Diabetic hypoglycemia

Diabetic hypoglycemia refers to low blood sugar levels in a person with diabetes. Blood sugar, also called glucose, is the main source of fuel for the body and brain. You can't function well if your blood sugar drops below a healthy range.

For many people, hypoglycemia is a blood sugar level below 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L). But your numbers might be different. Ask your healthcare professional about the right range for your blood sugar. This also is called your target range.

Pay attention to the early symptoms of hypoglycemia. Treat low blood sugar right away. You can raise your blood sugar quickly by taking glucose tablets. Or have a source of simple sugar, such as hard candy, fruit juice or regular soda. Also, tell family and friends to be aware of the symptoms that you might have with hypoglycemia. Let them know what to do if you're not able to treat the condition yourself.

Diabetic hypoglycemia can cause a number of symptoms. The symptoms depend on factors such as how long you've been getting low blood sugar and how serious it is. Even the time of day can play a role.

Early symptoms

At first, symptoms of diabetic hypoglycemia include:

• Faded skin color, also called pallor.
• Shakiness.
• Dizziness.
• Sweating.
• Hunger or upset stomach.
• A heartbeat that feels fast or irregular.
• Trouble concentrating.
• Weakness and lack of energy, also called fatigue.
• Irritable mood or anxiety.
• Headache.
• Tingling or loss of feeling in the lips, tongue or cheek.

Symptoms at night

If diabetic hypoglycemia happens when you're sleeping, symptoms that may disturb your sleep include:

• Damp sheets or nightclothes due to sweating.
• Nightmares.
• Tiredness, irritable mood or confusion when you wake up.

Severe symptoms

If diabetic hypoglycemia isn't treated, symptoms of low blood sugar get worse. These symptoms can include:

• Confusion, unusual behavior or both, such as not being able to complete routine tasks.
• Clumsiness or loss of coordination.
• Trouble speaking or slurred speech.
• Blurry or tunnel vision.
• Not being able to eat or drink.
• Muscle weakness.
• Drowsiness.

Severe hypoglycemia can cause:

• Uncontrolled shaking, also called convulsions.
• Seizures.
• Loss of consciousness or coma.
• Death, rarely.

Symptoms can differ from person to person. Symptoms also can differ each time a person's blood sugar becomes low. Some people don't have any symptoms that they notice. It's also possible to have no symptoms of hypoglycemia. That makes it important to check your blood sugar regularly. Also, keep track of how you feel when your blood sugar is low.

Severe hypoglycemia can lead to serious medical problems that need emergency care. These include seizures and loss of consciousness. Make sure your family, friends and co-workers know what to do in an emergency.

Teach people you trust how to recognize symptoms of hypoglycemia. If others know what symptoms to look for, they might be able to alert you to early symptoms. It's also important that family members and close friends know how to help you in case of an emergency.

For example, if you pass out due to very low blood sugar, you'll need someone to give you treatment. The treatment for severe hypoglycemia is an injection of glucagon. Glucagon is a hormone that causes the liver to release sugar into the blood. Tell family and friends where you keep glucagon and how to give it to you.

Here's some emergency information to give to others. If you're with someone who loses consciousness or can't swallow due to low blood sugar:

• Don't inject insulin. Insulin is a type of diabetes medicine that lowers blood sugar whether sugar is low or high to begin with. Injecting insulin causes blood sugar to drop even more.
• Don't give fluids or food because they could cause choking.
• Give glucagon by shot or a nasal spray.
• Call 911 or emergency services in your area for treatment right away if you can't find the person's glucagon. Also call emergency services if you don't know how to use glucagon or if the person is not conscious.

If you have symptoms of hypoglycemia several times a week, see your healthcare professional. Your treatment plan may need to be changed.

Diabetic hypoglycemia has a number of causes. Low blood sugar is most common among people who take insulin. But low blood sugar also can happen if you use certain oral diabetes medicines, which are taken by mouth.

Common causes of diabetic hypoglycemia include:

• Taking too much insulin or other diabetes medicine.
• Not eating enough.
• Postponing or skipping a meal or snack.
• Getting more exercise or physical activity without eating more or adjusting your medicines.
• Drinking alcohol.

Blood sugar control

Most of the body's blood sugar comes from food. The hormone insulin lowers blood sugar levels when blood sugar is too high. If you have type 1 or type 2 diabetes and need insulin to control your blood sugar, use insulin carefully. Taking more insulin than you need can cause your blood sugar level to drop too low. Hypoglycemia can happen as a result.

Your blood sugar may drop too low if you eat less than usual after you take your diabetes medicine. A drop in blood sugar also can happen if you exercise more than usual after taking your diabetes medicine. It isn't always easy to find the right balance between insulin, food and physical activity. But you can ask a member of your healthcare team to help you try to prevent low blood sugar levels. You might work with:

• Your primary care healthcare professional.
• A certified diabetes care and education specialist.
• A registered dietitian.

Some people have a greater risk of diabetic hypoglycemia, including:

• People who use insulin, especially those with type 1 diabetes.
• People who take diabetes medicines called sulfonylureas, such as glipizide (Glucotrol XL), glimepiride (Amaryl) or glyburide (Diabeta, Glynase).
• Young children and adults 65 and older.
• Those with conditions that affect how well the liver works or how well the kidneys work.
• People who've had diabetes for a long time.
• People who don't feel low blood sugar symptoms. This is called hypoglycemia unawareness.
• Those taking more than one medicine.
• Anyone with a medical condition that prevents a quick response to falling blood sugar levels.
• People who drink alcohol.

Diabetic hypoglycemia can lead to other medical problems. If you ignore the symptoms of hypoglycemia too long, you may lose consciousness. That's because your brain needs blood sugar to work. So, it's important to spot the symptoms of hypoglycemia early.

Without treatment, hypoglycemia can lead to:

• Seizures.
• Loss of consciousness or coma.
• Death, rarely.

Take early symptoms seriously. Diabetic hypoglycemia can raise the risk of serious — even deadly — accidents.

To help prevent diabetic hypoglycemia:

• Track your blood sugar. Depending on your treatment plan, you may need to check and record your blood sugar level many times each week or each day. This is the only way to make sure that your blood sugar level stays within your target range.
• Don't skip or delay meals or snacks. If you take insulin or oral diabetes medicine, be consistent about the amount you eat. Also be consistent about the timing of your meals and snacks.
• Measure medicine carefully and take it on time. Take any diabetes medicine as recommended by your healthcare professional.
• Adjust your medicine or eat more snacks if you boost your physical activity. The adjustment depends on the blood sugar test results, the type and length of activity, and what medicines you take. Follow your diabetes treatment plan when you make adjustments.
• If you choose to drink, drink alcohol with a meal or snack. Drinking alcohol on an empty stomach can cause hypoglycemia. Alcohol also can cause delayed hypoglycemia hours later. This makes it even more important to check your blood sugar.
• Keep a journal of times when you get low blood sugar. Note what you ate, any diabetes medicines that you took and any physical activity you did. This can help you and your care team find patterns as to why you might get hypoglycemia. It can help your team find ways to prevent bouts of low blood sugar.
• Carry some form of diabetes identification so that in an emergency others can see that you have diabetes. Use a medical identification necklace or bracelet and wallet card.