Preventing Hypoglycemia

Hypoglycemia occurs when the level of sugar (glucose) in the blood is too low. Hypoglycemia can happen in people who do or do not have diabetes (diabetes mellitus). It can develop quickly, and it can be a medical emergency. For most people with diabetes, a blood glucose level below 70 mg/dL (3.9 mmol/L) is considered hypoglycemia.

Glucose is a type of sugar that provides the body's main source of energy. Certain hormones (insulin and glucagon) control the level of glucose in the blood. Insulin lowers blood glucose, and glucagon increases blood glucose. Hypoglycemia can result from having too much insulin in the bloodstream, or from not eating enough food that contains glucose.

• If you take insulin or diabetes medicines to help lower your blood glucose or to help your body make more insulin.
• If you skip or delay a meal or snack.
• If you are ill.
• During and after exercise.

You can prevent hypoglycemia by working with your health care provider to adjust your meal plan as needed and by taking other precautions.

How can hypoglycemia affect me?

Mild symptoms

• Hunger.
• Sweating and feeling clammy.
• Dizziness or feeling light-headed.
• Sleepiness or restless sleep.
• Nausea.
• Increased heart rate.
• Headache.
• Blurry vision.
• Mood changes, including irritability or anxiety.
• Tingling or numbness around the mouth, lips, or tongue.

If mild hypoglycemia is not recognized and treated, it can quickly become moderate or severe hypoglycemia.

Moderate symptoms

• Confusion and poor judgment.
• Behavior changes.
• Weakness.
• Irregular heartbeat.
• A change in coordination.

Severe symptoms

• Fainting.
• Seizures.
• Loss of consciousness (coma).
• Death.

What nutrition changes can be made?

• Work with your health care provider or dietitian to make a healthy meal plan that is right for you. Follow your meal plan carefully.
• Eat meals at regular times.
• If recommended by your health care provider, have snacks between meals.
• Do not skip or delay meals or snacks. You can be at risk for hypoglycemia if you are not getting enough carbohydrates.

What lifestyle changes can be made?

• Work closely with your health care provider to manage your blood glucose. Make sure you know:
  • Your goal blood glucose levels.
  • How and when to check your blood glucose.
  • The symptoms of hypoglycemia. It is important to treat hypoglycemia right away to keep it from becoming severe.
• Do not drink alcohol on an empty stomach.
• When you are ill, check your blood glucose more often than usual. Make a sick day plan in advance with your health care provider. Follow this plan whenever you cannot eat or drink normally.
• Always check your blood glucose before, during, and after exercise.

How is this treated?

• 4 oz (120 mL) of fruit juice.
• 4 oz (120 mL) of regular soda (not diet soda).
• Several pieces of hard candy. Check food labels to find out how many pieces to eat for 15 grams.
• 1 Tbsp (15 mL) of sugar or honey.
• 4 glucose tablets.
• 1 tube of glucose gel.

Treating hypoglycemia if you have diabetes

• Take 15 grams of a fast-acting carbohydrate. Talk with your health care provider about how much you should take.
• Fast-acting options include:
  • Glucose tablets (take 4 tablets).
  • Several pieces of hard candy. Check food labels to find out how many pieces to eat for 15 grams.
  • 4 oz (120 mL) of fruit juice.
  • 4 oz (120 mL) of regular soda (not diet soda).
  • 1 Tbsp (15 mL) of sugar or honey.
  • 1 tube of glucose gel.
• Check your blood glucose 15 minutes after you take the carbohydrate.
• If the repeat blood glucose level is still at or below 70 mg/dL (3.9 mmol/L), take 15 grams of a carbohydrate again.
• If your blood glucose level does not increase above 70 mg/dL (3.9 mmol/L) after 3 tries, seek emergency medical care.
• After your blood glucose level returns to normal, eat a meal or a snack within 1 hour.

Treating severe hypoglycemia

Severe hypoglycemia is when your blood glucose level is below 54 mg/dL (3 mmol/L). Severe hypoglycemia is a medical emergency. Get medical help right away.

If you have severe hypoglycemia and you cannot eat or drink, you may need glucagon. A family member or close friend should learn how to check your blood glucose and how to give you glucagon. Ask your health care provider if you need to have an emergency glucagon kit available.

Severe hypoglycemia may need to be treated in a hospital. The treatment may include getting glucose through an IV. You may also need treatment for the cause of your hypoglycemia.

Where to find more information

• American Diabetes Association: www.diabetes.org
• National Institute of Diabetes and Digestive and Kidney Diseases: www.niddk.nih.gov
• Association of Diabetes Care & Education Specialists: www.diabeteseducator.org

Contact a health care provider if:

• You have problems keeping your blood glucose in your target range.
• You have frequent episodes of hypoglycemia.

Get help right away if:

• You continue to have hypoglycemia symptoms after eating or drinking something containing glucose.
• Your blood glucose level is below 54 mg/dL (3 mmol/L).
• You faint.
• You have a seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Know the symptoms of hypoglycemia and when you are at risk for it, such as during exercise or when you are sick. Check your blood glucose often when you are at risk for hypoglycemia.
• Hypoglycemia can develop quickly, and it can be dangerous if it is not treated right away. If you have a history of severe hypoglycemia, make sure your family or a close friend knows how to use your glucagon kit.
• Make sure you know how to treat hypoglycemia. Keep a fast-acting carbohydrate option available when you may be at risk for hypoglycemia.