Understanding Hypoglycemia: Risks, Prevention and Treatment

Last updated: August 2022

Hypoglycemia, or low blood sugar, is often considered the limiting factor in reaching glycemic goals. Hypoglycemia and the fear of hypoglycemia can negatively impact quality of life for people with diabetes. Recurrent hypoglycemia increases the risk of having a severe hypoglycemic episode and may also result in hypoglycemia unawareness. This article will easily explain if you are at risk for hypoglycemia and how to properly treat a hypoglycemic episode.

What blood sugar reading is considered low?

The American Diabetes Association classifies a low blood sugar as less than 70 mg/dL. It should be noted that some people might feel symptoms of a low blood sugar at a higher or lower reading.

There is a risk of hypoglycemia with any of the following medications:

  • Insulin: Lantus, Levemir, NPH, Regular, Novolog, Humalog, Apidra
  • Sulfonylureas: Diabeta, Micronase, Glucotrol, Glucotrol XL, Amaryl, Glynase
  • Meglitinides: Prandin, Starlix

What are common causes of hypoglycemia?

  • Dose of insulin or oral medication is too high
  • Delayed or missed meal
  • Exercise
  • Giving an insulin injection into a muscle
  • Taking a hot bath or shower soon after taking an insulin shot
  • Alcohol (avoid drinking alcohol on an empty stomach)

What are the signs and symptoms of hypoglycemia?

Common symptoms of hypoglycemia can include:

  • Shaking
  • Sweating
  • Hunger
  • Headache
  • Confusion
  • Behavioral changes
  • Double vision
  • Face may become red or pale

If symptoms are ignored or not recognized, a severe hypoglycemia episode may occur, leading to a seizure and/or unconsciousness.

What is the proper treatment for hypoglycemia?

  1. Use the Rule of 15
  2. Check blood sugar with a blood glucose meter
  3. If blood sugar is less than 70 mg/dL, consume 15 grams of quick-acting carbohydrates (see list below). Avoid over-treating, which can cause blood sugar spikes.
  4. Recheck blood sugar in 15 minutes. Repeat treatment if blood sugar is still below 70 mg/dL after 15 minutes.
  5. Once blood sugar is above 70 mg/dL eat another 15 grams of carbohydrate with some protein if no meal or snack will be consumed in the next 1-2 hours.

Quick-acting carbohydrates include:

  • 4 oz fruit juice
  • 3-4 glucose tablets
  • 1 tube glucose gel
  • 4 oz regular pop
  • 15 Skittles
  • 4 Lifesavers hard candy
  • 1 tablespoon honey

Foods with fat and protein (cookies, cake, candy bars, milk, etc.) should not be used for the treatment of hypoglycemia. Fat and protein slow down the absorption of carbohydrates. As a result, it will take longer for the blood sugar to rise if such foods are used as treatment.

How to prevent hypoglycemia

In order to prevent hypoglycemia, avoid skipping meals and monitor blood sugar regularly. Some other tips include:

  • Carry quick acting carbohydrates with you at all times.
  • If you exercise more or longer than usual, have a carbohydrate snack.
  • Avoid consuming alcohol on an empty stomach.
  • Avoid taking a hot shower right after an insulin injection.

Preventing recurrent hypoglycemia will reduce the risk of developing hypoglycemia unawareness. Hypoglycemia unawareness is when symptoms typical of a low blood sugar do not occur. This puts a person at greater risk for having a severe low blood sugar.

What is glucagon?

Glucagon is an emergency injection used to treat a severe low blood sugar episode when a person is unconscious or having a seizure. Glucagon is a hormone that tells the liver to release stored sugar (glycogen). People who treat their diabetes with insulin should keep glucagon on hand. A prescription is needed for glucagon.

If your diabetes treatment carries a risk of hypoglycemia, wearing diabetes identification is especially important.

The bottom line

Don’t let the fear of hypoglycemia prevent you from reaching your glycemic goals. The first step is learning if your medication puts you at risk for hypoglycemia. A little extra planning can help prevent a low blood sugar from occurring and also help prepare should you experience a low blood sugar.

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