • 3 sugar tablets (glucose pills).
    • 6–8 pieces of hard candy.
    • 4 oz (120 mL) of fruit juice.
    • 4 oz (120 mL) of regular (not diet) soda.
  • Check your blood sugar 15 minutes after you take the carb.
  • If your blood sugar is still at or below 70 mg/dL (3.9 mmol/L), take 15 grams of a carb again.
  • If your blood sugar does not go above 70 mg/dL (3.9 mmol/L) after 3 tries, get help right away.
  • After your blood sugar goes back to normal, eat a meal or a snack within 1 hour.

Treating very low blood sugar

If your blood sugar is at or below 54 mg/dL (3 mmol/L), you have very low blood sugar (severe hypoglycemia). This may also cause:

  • Passing out.
  • Jerky movements you cannot control (seizure).
  • Losing consciousness (coma).

This is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

If you have very low blood sugar and you cannot eat or drink, you may need a glucagon shot (injection). A family member or friend should learn how to check your blood sugar and how to give you a glucagon shot. Ask your doctor if you need to have a glucagon shot kit at home.

Follow these instructions at home:

General instructions

  • Take over-the-counter and prescription medicines only as told by your doctor.
  • Stay aware of your blood sugar as told by your doctor.
  • Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
  • Keep all follow-up visits as told by your doctor. This is important.

If you have diabetes:

  • Always keep a source of fast-acting carb with you, such as:
    • Glucose gel.
    • Sugar tablets.
    • Hard candy.
    • Fruit juice.
    • Regular soda (not diet soda).
  • Follow your diabetes care plan as told by your doctor. Make sure you:
    • Know the signs of low blood sugar.
    • Take your medicines as told.
    • Follow your exercise and meal plan.
    • Eat on time. Do not skip meals.
    • Check your blood sugar as often as told by your doctor. Always check it before and after exercise.
    • Follow your sick day plan when you cannot eat or drink normally. Make this plan ahead of time with your doctor.
  • Share your diabetes care plan with:
    • Your work or school.
    • People you live with.
  • Check your pee (urine) for ketones:
    • When you are sick.
    • As told by your doctor.
  • Carry a card or wear jewelry that says you have diabetes.

Contact a doctor if:

  • You have trouble keeping your blood sugar in your target range.
  • You have low blood sugar often.

Get help right away if:

  • You still have symptoms after you eat or drink something sugary.
  • Your blood sugar is at or below 54 mg/dL (3 mmol/L).
  • You have jerky movements that you cannot control.
  • You pass out.

These symptoms may be an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • Hypoglycemia happens when the level of sugar (glucose) in your blood is too low.
  • Low blood sugar can happen to people who have diabetes and people who do not have diabetes. Low blood sugar can happen quickly, and it can be an emergency.
  • Make sure you know the signs of low blood sugar and know how to treat it.
  • Always keep a source of sugar (fast-acting carb) with you to treat low blood sugar.
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