Hypoglycaemia

Have you ever felt dizzy, shaky, or irritable for no apparent reason? These could be signs of hypoglycaemia, a condition that can affect anyone. Hypoglycaemia, or low blood sugar, happens when glucose levels in the blood drop below normal. If left untreated, this common health issue can cause numerous low-sugar symptoms, from mild discomfort to severe complications. This blog aims to shed light on the symptoms and causes of low blood sugar. 

What is Hypoglycaemia (Low Blood Sugar)? 

Hypoglycaemia, commonly known as low blood sugar, glucose develops when blood sugar glucose levels drop below normal. This condition occurs when there's too little sugar in the bloodstream to fuel the body's activities. When fasting, the normal range for blood glucose is between (60 to 99 mg/dL). These levels can fluctuate throughout the day. 

When blood sugar levels are less than 3.9 mmol/L (70 mg/dL), it's considered a low glucose range or hypoglycaemia. This drop can impact the body's functioning, as glucose is the major energy source for all the cells in our body. The brain particularly relies heavily on glucose to operate effectively. 

Types of Hypoglycaemia 

Hypoglycaemia has different classifications based on its timing and underlying causes. 

• Timing-based Classification: 
  • Fasting Hypoglycaemia or Early Morning: This type occurs when blood sugar drops after not eating for an extended period. 
  • Postprandial Hypoglycaemia: Also known as reactive hypoglycaemia, it occurs within 2-4 hours after a meal. 
  • Exercise-related Hypoglycaemia: This type happens during or after physical activity. 
• Cause-based Classification: 
  • Insulin-mediated Hypoglycaemia: This results from excessive insulin in the body, either from natural causes like insulinomas or iatrogenic causes like insulin medications. 
  • Non-insulin-mediated Hypoglycaemia: This type has various causes, including alcohol consumption, organ failure, critical illness, hormone deficiencies, and certain medications. 
• Severity-based Classification: 
  • Level 1 (Hypoglycaemia alert value): Blood glucose ≤70 mg/dL (3.9 mmol/L) 
  • Level 2 (Clinically significant hypoglycaemia): Blood glucose <54 mg/dL (3.0 mmol/L) 
  • Level 3 (Severe hypoglycaemia): No specific glucose threshold but requires external assistance for recovery 

Symptoms of Hypoglycaemia 

Hypoglycaemia symptoms can appear suddenly and vary from person to person. Common low in sugar symptoms include: 

• Shaking or trembling 
• Weakness and fatigue 
• Sweating and chills 
• Extreme hunger 
• Rapid heartbeat 
• Dizziness or lightheadedness 
• Confusion or trouble concentrating 
• Coma 
• Anxiety or irritability 
• Pale skin 
• Numbness or tingling sensation in lips, tongue, or cheeks 
• Severe hypoglycaemia has more serious signs: 
• Blurred or double vision 
• Slurred speech 
• Coordination difficulties 
• Disorientation 
• Seizures 
• Loss of consciousness 

Nocturnal hypoglycaemia, which occurs during sleep, has its own set of low blood sugar symptoms: 

• Restless sleep 
• Sweating through pyjamas or sheets 
• Crying out during sleep 
• Nightmares 
• Feeling tired, disoriented, or confused upon waking 

Causes of Hypoglycaemia 

The leading causes of hypoglycaemia include: 

• Excess insulin 
• Taking too much diabetes medication or incorrect timing of insulin and diet intake 
• Skipping meals 
• Increased physical activity without eating 
• Pregnant women with Type 1 diabetes may experience low blood sugar in the first trimester. 
• For individuals without diabetes, causes of hypoglycaemia include: 
• Reactive Hypoglycaemia: Occurs 2-4 hours after eating, possibly due to rapid blood sugar fluctuations. 
• Fasting Hypoglycaemia: Occurs from excessive alcohol consumption, critical illnesses, or hormonal disorders. 
• Medical Conditions: Adrenal insufficiency, insulinomas, Tumour/cancer of the pancreas, and non-islet cell tumour hypoglycaemia can lead to low blood sugar, pancreas, and dictum.

Risk Factors for Hypoglycaemia 

Several factors increase the likelihood of developing hypoglycaemia, such as: 

• People with diabetes, especially those taking insulin or certain medications 
• Smokers who have diabetes 
• Excessive alcohol consumption without eating can prevent the liver from releasing glucose. 
• Certain medical conditions like severe liver illnesses, kidney disorders, advanced heart disease, and long-term starvation 

Complications of Hypoglycaemia 

Hypoglycaemia can lead to serious complications if left untreated, such as: 

• Short-term effects include dizziness, weakness, and falls, which can result in injuries. 
• In severe cases, hypoglycaemia can cause brain bleeds, heart attacks, and impaired cognitive function. 
• Long-term complications involve an increased risk of cardiovascular disease, eye problems, kidney conditions, and nerve damage. 
• Older adults with frequent episodes of low blood sugar have a greater chance of developing dementia. 
• Hypoglycaemia can also affect various body systems. It can cause gastroparesis, a condition that disrupts the digestive system, resulting in stomach pain, nausea, and vomiting. Severe cases can damage the endocrine and circulatory systems. 

In extreme situations, prolonged severe hypoglycaemia can result in: 

• Multiple organ failure 
• Cardiac arrhythmias 
• Permanent brain damage 
• Coma 
• Death 

Diagnosis 

Diagnosing hypoglycaemia involves a combination of symptom assessment and blood glucose testing. Doctors typically start by reviewing a patient's medical history and conducting a physical examination. For individuals using insulin or other diabetes medications, self-testing with a blood glucose meter is crucial when experiencing low blood sugar levels symptoms. It's essential to record these results and the lower blood sugar level. 

• Mixed-meal tolerance test (MMTT): To detect suspected reactive hypoglycaemia. This test involves consuming a special drink containing protein, fats, and sugar, followed by blood glucose checks over five hours. 
• Continuous glucose monitoring (CGM) devices can help identify and prevent low blood sugar episodes, as they can be programmed to alert users to dropping levels. 

Hypoglycaemia Treatments 

The 15-15 rule is the cornerstone of treatment of hypoglycaemia. This approach involves consuming 15 gm of fast-acting carbohydrates and checking blood sugar levels after 15 minutes. The process is repeated if blood sugar remains below 70 mg/dL (3.9 mmol/L) until levels normalise. 

Fast-acting carbohydrates suitable for treating hypoglycaemia include: 

• 4 ounces (120 millilitres) of fruit juice or regular soda 
• One tablespoon (15 millilitres) of sugar, honey, or syrup 
• 3-4 glucose tablets 
• 5-6 pieces of hard candy or jelly beans 

After blood sugar levels stabilise, it's crucial to have a snack or meal to prevent another drop and replenish glycogen stores. 

For severe hypoglycaemia, where a person is unconscious or unable to swallow safely, emergency glucagon is necessary. Glucagon, available as an injection or nasal powder, triggers the liver to release stored glucose. Call emergency services if glucagon is 
unavailable. 

When to see a doctor 

Immediate medical attention is necessary if: 

• Someone experiences signs and symptoms of low blood sugar without having diabetes even a diabetic pt
• A person with diabetes has hypoglycaemia that doesn't respond to treatment (e.g., drinking juice, eating candy, or taking glucose tablets) 
• Someone with diabetes or a history of hypoglycaemia shows signs of severe hypoglycaemia or loses consciousness  

Prevention of Hypoglycaemia 

You can lower the risk of low blood sugar episodes by following a few key strategies, such as: 

• Take all medications exactly as prescribed. 
• Following instructions about food and exercise is equally important. Regular meals spaced no more than 4 to 5 hours apart can help prevent sudden drops in blood sugar. 
• Monitor blood glucose levels regularly. 
• For those who drink alcohol, moderation is key. 
• Lastly, carrying an identification bracelet indicating diabetes can be lifesaving in emergencies. 

Conclusion 

Understanding hypoglycaemia has a significant impact on managing overall health. This condition, characterised by low blood sugar levels, can affect anyone, though it's more common in individuals with diabetes. Recognising the signs of low blood glucose, from mild discomfort to severe complications, is crucial to prevent potential health risks. By being aware of the various types, causes, and risk factors associated with hypoglycaemia, individuals can take proactive measures to achieve stable blood sugar levels. 

FAQ's 

1. How common is low blood glucose? 

Low blood glucose, or hypoglycaemia, is quite common in people with diabetes. For those with type 1 diabetes, symptoms may occur up to twice a week. In a large global study, 80% of people with type 1 diabetes & nearly 50% of those with type 2 diabetes had a low blood sugar (hypoglycaemic) event at least once over a 4-week period. 

2. Can you be hypoglycaemic and not diabetic? 

Yes, non-diabetic hypoglycaemia is possible, although less common. It can occur due to certain medications, excessive alcohol consumption, severe infections, kidney disorders, or long-term starvation. 

3. Who is more susceptible to low blood glucose? 

People with type 1 diabetes, those taking insulin or certain diabetes medications, individuals over 65, and those with a history of low blood glucose are at higher risk. Other risk factors include health problems like kidney disease, heart disease, or cognitive impairment. 

4. What food reduces sugar levels? 

Several foods can help lower blood sugar levels: 

• Vinegar 
• Turmeric 
• Onions 
• Bitter gourd 
• Green tea 

5. What deficiency causes hypoglycaemia? 

Hormone deficiencies, particularly in the adrenal gland and pituitary hormones, can result in inadequate glucose production or metabolism, leading to hypoglycaemia. 

6. How do you control sugar levels immediately? 

To quickly lower blood sugar, take fast-acting insulin as your doctor prescribes. Exercise can also help diminish blood sugar levels rapidly. For hypoglycaemia, consume 15 gm of fast-acting carbohydrates, such as fruit juice or glucose tablets. 

7. Can hypoglycaemia turn into diabetes? 

Reactive hypoglycaemia, which occurs within a few hours after a meal, may indicate an increased risk of developing diabetes. However, hypoglycaemia itself does not directly cause diabetes. 

8. What is the root cause of hypoglycaemia? 

The primary cause of hypoglycaemia is an imbalance between insulin levels and glucose in the blood. This imbalance can result from over-treatment with diabetes medications, not eating enough, vigorous exercise, or underlying health conditions affecting glucose regulation.

Dr. Vaibhav Agrawal

MBBS, MD
Ganga CARE Hospital Limited, Nagpur

To Book an Appointment, call:

+91 406 810 6585