The human body relies on blood sugar (glucose) to provide energy to its cells. This energy helps to carry out basic life functions such as breathing, moving, and maintaining heart rhythm, among many others.
When there are imbalances in blood sugar levels, it can create symptoms that alert the individual experiencing the symptoms that something is off balance.
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Blood sugar balance
One of the organs responsible for helping to balance blood sugar levels in the pancreas. When the pancreas is healthy and functioning, blood sugar levels tend to be regulated very well without any intervention.
The pancreas usually releases enough insulin (a hormone helping to move energy from the bloodstream into cells) to keep blood sugar levels from rising too high and usually doesn’t release too much insulin to make blood sugar levels dangerously low.
The other organ responsible for maintaining blood sugar balance is the liver, which can store and release sugar to prevent hypoglycemia (low blood sugar). The liver can release stored sugar into the bloodstream when blood sugar is getting low; this protects people from low blood sugars during fasting periods (no food for at least eight hours).
Blood sugar levels rise as a result of eating, stress, illness, and other conditions. The most common cause of blood sugar increases in the diet. Foods that contain carbohydrates such as fruits, vegetables, grains, legumes, and particular dairy products break down into sugar, thus increasing blood sugar levels. Carbohydrates have the most significant impact on blood sugar levels compared to protein and fats.
When the pancreas’ insulin-producing abilities are impacted, such as with diabetes, blood sugar levels become more difficult to keep balanced. As a result, both high and low blood sugars can result. High and low blood sugars are potentially dangerous and require medical management.
The ultimate goal of managing diabetes is keeping blood sugars in a healthy range between 70-140 mg/dL (milligrams per deciliter). People without diabetes can also experience blood sugar imbalances, including hypoglycemia/low blood sugar. Low blood sugars are often referred to as a “blood sugar crash.”
What is a sugar crash?
A “sugar crash” is another word for low blood sugar or hypoglycemia. Hypoglycemia occurs when blood glucose falls below 70 mg/dL. When blood sugar is low, it causes negative and disruptive symptoms. Prolonged periods of severe hypoglycemia can cause insulin shock. Insulin shock can be life-threatening and lead to coma and death if it’s not treated promptly.
There are different levels of hypoglycemia, which correlate with the severity of the sugar crash.
- Level 1 (mild) hypoglycemia: Blood glucose is less than 70 mg/dL but is 54 mg/dL or higher.
- Level 2 (moderate) hypoglycemia: Blood glucose is less than 54 mg/dL.
- Level 3 (severe) hypoglycemia: A person cannot function because of mental or physical changes. They need help from another person. In this case, blood glucose is often below 40 mg/dL.
There are many possible symptoms of a sugar crash. People experience different low blood sugar symptoms, so it’s important to know that someone experiencing a sugar crash won’t necessarily have all of the common symptoms.
The most common symptoms of a sugar crash include:
- Feeling shaky and/or dizzy
- Feeling irritable or moody
- Feeling anxious or nervous
If a sugar crash isn’t treated, severe hypoglycemia can occur. Signs and symptoms of severe hypoglycemia include:
- Clumsiness or jerky movements
- Muscle weakness
- Slurred speech or difficulty speaking
- Blurry or double vision
- Convulsions or seizures
What causes a sugar crash?
There are different reasons behind a sugar crash. Many of them are related to diabetes, but people without diabetes can experience a sugar crash as well.
Too much insulin
Injecting insulin lowers blood sugar more quickly than any other diabetes medication. The risk of low blood sugar is highest with short- and rapid-acting insulins. Fast-acting insulin is usually taken around meals because eating raises blood sugar, so it works quickly to counteract the rise in blood sugar. Taking short- and rapid-acting insulins without eating may result in a sugar crash shortly after.
Long-acting or basal insulin works the slowest out of all of the types of insulin. It is usually injected once or twice a day. Long-acting insulin mimics the body’s natural ability to constantly release a small amount of insulin throughout the day and night.
Intermediate-acting insulin works more slowly than fast-acting but is faster than basal insulin. They are often injected twice per day.
Insulin doses can overlap, which increases the risk of a sugar crash. For example, taking a morning dose of intermediate-acting insulin and a dose of rapid-acting insulin before lunch can cause a “stacking up” of insulin levels in the body and increase the risk of a hypo.
Too much of another kind of diabetes medication
Other diabetes medications besides insulin can cause low blood sugar. These medications include:
- Sulfonylureas, such as glipizide, glyburide, and glimepiride.
- Meglitinides, such as Prandin and Starlix.
- Exenatide (Byetta) can cause hypoglycemia if it’s also taken with a sulfonylurea; it usually doesn’t cause hypoglycemia on its own, though.
People who have had diabetes for a long time may not be aware of the symptoms of a sugar crash. This can occur due to autonomic neuropathy, which is a complication of long-term high blood sugar. This makes a blood sugar crash much more dangerous because the symptoms might not be felt until it turns severe.
Not enough food, especially carbohydrates
Foods that contain carbohydrates, such as bread, milk, fruit, and starchy vegetables, turn into sugar when digested. If someone isn’t eating many carbohydrates, especially if they’re also taking insulin or other diabetes medications, hypoglycemia can occur.
Exercise and weight loss
Physical activity stimulates the body to take up more glucose for energy, which can cause low blood sugar if food or drink containing carbohydrates aren’t taken in regular amounts while exercising for long periods.
The liver stores sugar in the form of glycogen. Glycogen helps provide our bodies with sugar when we are fasting and during exercise, which reduces hypoglycemia risk.
During prolonged periods of exercise or fasting, glycogen stores can become used up. Severe weight loss can also use up glycogen stores due to being in a fasting state. Without adequate glycogen stores, a sugar crash can occur.
People with and without diabetes can produce too much insulin to eat, especially simple sugars like candy and juice. This is called reactive hypoglycemia, and it usually occurs within minutes to hours after eating. Processed foods can contain high amounts of added sugar, which may cause a sugar crash later on.
Gastroparesis is the slowing of stomach emptying, which can occur as a complication of diabetes. When food isn’t emptied from the stomach very quickly, it isn’t available to be digested and converted into sugar in the bloodstream. Hypoglycemia risk increases in people with gastroparesis who also take insulin.
Too much alcohol
Alcohol can cause an increase in insulin secretion and interfere with the liver’s ability to create sugar, which can cause a sugar crash.
Other causes not related to diabetes
Pancreatic tumors, adrenal or pituitary problems, kidney problems, liver problems, and certain non-diabetic medications can cause hypoglycemia.
How to reverse a sugar crash
If blood sugar is below 70 mg/dL, it should be treated by consuming a food or beverage containing 15 grams of carbohydrate. Sugary drinks and hard candies are preferred as they are rapidly absorbed into the bloodstream. It doesn’t take much juice to get to 15 grams of carbohydrates; about one-half cup is enough.
Glucose tablets are a popular treatment for sugar crashes because they’re easy to have on hand in all different types of situations. They dissolve quickly and provide pure glucose, so they are rapidly absorbed into the bloodstream as glucose. Each tablet contains 4 grams of carbohydrates; in the case of a sugar crash, 3-4 tablets should be used to provide 12-16 grams of carbohydrates.
Foods consisting mainly of protein and fat, such as cheese and peanut butter, shouldn’t be used to treat a sugar crash. However, protein and fat may help prevent sugar crashes when combined with carbohydrate foods.
If blood sugar levels don’t rise above 70 mg/dL despite treatment, or if they are dangerously low and/or the person is unresponsive, a glucagon emergency kit may be used.
A medical professional must prescribe glucagon, and it’s in the form of an injection. Glucagon is a hormone that helps convert the body’s stored sugar (glycogen) into blood sugar. Glucagon is helpful when the person with the sugar crash is too unresponsive to take in food or drink since it is injected under the skin and done by another person.
Preventing blood sugar crashes
- Eat consistently. Eating a variety of foods, including protein, fat, and carbohydrates, every few hours can help keep blood sugar levels stable. Some people find that eating protein helps promote steady blood sugars and prevent sugar crashes. For example, eating cheese with fruit instead of just fruit can help slow the breakdown of those carbs into blood sugar, thus promoting more stable blood sugar levels.
For people with reactive hypoglycemia, avoiding simple sugars and processed foods may help prevent those blood sugar crashes. This is because simple sugars such as soda and sweets stimulate the pancreas to release insulin more quickly than more complex carbohydrates like fruit and bread and mixed meals with protein and fat. When insulin secretion is increased, blood sugar can be lowered too much, causing a sugar crash.
- Take insulin and medications as prescribed. While very useful, insulin is a potentially dangerous medication because of its immediate effectiveness at reducing blood sugar. Insulin should only be used under the guidance of a healthcare provider and only as prescribed. If someone’s blood sugar levels are high, they should discuss it with their healthcare provider and never change insulin doses independently.
The timing of insulin is also very important. A rapid-acting insulin is designed to be taken a few minutes before starting a meal. If someone forgets to take their rapid-acting insulin, it can often be safer to skip that dose instead of taking it several hours after the meal.
- Use snacks as a tool. For someone prone to sugar crashes, snacks can be a very useful tool in preventing them. Having a snack before exercising or before taking a bedtime dose of insulin can help offset the blood sugar-lowering effects of these things.
- Don’t drink alcohol on an empty stomach. Drinking alcohol can lower blood sugar. Suppose someone taking diabetes medications chooses to drink. In that case, they should be sure to eat something first, as drinking alcohol on an empty stomach can worsen hypoglycemia and cause a sugar crash.
A sugar crash is a term for hypoglycemia or low blood sugar. Blood sugar is considered low if it’s below 70 mg/dL. Low blood sugar is dangerous and can lead to unconsciousness, coma, and even death if severe enough. Low blood sugar symptoms include feeling shaky and/or dizzy, sweating, increased hunger, irritability or moodiness, anxiety/nervousness, and headache.
Blood sugar crashes can occur in people with and without diabetes. They can occur for many reasons, including too much insulin or diabetes medications, skipping a meal or snack, and eating or drinking something high in simple sugars.
Sugar crashes can be prevented by eating well-balanced meals and snacks, as well as avoiding foods and drinks rich in simple sugar, which can cause a spike in blood sugar and then a crash later on. For people with diabetes, sugar crashes can be prevented by taking medications as prescribed and keeping up with regular visits to their healthcare provider for diabetes.