Diagnosis

Your doctor will use three criteria — often referred to as Whipple's triad — to diagnose hypoglycemia. Whipple's triad includes the following factors:

  • Signs and symptoms of hypoglycemia. You may not exhibit signs and symptoms of hypoglycemia during your initial visit with your doctor. In this case, your doctor may have you fast overnight (or for a longer period). This will allow hypoglycemic symptoms to occur so that he or she can make a diagnosis.

    It's also possible that you'll need to undergo an extended fast in a hospital setting. Or if your symptoms occur after a meal, your doctor will want to test your glucose levels after a meal.

  • Documentation of low blood glucose when the signs and symptoms occur. Your doctor will draw a sample of your blood to be analyzed in the laboratory.
  • Disappearance of the signs and symptoms. The third part of the diagnostic triad involves whether your signs and symptoms go away when blood glucose levels are raised.

In addition, your doctor will likely conduct a physical examination and review your medical history.

Treatment

Treatment of hypoglycemia involves:

  • Immediate initial treatment to raise your blood sugar level
  • Treatment of the underlying condition that's causing your hypoglycemia to prevent it from recurring

Immediate initial treatment

The initial treatment depends on your symptoms. Early symptoms can usually be treated by consuming 15 to 20 grams of a fast-acting carbohydrate. Fast-acting carbohydrates are foods that are easily converted to sugar in the body, such as candy, fruit juice, regular — not diet — soft drinks, or glucose tablets or gel. Foods containing fat or protein aren't good treatments for hypoglycemia, because protein and fat can slow the body's absorption of sugar.

Recheck blood sugar levels 15 minutes after treatment. If blood sugar levels are still under 70 mg/dL (3.9 mmol/L), treat with another 15 to 20 grams of fast-acting carbohydrate, and recheck the blood sugar level again in 15 minutes. Repeat these steps until the blood sugar is above 70 mg/dL (3.9 mmol/L).

Once the blood sugar levels are back to normal, it's important to have a snack or meal to help stabilize your blood sugar. This also helps the body replenish glycogen stores that may have been depleted during the hypoglycemia.

If your symptoms are more severe, impairing your ability to take sugar by mouth, you may need an injection of glucagon or intravenous glucose. Do not give food or drink to someone who is unconscious, as he or she may aspirate these substances into the lungs.

If you're prone to severe episodes of hypoglycemia, ask your doctor if a home glucagon kit might be appropriate for you. In general, people with diabetes who are treated with insulin should have a glucagon kit for low blood sugar emergencies. Family and friends need to know where to find the kit, and need to be taught how to use it before an emergency occurs.

Treatment of the underlying condition

Preventing recurrent hypoglycemia requires your doctor to identify the underlying condition and treat it. Depending on the underlying cause, treatment may involve:

  • Medications. If a medication is the cause of your hypoglycemia, your doctor will likely suggest changing the medication or adjusting the dosage.
  • Tumor treatment. A tumor in your pancreas is treated by surgical removal of the tumor. In some cases, partial removal of the pancreas is necessary.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Preparing for your appointment

Hypoglycemia is common in type 1 diabetes, with symptomatic hypoglycemia occurring an average of twice a week. But if you notice that you're having more hypoglycemia, or if your blood sugar levels are dropping significantly lower, talk with your doctor to find out how you might need to change your diabetes management.

If you haven't been diagnosed with diabetes, make an appointment with your primary care provider.

Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

  • Write down your symptoms, including when they started and how often they occur.
  • List your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
  • Log details about your recent diabetes management if you have diabetes. Include the timing and results of recent blood sugar tests, as well as the schedule on which you've been taking your medications, if any.
  • List your typical daily habits, including alcohol intake, meals and exercise routines. Also, note any recent changes to these habits, such as a new exercise routine, or a new job that's changed the times you eat.
  • Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Questions to ask your doctor if you have diabetes include:

  • Are my signs and symptoms due to hypoglycemia?
  • What do you think is triggering my hypoglycemia?
  • Do I need to adjust my treatment plan?
  • Do I need to make any changes to my diet?
  • Do I need to make any changes to my exercise routine?
  • I have other health conditions. How can I best manage both conditions?
  • What else do you recommend to help me better manage my condition?

Questions to ask if you haven't been diagnosed with diabetes include:

  • Is hypoglycemia the most likely cause of my signs and symptoms?
  • What else might be causing these signs and symptoms?
  • What tests do I need?
  • What are the possible complications of this condition?
  • How is this condition treated?
  • What self-care steps, including lifestyle changes, can I take to help improve my signs and symptoms?
  • Should I see a specialist?

What to expect from your doctor

A doctor who sees you for signs and symptoms of hypoglycemia is likely to ask you a number of questions. The doctor may ask:

  • What are your signs and symptoms, and when did you first notice them?
  • When do your signs and symptoms typically occur?
  • Does anything seem to provoke your signs and symptoms?
  • Have you been diagnosed with any other medical conditions?
  • What medications are you currently taking, including prescription and over-the-counter drugs, vitamins and supplements?
  • What is your typical daily diet?
  • Do you drink alcohol? If yes, how much?
  • What is your typical exercise routine?
Jan. 20, 2015
References
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  2. Hypoglycemia. National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/index.aspx. Accessed Dec. 28, 2014.
  3. Gardner DG, et al. Greenspan's Basic & Clinical Endocrinology. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://accessmedicine.mhmedical.com/book.aspx?bookId=380. Accessed Dec. 24, 2014.
  4. Standards of medical care in diabetes — 2015. Diabetes Care. 2015;38 (suppl):s7.
  5. Service FJ, et al. Hypoglycemia in adults: Clinical manifestations, definition, and causes. http://www.uptodate.com/home. Accessed Dec. 24, 2014.
  6. Hypoglycemia. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/diabetes_mellitus_and_disorders_of_carbohydrate_metabolism/hypoglycemia.html#v989452. Accessed Dec. 24, 2014.