If you’ve ever experienced low blood sugar, you probably know it’s not a pleasant sensation.
With so much focus on treating high blood sugar with diabetes, it can be easy to forget that low blood sugar isn’t desirable either.
Low blood sugar impacts many people with diabetes at some point. Taking diabetes medication such as insulin might make you anxious about the possibility of having low blood sugar.
Understanding what low blood sugar can feel like, as well as ways to prevent and treat it, are among the best ways to prevent low blood sugar from disrupting your life.
What is low blood sugar?
Hypoglycemia is the term for low blood glucose (blood sugar) levels. Hypoglycemia occurs when blood sugar drops below 70 milligrams per deciliter (mg/dL).
It can be mild, moderate, or severe. Severe hypoglycemia can become life-threatening if it isn’t treated quickly, so it’s important to treat low blood sugar quickly.
There are different levels of hypoglycemia, which correlate with the severity of low blood sugar.
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 is unable to function because of mental or physical changes, and they need help from another person. In this case, blood glucose is often below 40 mg/dL.
What causes low blood sugar?
There are several different causes of low blood sugar, which we discuss below.
Too much insulin or diabetes medications
Medications that lower blood glucose can cause low blood sugar. Insulin and sulfonylureas are examples of popular diabetes medications that can cause low blood sugar, especially if you take them without eating or at higher doses than are prescribed.
Not eating enough carbohydrates
Carbohydrates are a type of nutrient found in foods like grains, starchy vegetables, fruit, and some dairy products like milk and yogurt. Carbohydrates turn into blood glucose when digested, so they have the biggest impact on blood glucose levels compared to proteins and fats.
Not eating enough carbohydrates, especially while also taking blood sugar-lowering medications like insulin, can cause hypoglycemia.
Physical activity stimulates your body to take up more glucose for energy which can cause low blood sugar, especially during prolonged periods of exercise. If you don’t eat enough carbohydrates around the time you exercise, your risk of low blood sugar can be higher.
People with and without diabetes can produce too much insulin in response to eating, especially simple sugars like candy and juice. This is called reactive hypoglycemia, and it usually occurs within minutes to hours after eating.
Reactive hypoglycemia occurs when your body makes too much insulin in response to eating foods that quickly raise blood sugar.
When your kidneys don’t filter blood as quickly as they should (such as in the case of chronic kidney disease), insulin and other diabetes medications can stay in your bloodstream longer than they should, causing low blood sugar.
Your body stores extra sugar as glycogen in your liver. If you lose weight, especially from eating a low-carbohydrate diet, your glycogen stores can become used up. Without adequate glycogen stores, your body can’t correct low blood sugar on its own.
What does low blood sugar feel like?
There are several common symptoms associated with low blood sugar. These low blood sugar symptoms arise from your adrenal glands (located on top of the kidneys) releasing both epinephrine and cortisol in response to hypoglycemia.
It’s important to know that not everyone will feel the same or experience the more common symptoms of low blood sugar. If you suspect you have low blood sugar, the best thing to do is check your blood sugar to confirm since low blood sugar symptoms can change over time.
If you’ve had diabetes for a long time or have experienced hypoglycemia frequently, you might develop hypoglycemia unawareness.
Hypoglycemia unawareness is a complication where you don’t experience the usual warning signs of low blood sugar. Up to 40% of people with type 1 diabetes experience hypoglycemia unawareness.
Hypoglycemia unawareness is dangerous because you don’t feel symptoms of low blood sugar soon enough to treat it. This increases the risk of developing severe hypoglycemia or having a fall or accident related to hypoglycemia.
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Symptoms of hypoglycemia
The most common symptoms of hypoglycemia include:
- Feeling shaky and/or dizzy
- Irregular heartbeat
- Pale skin
- Tingling or numbness of the lips, tongue, or cheek
- Feeling irritable or moody
- Feeling anxious or nervous
Some people experience nocturnal hypoglycemia, which is low blood sugar overnight. Nocturnal hypoglycemia can be even more dangerous because you aren’t awake and may not notice the symptoms.
Signs of nocturnal hypoglycemia include:
- Damp sheets or nightclothes from sweating due to low blood sugar
- Feeling tired, irritable, or confused after waking up
It can become a low blood sugar emergency if hypoglycemia isn’t treated. Signs and symptoms of severe hypoglycemia include:
- Clumsiness or jerky movements
- Muscle weakness
- Slurred speech or difficulty speaking
- Blurred vision or double vision
- Convulsions or seizures
When should you see a doctor about low blood sugar?
You should consult with your healthcare provider if you experience low blood sugar regularly. If you don’t seek medical attention, you might have an accident from low blood sugar, like falling or fainting while driving.
Your diabetes care team can help assess the reason for recurrent low blood sugar. If you have type 1 diabetes or have been taking insulin for type 2 diabetes for a long time, you may be a good candidate for an insulin pump.
Insulin pumps deliver insulin under the skin and are worn 24/7. Some insulin pumps have a feature that detects when your blood sugar levels are falling and temporarily suspends insulin administration.
Continuous glucose monitors are another helpful tool if you’re experiencing frequent low blood sugar. Continuous glucose monitors measure blood glucose levels every five minutes and can detect trends in your blood sugar levels in real-time.
They have a low blood sugar detection feature to help treat low blood sugar. You can set custom ranges for your continuous glucose monitor to alert you for both high blood sugar and low blood sugar.
What can happen if your blood sugar is low for too long?
If you have periods of mild to moderate low blood sugar and treat it promptly, your overall prognosis is good. However, severe hypoglycemia left untreated can lead to serious problems like seizures, losing consciousness, coma, and even death.
If you frequently experience low blood sugar, you’re more likely to develop hypoglycemia unawareness. Once you develop hypoglycemia unawareness, you’re more likely to have severe hypoglycemia in the future.
How to treat low blood sugar
The best way to approach low blood sugar treatment is through prevention. Eating consistent meals and snacks containing carbohydrates, monitoring your blood sugar levels regularly, and taking your medications as prescribed are all ways to prevent hypoglycemia.
If you do develop low blood sugar, there are several things you can do at home.
Eating or drinking carbohydrates
If your blood sugar is below 70 mg/dL, it should be treated by eating or drinking something containing 15 grams of carbohydrate.
Fruit juice and candies are preferred since they are rapidly absorbed into your bloodstream. It doesn’t take much juice to treat low blood sugar – about one-half cup of juice contains around 15 grams of carbohydrates.
Glucose tablets or glucose gels are a popular treatment for low blood sugar 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 your bloodstream to raise blood sugar quickly.
They are available over the counter without a prescription. Keep glucose tablets in your car, purse, or with you when you’re exercising.
For cases of severe hypoglycemia, people can use glucagon injections. Like insulin, glucagon is a hormone the pancreas produces.
However, glucagon has the opposite effect as insulin by stimulating the breakdown of liver glycogen stores into glucose, which raises blood sugar.
Medical professionals must prescribe glucagon injections. Glucagon is especially helpful for severe hypoglycemia or if the person is unresponsive and can’t eat or drink to treat low blood sugar.
After taking some carbohydrates or using a glucagon injection, you should recheck your blood sugar in 15 minutes. If your blood sugar levels aren’t increasing enough, the treatment should be repeated, and your blood sugar retested in another 15 minutes.
This process should be repeated until blood sugar is at your target level (usually at least 70 mg/dL). If your blood sugar isn’t increasing enough, your healthcare provider should be notified.
Unresponsiveness from hypoglycemia always warrants prompt medical attention.
The best way to handle hypoglycemia is to work to prevent it. There are times you might develop low blood sugar even if you’re doing all you can to prevent it, so it’s essential to understand what low blood sugar can feel like and how to treat it.
The most common low blood sugar symptoms to watch out for are dizziness, shakiness, sweating, hunger, and fatigue.
If you experience frequent hypoglycemia, you should consult your diabetes care team to determine the cause of your low blood sugar.
The good news is that there are advances in medical technology that can help you if you’re experiencing frequent low blood sugar, such as continuous glucose monitors and insulin pumps.