Definition

Hypoglycemia is a disorder characterized by a reduction or drop in blood sugar levels below the normal range or low blood glucose. Hypoglycemia is a prevalent condition in individuals with diabetes, particularly those with type 1 diabetes.

Glucose is mostly derived from the carbohydrates present in food and beverages. Glucose serves as the primary energy for the human body. The circulatory system transports glucose throughout the body to serve as a vital energy source, particularly for the brain.

The body autonomously regulates blood glucose levels in non-diabetic individuals to remain within the normal range. The pancreas produces the hormone insulin, which controls blood sugar levels. Glucagon, another important hormone, also participates in this metabolic process. Hypoglycemia frequently arises from an overabundance of insulin, either due to excessive endogenous synthesis or exogenous injection.

Hypoglycemia is characterized by a drop in blood sugar level below 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L) in individuals with diabetes. Hypoglycemia manifests in healthy individuals when blood glucose concentration falls below 55 mg/dL or 3.1 mmol/L.

Causes

Hypoglycemia can manifest in individuals without diabetes as well. Nevertheless, several conditions might lead to hypoglycemia in individuals with diabetes:

• Inappropriate use of insulin, such as into muscles instead of adipose tissue.
• Insulin noncompliance and improper carbohydrate consumption (e.g., delaying mealtime after administering insulin).
• Overdose or excessive dosage of antidiabetic medications.
• Increased levels of activity
• Alcohol consumption without food
• Skipping meals or eating late
• Imbalanced dietary components, including fat, protein, and fiber

In patients without diabetes, there are two potential etiologies.

• Reactive hypoglycemia

It occurs when a person experiences hypoglycemia following a meal, typically two to four hours after the meal. The precise etiology remains unknown; however, scientists hypothesize that specific foods, including basic carbohydrates like rice, potatoes, bread, and cakes, induce fluctuations in blood sugar levels.

• Fasting hypoglycemia

This condition develops when the body controls blood sugar levels by drawing on hormones and stored carbohydrates.

During the first three months of pregnancy, known as the first trimester, hormonal changes may result in hypoglycemia in pregnant women with type 1 diabetes.

Risk factor

A higher risk of hypoglycemia is present in diabetics; in such cases, diabetes medication is administered to reduce the patient's blood sugar. Specific antidiabetics have the potential to inhibit the synthesis of insulin, resulting in a reduction of blood glucose levels. Diabetes patients who rely on insulin to control their blood sugar may experience hypoglycemia if the insulin is administered improperly. Alcohol consumption, inadequate carbohydrate consumption, prolonged exercise, and consuming insufficient carbohydrates can all elevate the risk of hypoglycemia.

Symptoms

The onset of hypoglycemia symptoms might be fast and differ across individuals. Several of these symptoms or indicators include:

• Tremor
• Weakness
• Sweating and shivering
• Excessive appetite (polyphagia)
• Tachycardia
• Vertiginous
• Cognitive disorientation or impaired focus
• Anxiety or irritable
• Discoloration of the skin (pallor)
• Itching of the mouth, tongue, or cheeks

Severe hypoglycemia symptoms include:

• Visual impairment is characterized by a lack of clarity or the perception of two overlapping images.
• Aphasia
• Lack of coordination
• Disorientation
• Seizures
• Unconsciousness

Diagnosis

A glucometer to measure blood sugar levels is an effective method for detecting hypoglycemia. Individuals without diabetes can have their blood sugar levels evaluated by their doctor at hourly intervals during a multi-day fasting period. In addition, you will have several examinations to determine the underlying reason for hypoglycemia, including further screenings to identify the presence of a tumor that may be responsible for the low blood sugar levels.

A mixed-meal tolerance test (MMTT) may be recommended for reactive hypoglycemia. Special protein, fat, and sugar drinks will be served during this testing period. These drinks may increase blood sugar and insulin production. The doctor will monitor your blood sugar multiple times for five hours.

Management

Sugary foods and drinks can treat mild-to-moderate hypoglycemia. The American Diabetes Association recommends the 15-15 rule for mild to moderate hypoglycemia:

• Consume 15 grams of rapidly acting carbohydrates to promptly increase your blood sugar levels.
• Check blood sugar after 15 minutes.
• If below 70 mg/dL, add 15 grams of fast-acting carbohydrates.
• Repeat until your blood sugar reaches 70 mg/dL.

Several food options containing 15 grams of rapidly metabolized carbohydrates include a single serving of fruit (such as half a banana), half a cup of juice or soda, or a tablespoon of sugar, honey, or syrup. If you are experiencing hypoglycemia symptoms but cannot check your blood glucose levels, follow the 15-15 rule until you are relieved of symptoms.

In cases of more severe hypoglycemia, the administration of emergency glucagon may be necessary, either through injection or nasal powder. Avoid providing food or beverages to individuals experiencing unconsciousness due to hypoglycemia, as it may lead to choking.

Complications

Prolonged exposure to severe hypoglycemia can result in life-threatening complications, including:

• Dysfunction of multiple organ systems
• Arrhythmia
• Cardiac arrest
• Irreversible cognitive impairment
• Coma
• Death

Prevention

Avoid extremely low blood sugar levels by following the instructions below:

• Follow the doctor's recommendations regarding medicine
• Follow the rules or instructions from the doctor regarding your food and exercise
• Consistently monitor your blood sugar levels with a blood glucose test before and after meals, exercise, and bedtime.

Following treatment for low blood sugar, keeping a detailed record of the incident is helpful, including the time, what you ate, your physical condition during exercise, symptoms, and your glucose level. This helps you and your doctor improve the treatment plan and prevent future episodes.

When to see a doctor?

Contact your doctor if you have diabetes and frequently experience low blood sugar for help with diabetes treatment or care. Your doctor will help you modify your treatment regimen, which may involve modifying your diet, exercise routine, or medication dosage.

Inform your doctor of your low blood sugar if you are not diabetic. The doctor may recommend multiple tests to diagnose this problem. See a doctor if the cause is serious.

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