Hypoglycemia

Hypoglycemia (or “low blood sugar”) occurs when blood glucose levels fall below 4 mmol/L. At first, symptoms may be benign—irritability, mild nausea—but if the situation is not addressed, hypoglycemia can lead to fainting or even coma.

Signs

Symptoms caused by adrenaline secretion (adrenergic or neurogenic)

These symptoms are usually the first to appear and should be considered "alarm bells":

• Trembling
• Palpitations
• Sweating
• Anxiety
• Hunger
• Nausea
• Tingling

Symptoms caused by a lack of glucose in the brain (neuroglycopenic)

If nothing is done, the following symptoms may occur: 

• Difficulty coordinating
• Mood swings
• Confusion
• Weakness
• Drowsiness
• Vision changes
• Difficulty speaking
• Headache
• Dizziness

Moreover, if hypoglycemia occurs during the night, a person could experience:

• Profuse sweating
• Nightmares
• Restless sleep
• Headache upon awakening 

The symptoms can vary from person and from one episode to another. Sometimes, no symptoms appear, particularly in people who have been diabetic for a long time or if blood glucose levels drops slowly.

When it occurs, hypoglycemia can manifest through strong perspiration and restless sleep. You may also experience headaches when you wake up. 

Causes

Psychological or physical stress, alcohol, dietary choices, physical activity or certain medications can cause your blood sugar level to drop. So can taking too large a dose of insulin compared to what you ate or drank—for example, if you skipped a meal or snacked later than usual. 

It’s a good idea to note what you ate or drank and what activities you performed before an episode of hypoglycemia.

Note that people taking insulin or a medication that increases insulin production by the pancreas are at higher risk of hypoglycemia.

How to prevent it

• Eat regularly and always have a snack or source of sugar with you.
• Keep your glucose meter with you and measure your blood sugar often, especially before and after meals or before and after a physical activity.
• Adjust your insulin dose based on what you ate or drank and depending on your activities.
• Make sure those around you can recognize the signs of hypoglycemia.
• Wear something, such as a bracelet, to indicate that you are living with diabetes.

What about glucagon?

Produced by the pancreas, the purpose of this hormone is to increase blood sugar levels. A person being treated with insulin who experiences an episode of severe hypoglycemia may require an injection of glucagon.

If your doctor prescribes it to you, make sure your relatives know where your medical kit is and how to administer the substance.

What to do in case of hypoglycemia 

• At the very first signs, check your blood glucose. If you can’t use your meter, don’t take any risks: treat your symptoms anyway. 
• Take 15 g of fast-acting glucose. For example, three or four glucose tablets, ¾ cup or 175 ml of fruit juice or soda, a tablespoon of honey or maple syrup. 
• Wait 10 to 15 minutes, then check your blood glucose again. If it is still low, repeat the process or talk to your healthcare professional about those episodes.

In conclusion

We’re all in a hurry or distracted sometimes and it’s easy to forget to take a snack or think we can wait a little longer. But even if a meal is coming up soon, you’d better have a bite to eat and, as always, measure your blood glucose.