What Causes Low Blood Glucose In People With Diabetes
Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level.
Two types of diabetes pills can cause low blood glucose
- sulfonylureas, usually taken once or twice per day, which increase insulin over several hours
- meglitinides, taken before meals to promote a short-term increase in insulin
The following may also lower your blood glucose level
Why Should You Care About Blood Sugar
Many problems become the result of imbalanced blood sugar levels.
First lets start with sugar itself.
Sugar may seem harmless enough and we may have eaten it our whole lives, but do you know how damaging sugar actually is?
White refined sugar provides no nutritive value. One teaspoon contains 60 calories in carbohydrate form with absolutely no nutrients. These empty calories then displace vital nutrients and have a major impact on energy!
As I wrote about in Confessions of a Sugar Addict, eating high sugar foods is toxic to our bodies and brains. It makes us crave more to the point of addiction. It encourages sleep Chatter and depletes vitamins and minerals which cause stress in the body. This leads to inflammation and weak immunity. Sugar also inactivates B vitamins, causing low energy and moodiness. As sugar stops cells from being able to repair themselves, we get sick and catch colds faster.
Eventually, our weakened immune system may lead to inflammation and disease, which creates more stress in our body. In fact, many diseases, including diabetes, pre-diabetes, high blood pressure, cancer, and heart disease can all result from a high sugar diet.
Now we know what sugar itself can do to the body. Remember those highs and lows we get when we eat sugar?
These sugar highs and lows can affect any part of our body from skin, bones, and muscles, to heart function, and cause hormonal imbalances, inflammation, and digestive problems.
Check Your Blood Sugar Often
Talk with your provider about when you should check your blood sugar every day. People who have low blood sugar need to check their blood sugar more often.
The most common causes of low blood sugar are:
- Taking your insulin or diabetes medicine at the wrong time
- Taking too much insulin or diabetes medicine
- Taking insulin to correct high blood sugar without eating any food
- Not eating enough during meals or snacks after you have taken insulin or diabetes medicine
- Skipping meals
- Waiting too long after taking your medicine to eat your meals
- Exercising a lot or at a time that is unusual for you
- Not checking your blood sugar or not adjusting your insulin dose before exercising
- Drinking alcohol
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Treating An Episode Of Hypoglycaemia
The immediate treatment for hypoglycaemia is to have some sugary food or drink to end the attack.
For example, this could be:
- a glass of fruit juice or non-diet soft drink
- between three and five dextrose tablets
- a handful of sweets
At first you should avoid fatty foods and drinks, such as chocolate and milk, because they dont usually contain as much sugar and the sugar they do contain may be absorbed more slowly.
After having something sugary, you should have a longer-acting carbohydrate food, such as a few biscuits, a cereal bar, a piece of fruit or a sandwich.
It will usually take around 15 minutes to recover from a mild episode of hypoglycaemia. If you have a blood glucose meter, measure your blood sugar again after 15 to 20 minutes. If its still too low , you should have some more sugary food or a drink before testing your levels again in another 15 to 20 minutes.
When treating someone else with hypoglycaemia, if the above treatment isnt effective, you may be able to help them by applying glucose gel to the inside of their cheeks, and gently massaging the outside of their cheeks.
It may take 10 to 15 minutes before they feel better. This shouldnt be done if the person is drowsy or unconscious because of the risk of choking.
High Blood Glucose: Diabetic Ketoacidosis
If your insulin level is too low, your blood glucose could become so high that it is unsafe. You might develop a serious problem called diabetic ketoacidosis . This usually happens in people with Type 1 diabetes and those with glucose levels over 500.
If you have DKA, chemicals called ketones start to make a lot of acid in your body. The acid and high blood glucose can make you very sick. You might also become dehydrated . You can prevent DKA by carefully giving yourself the correct insulin dose every day.
If you have any of the following symptoms of DKA, get to your local emergency department right away. You need to be treated with insulin and fluids that are given to you through an IV :
- Blurry vision
- Dry mouth, eyes or skin
- Fast breathing
- Feeling very weak or tired
- Fruity-smelling breath
- Stomach pain, nausea or vomiting
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How Do I Treat An Episode Of Hypoglycemia
The American Diabetes Association recommends the 15-15 rule for an episode of hypoglycemia:
- Eat or drink 15 grams of carbs to raise your blood sugar.
- After 15 minutes, check your blood sugar.
- If its still below 70 mg/dL, have another 15 grams of carbs.
- Repeat until your blood sugar is at least 70 mg/dL.
If you have symptoms of hypoglycemia but cant test your blood sugar, use the 15-15 rule until you feel better.
Note: Children need fewer grams of carbs. Check with your healthcare provider.
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Checking For Low Blood Sugar Levels
The warning signs of hypoglycemia are the body’s natural response to low blood sugar levels. When blood sugar levels fall too low, the body releases the hormone adrenaline, which helps get stored glucose into the bloodstream quickly. This can make someone:
- pale
- start shaking
- have an increased heart rate
If the hypoglycemia isn’t treated, more serious symptoms may happen, such as drowsiness, confusion, seizures, and loss of consciousness.
The only way to know for sure if you’re having a low blood sugar level is to test. Blood sugar levels can be tested with a . This computerized device measures and displays the amount of glucose in a blood sample. But if you can’t quickly check your blood sugar level, it’s important to treat yourself for hypoglycemia immediately to prevent symptoms from getting worse.
Sometimes a person with diabetes may have symptoms of low blood sugar levels, but blood sugar levels are not actually low. This is a called a false reaction. The hormone adrenaline is not just released when blood sugar drops too low it’s also released when blood sugar levels fall quickly when they’re too high. If you’re having a false reaction, you might actually have blood sugar levels in a healthy range but feel as if you have low blood sugar. Testing blood sugar levels before treating yourself for hypoglycemia can help you figure out if you’re having a false reaction.
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Caution: Birth Control Pills
Types that have estrogen can affect the way your body handles insulin. Still, oral contraceptives are safe for women with diabetes. The American Diabetes Association suggests a combination pill with norgestimate and synthetic estrogen. The group also says birth control shots and implants are safe for women with the condition, though they can affect your blood sugar levels.
Your Diabetes Devices And Hypoglycemia
Several insulin pumps are now available that make managing blood sugar levels easier, particularly when connected to a glucose meter or a CGM.
Some of the most important advantages of CGM devices are the improved insulin control and the ability to detect trends and lows early. With improved technology, it is now possible for parents to track blood sugar trends in their kids even when they are hundreds of miles apart .
In addition, automated insulin delivery systems, also known an artificial pancreas or a hybrid closed-loop system, will automatically adjust insulin to match your bodys need to help you spend more time in your target range.
Resources that provide people with T1D and their families with more detailed information about pumps and CGM devices are available through JDRF here. For people looking for a deeper understanding of technology that helps people with T1D better manage their blood sugar, JDRF resources are available here.
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How Can I Be Better Prepared For Hypoglycemia
You can take some steps to be ready for hypoglycemia:
- Be aware of the symptoms and treat them early.
- Carry some fast-acting carbs with you all the time.
- Check your glucose levels frequently, especially around meals and exercise.
- Inform family, friends and co-workers so they know what do if you need help.
- Talk to your healthcare provider regularly to make and update your plan.
- Wear a medical bracelet that lets people know you have diabetes. Carry a card in your purse or wallet with instructions for hypoglycemia.
A note from Cleveland Clinic
Hypoglycemia is quite common in people with diabetes. If not treated, it can cause troubling symptoms, and even serious health problems. Fortunately, you can avoid hypoglycemic episodes by monitoring your blood sugar. You can also make small adjustments to eating and exercising routines.
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Why Am I Having Lows
If you are experiencing low blood sugar and youre not sure why, bring a record of blood sugar, insulin, exercise and food data to a health care provider. Together, you can review all your data to figure out the cause of the lows.
The more information you can give your health care provider, the better they can work with you to understand what’s causing the lows. Your provider may be able to help prevent low blood sugar by adjusting the timing of insulin dosing, exercise and meals or snacks. Changing insulin doses or the types of food you eat may also do the trick.
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What Is The Best Thing To Eat When Your Blood Sugar Is Low
Fruits that provide the appropriate amount of carbohydrates include half a banana, 15 grapes, two tablespoons of raisins or a small apple or orange. Fruit juice can also boost blood sugar levels. Norton suggests half a cup of your favorite fruit juice, such as apple, orange, pineapple or cranberry juice.
When Your Blood Sugar Gets Low
Check your blood sugar whenever you have symptoms of low blood sugar. If your blood sugar is below 70 mg/dL, treat yourself right away.
1. Eat something that has about 15 grams of carbohydrates. Examples are:
- 3 glucose tablets
- One half cup of fruit juice or regular, non-diet soda
- 5 or 6 hard candies
- 1 tablespoon or 15 mL of sugar, plain or dissolved in water
- 1 tbsp of honey or syrup
2. Wait about 15 minutes before eating any more. Be careful not to eat too much. This can cause high blood sugar and weight gain.
3. Check your blood sugar again.
4. If you do not feel better in 15 minutes and your blood sugar is still lower than 70 mg/dL , eat another snack with 15 g of carbohydrates.
You may need to eat a snack with carbohydrates and protein if your blood sugar is in a safer range — over 70 mg/dL — and your next meal is more than an hour away.
Ask your provider how to manage this situation. If these steps for raising your blood sugar do not work, call your doctor right away.
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Talk To Your Doctor Or Nurse
If you use insulin and your blood sugar is frequently or consistently low, ask your doctor or nurse if you:
- Are injecting your insulin the right way
- Need a different type of needle
- Should change how much insulin you take
- Should change the kind of insulin you take
DO NOT make any changes without talking to your doctor or nurse first.
Sometimes hypoglycemia can be due to taking the wrong medicines. Check your medicines with your pharmacist.
So Thats What Happens
Some of the effects on the body may even seem daunting, but as long as youre keeping track of blood sugar levels, then it shouldnt be a problem.
Obviously, this is easier said than done sometimes. Instead, try letting Hedia do some of the work. Hedia can remind you to check your blood sugar, while also keeping track of the different readings with the diabetes tracker.
And, of course in case of low blood sugar, or if Hedia can see that you have too much insulin on board Hedia will recommend carb intake to keep you in range. Give it a whirl for free at the App Store or !
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Can You Die Suddenly From Diabetes
There is considerable evidence implicating hypoglycemia as a cause of sudden death in patients with both type 1 and type 2 diabetes. Hypoglycemia has been recognized as a potential cause of death, particularly due to cerebral damage, ever since the introduction of insulin therapy.
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Symptoms Of Low Blood Sugar
How you react to low blood sugar may not be the same as how someone else with low blood sugar reacts. Its important to know your signs. Common symptoms may include:
- Fast heartbeat
- Hunger
If youve had low blood sugar without feeling or noticing symptoms , you may need to check your blood sugar more often to see if its low and treat it. Driving with low blood sugar can be dangerous, so be sure to check your blood sugar before you get behind the wheel.
You may not have any symptoms when your blood sugar is low . If you dont have symptoms, it will be harder to treat your low blood sugar early. This increases your risk of having severe lows and can be dangerous. This is more likely to happen if you:
- Have had diabetes for more than 5-10 years.
- Frequently have low blood sugar.
- Take certain medicines, such as beta blockers for high blood pressure.
If you meet one or more of the above and you have hypoglycemia unawareness, you may need to check your blood sugar more often to see if its low. This is very important to do before driving or being physically active.
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Causes Of Low Blood Sugar
There are many reasons why you may have low blood sugar, including:
- Taking too much insulin.
- Not eating enough carbs for how much insulin you take.
- Timing of when you take your insulin.
- The amount and timing of physical activity.
- Drinking alcohol.
- How much fat, protein, and fiber are in your meal.
- Hot and humid weather.
- Unexpected changes in your schedule.
- Spending time at a high altitude.
- Going through puberty.
- Menstruation.
What Is The First Organ Affected By Hypoglycemia
The brain is one of the first organs to be affected by hypoglycemia. Shortage of glucose in the brain, or neuroglycopenia, results in a gradual loss of cognitive functions causing slower reaction time, blurred speech, loss of consciousness, seizures, and ultimately death, as the hypoglycemia progresses.
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Preventing A Low Blood Sugar Level
If you have diabetes, you can reduce your chance of getting a low blood sugar level if you:
- Check your blood sugar level regularly and be aware of the symptoms of a low blood sugar level so you can treat it quickly.
- Always carry a sugary snack or drink with you, such as glucose tablets, a carton of fruit juice or some sweets. If you have a glucagon injection kit, always keep it with you.
- Do not skip meals.
- Be careful when drinking alcohol. Do not drink large amounts, check your blood sugar level regularly, and eat a carbohydrate snack afterwards.
- Be careful when exercising eating a carbohydrate snack before exercise can help to reduce the risk of a hypo. If you take some types of diabetes medicine, your doctor may recommend you take a lower dose before or after doing intense exercise.
- Have a carbohydrate snack, such as toast, if your blood sugar level drops too low while you’re asleep
If you keep getting a low blood sugar level, talk to your diabetes care team about things you can do to help prevent it.
What Causes A Low Blood Sugar Level
In people with diabetes, the main causes of a low blood sugar level are:
- the effects of medicine especially taking too much insulin, medicines called sulfonylureas , medicines called glinides , or some antiviral medicines to treat hepatitis C
- skipping or delaying a meal
- not eating enough carbohydrate foods in your last meal, such as bread, cereals, pasta, potatoes and fruit
- exercise, especially if it’s intense or unplanned
- drinking alcohol
Sometimes there’s no obvious reason why a low blood sugar level happens.
Very occasionally, it can happen in people who do not have diabetes.
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What Is The Outlook For People With Hypoglycemia
Hypoglycemia can be managed when you and your healthcare provider understand what causes your blood sugar to go down. Give your healthcare provider as much information as possible about any hypoglycemic episodes. Fixing the problem may be as simple as changing the times you take medication, eat and exercise. Minor changes to the types of food you eat may also help.
What To Do If The Person Is Unconscious Drowsy Or Unable To Swallow
If a person with diabetes is unconscious, drowsy or unable to swallow THIS IS AN EMERGENCY.
Do not give them any food or drink by mouth, treat as follows:
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