Hypoglycemia – Causes , Types, Risk Factors

Overview

Blood sugar (glucose) levels that are below normal are referred to as Hypoglycemia. The body uses glucose as its primary energy source.

Diabetic management and Hypoglycemia often go hand in hand. This is because, people without Diabetes can experience low blood sugar due to certain medications or medical conditions (this is very rare).

Treatment for Hypoglycemia should start right away. For many individuals, a fasting blood sugar of 70 mg/dL, or 3.9 mmol/L, or less, acts as a warning sign for Hypoglycemia. However, your values can be different.

Types of Hypoglycemia

Non-diabetic Hypoglycemia comes in two types,

• Reactive hypoglycemia — occurs a few hours after eating a high carbohydrate meal.
• Fasting hypoglycemia — caused because of too much time between meals or brought on by medications like quinine (malarial treament), pentamidine, sulfa drugs, salicylates (like aspirin), sulfa drugs (antibiotics).

Depending on its severity, there are three types of Hypoglycemia.

1. Mild Hypoglycemia 

Mild hypoglycemia is a state in which the patient can recognise the symptoms of Hypoglycemia and is capable of managing them on their own. One option to raise blood glucose levels is to consume sweets or beverages with added sugar.

2. Moderate Hypoglycemia 

In this condition, you may experience Hypoglycemia symptoms but cannot self-treat it. You require assistance from a caregiver or a family member. To raise the patient’s blood glucose levels, the caregiver will have to feed the them foods high in sugar.

3. Severe Hypoglycemia

A patient with severe Hypoglycemia may enter a stage of comatose, which indicates an urgent medical issue. Attendees or caregivers should not attempt to force feed the patient sugar if they are experiencing hypoglycemic symptoms.

This is due to the possibility of glucose getting aspirated into the lungs, which may lead to additional health issues.

The only option for treatment in such a scenario is to take the patient to the closest hospital for intravenous glucose (injectable glucose).

Symptoms of Hypoglycemia  

Hypoglycemia symptoms can appear suddenly, and different people will experience them in various ways. Hypoglycemia symptoms are uncomfortable. However, they serve as valuable reminders to act before your blood sugar levels fall even lower. Symptoms include

• Trembling or shaking
• Chills and sweat
• A feeling of faintness or dizziness
• Increased heart rate
• Headaches
• Hunger
• Nausea
• Anxiety or irritation
• Pale skin
• Sleep disturbances
• Weakness

 You might also have the following symptoms when you sleep:

• Crying loudly
• Feeling tired or confused after awakening.
• Having nightmares

Because the brain doesn’t receive enough sugar as the Hypoglycemia episode progresses, you might experience

• Blurry vision
• Confusion or difficulty focusing
• Sleepiness
• Slurred speech
• Stinging sensation or numbness in the face or mouth

Someone experiencing a severe hypoglycemia episode might:

• Not be able to eat and drink
• Experience convulsions or a seizure (out-of-control body jerks)
• Become unconscious
• Fatal or go into a coma (very rarely)

Risk factors for Hypoglycemia

Once you have determined your risk factors, you can work with your doctor to devise a plan of action to prevent hypoglycemic episodes. Additionally, you can develop a strategy for handling an incident before it gets out of hand.

The following risk factors can make you more likely to experience Hypoglycemia.

1. Increasing age

With every decade of life over 60, the risk of experiencing severe Hypoglycemia roughly doubles. This may be because older people are more sensitive to medications which may lower their blood suagr.

2. Skipping meals

If you have Diabetes, skipping meals can mess with your blood sugar balance and lower your glucose levels. Your risk of experiencing a hypoglycemic episode can significantly rise if you take some Diabetes medications without eating.

Skipping meals can also cause you to eat more refined carbohydrate-rich foods, which is terrible for people with Diabetes.

3. Irregular eating patterns

A day of irregular eating might reduce the balance between your diabetic treatments and blood sugar levels. Additionally, studies show that those with regular eating patterns are less likely to have Hypoglycemia than those with irregular eating patterns.

4. Weight loss

Weight management is crucial in treating Diabetes because obesity increases your chance of developing the disease. However, if you take Diabetes medications, reducing weight too quickly poses risks.

You may become more insulin-sensitive after losing weight. Hence, you will probably need to use fewer medications to manage your Diabetes.

It is essential to visit your doctor when actively losing weight. To avoid hypoglycemia episodes, you may need to talk about changing the dosage of your Diabetes drugs.

5. Using beta-blockers

Drugs called beta-blockers are used to treat conditions including high blood pressure. Even though beta-blockers do not increase your risk of Hypoglycemia; they can make it more challenging to spot the symptoms of an episode.

For instance, a rapid heartbeat is one of the initial indicators of Hypoglycemia. However, you cannot rely on this symptom because beta-blockers decrease your heart rate.

You must monitor your blood sugar levels more frequently and eat regularly if you take a beta-blocker.

6. Overusing the same injection site

When you repeatedly inject insulin into the same area, fat and scar tissue might gather beneath the skin’s surface. This is called Lipohypertrophy.

Lipohypertrophy can impact the way your body absorbs insulin. You have a higher chance of developing hypo and hyperglycemia if you use the exact injection location.

Bear in mind that insulin is absorbed differently by different bodily areas. Your abdomen absorbs insulin the fastest, followed by your arm, and the slowest insulin absorption occurs in the buttocks.

7. Using antidepressants

A study involving more than 1,200 diabetics found a high correlation between antidepressant use and Hypoglycemia. The risk of severe Hypoglycemia was more significantly linked to tricyclic antidepressants than selective serotonin reuptake inhibitors.

The study’s authors noted that depression-related symptoms, such as appetite loss, may potentially raise the risk of Hypoglycemia.

8. Consuming alcohol

Your glucose levels may drop overnight if you drink alcohol. According to PubMed Central, alcohol inhibits the liver’s ability to make glucose. Your blood sugar can decrease quickly if you use alcohol and Diabetes medications.

Remember to eat something before bed if you drink alcohol. Monitor your blood sugar levels carefully the following day as well.

9. Underlying kidney disease

Your kidneys are crucial for the body’s metabolism of insulin, the reabsorption of glucose and the elimination of medications. As a result, individuals with Diabetes and kidney disease may be more susceptible to Hypoglycemia.

10. Being long-term diabetic

For those with a more extended history of Diabetes, the risk of Hypoglycemia also rises. This is because of long-term insulin therapy.

Diagnosis of Hypoglycemia

1. Physical exam

Your doctor will do a physical exam and inquire about any medications you are currently taking to identify non-diabetic Hypoglycemia. They will question you about your health, including any past illnesses or stomach surgeries.

2. Mixed-meal tolerance test (MMTT)

A mixed-meal tolerance test (MMTT) may be required to assess for reactive Hypoglycemia. The mixed meal tolerance test (MMTT) involves consuming a liquid meal beverage containing fats, protein, and carbohydrates. Then, over the next few hours, the doctor will check your blood sugar levels.

3. Blood glucometer 

Your doctor can advise a home glucometer so you can self-monitor your blood sugar levels. A blood glucose reading will reveal whether you are experiencing Hypoglycemia.

Treatment of Hypoglycemia

Use a blood glucose meter to check your blood sugar level if you believe it may be dropping too low. If you experience low blood sugar symptoms but cannot immediately check your blood sugar level, presume that your blood sugar is low and begin treating Hypoglycemia.

• Eat or drink 15–20 grams of fast-acting carbs. Try fruit juice, regular cola (not diet), honey, glucose gel or tablets, sugary chocolates etc., These are high-sugar, low-protein and low-fat foods and drinks that the body may quickly turn into sugar.
• After 15 minutes of intervention, recheck blood sugar levels. If your blood sugar is still under 70 mg/dL (3.9 mmol/L), take another 15 to 20 grams of fast-acting carbohydrates and recheck it in 15 minutes. The blood sugar should be over 70 mg/dL (3.9 mmol/L) by repeating these steps.
•  Enjoy a meal or snack. Eating a healthy snack or meal after your blood sugar has returned to the normal range will help prevent further drops in blood sugar.

In the event of severe Hypoglycemia, patients could require an infusion of glucagon or intravenous glucose. Three drugs have received FDA approval to treat extremely low blood sugar:

• Baqsimi – a nasal power
• Dasiglucagon (Zegalogue) is administered intravenously
• Gvoke is an injection-only medication

Prevention of Hypoglycemia

If you take insulin or other blood glucose-lowering medications, taking the following steps may help you avoid having low blood sugar levels.

1. Monitor your blood glucose level

Find out how to monitor your blood glucose level from your doctor. Using a blood glucose meter is the most typical way to achieve this.

A continuous glucose monitor (CGM) can be a helpful alternative if you frequently have low blood glucose or are unaware of Hypoglycemia.

The CGM regularly measures your blood glucose level, which can also alert you if it drops below the desired range.

2. Consume carbs regularly

To help keep your blood glucose level within the desired range, ensure your regular eating schedule includes meals, snacks and beverages with sufficient carbohydrates.

Always have a source of fast-acting carbohydrates on hand, such as glucose pills or a juice box. Additionally, if you decide to have alcohol, it is safer to do so while eating meals.

3. Be careful when engaging in physical activity

Your blood glucose can go low during exercise and for hours afterwards. To prevent low blood glucose, you might need to check your blood sugar levels before, during and after physical activity and modify your medication or carbohydrate consumption. For instance, you could consume a snack before exercising to avoid low blood sugar.

4. Limit or do not drink alcohol

If someone intends to drink, they should eat enough food beforehand because drinking alcohol can cause blood sugar to drop for several hours. To keep blood sugar levels in the desired range, doctors advise eating carbohydrates before and after drinking.

On the same day that they drink alcohol, people should refrain from engaging in strenuous exercise. The risk of Hypoglycemia rises as insulin sensitivity increases with increased activity.

5. Work with your doctor or health care provider

To avoid low blood sugar:

1. Work with your doctor.
2. Find out from your doctor if any diabetic medications can result in low blood glucose and how to prevent and manage symptoms.
3. If necessary, work with your doctor to modify your Diabetes treatment strategy.

When should you visit a doctor?

Immediately visit a doctor if,

• You have signs of Hypoglycemia, but you do not have Diabetes.
• You have Diabetes, and nothing seems to work despite trying to manage your Hypoglycemia by drinking juice or regular (not diet) soft drinks, eating candy or taking glucose tablets.

If you have Diabetes or a history of Hypoglycemia and experience severe hypoglycemia symptoms or become unconscious, you should seek emergency medical attention.

Conclusion

Hypoglycemia occurs when your blood sugar falls below a healthy range. A blood sugar level of less than 70 mg/dL is considered low.

Diabetic patients typically experience Hypoglycemia. Hypoglycemia can also affect people without Diabetes, even though this is much less common.

In addition to the pale complexion, a quick heartbeat, headache, sweating, lack of focus, shakiness, hunger, dizziness and irritability are some of the most apparent symptoms of Hypoglycemia.

It is important to consume 15 grammes of fast-acting carbohydrates immediately if you are feeling mild or moderate symptoms. Blood sugar levels that are too low might be harmful and require emergency medical attention.

FAQ’s