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Hypoglycemia – Causes, Symptoms and Treatment

Hypoglycemia refers to an abnormally low blood sugar level. It is most common in people with diabetes and can become life-threatening if left untreated.

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Things worth knowing about "Hypoglycemia"

Hypoglycemia refers to an abnormally low blood sugar level. It is most common in people with diabetes and can become life-threatening if left untreated.

What is Hypoglycemia?

Hypoglycemia (also spelled hypoglycaemia) is a medical condition characterized by an abnormally low level of glucose (sugar) in the blood. Clinically, hypoglycemia is defined as a blood glucose level below 70 mg/dL (3.9 mmol/L). Since the brain depends almost entirely on glucose as its energy source, a significant drop in blood sugar can rapidly impair brain function and, in severe cases, lead to loss of consciousness.

Causes

Hypoglycemia can result from a variety of causes, including:

Diabetes mellitus: The most common cause. It occurs when insulin or other glucose-lowering medications are not properly balanced with food intake or physical activity.
Medications: Insulin, sulfonylureas, and other antidiabetic drugs can lower blood sugar too much.
Alcohol consumption: Alcohol inhibits glucose release from the liver, which can cause blood sugar levels to drop.
Skipping meals or prolonged fasting: Insufficient carbohydrate intake leads to falling blood glucose levels.
Hormonal deficiencies: Low levels of cortisol or growth hormone can impair glucose regulation.
Insulinoma: A rare, usually benign tumor of the pancreas that produces excessive amounts of insulin.
Reactive hypoglycemia: A drop in blood sugar a few hours after a carbohydrate-rich meal, often seen in people who have had stomach surgery.

Symptoms

Symptoms of hypoglycemia are generally divided into two categories:

Adrenergic (Autonomic) Symptoms

These occur when the body releases stress hormones (such as adrenaline) to raise blood sugar:

Trembling and sweating
Rapid heartbeat (palpitations)
Pallor and anxiety
Intense hunger
Nausea

Neuroglycopenic Symptoms

These result from insufficient glucose supply to the brain:

Difficulty concentrating and confusion
Headache and blurred vision
Slurred speech and loss of coordination
Seizures
Loss of consciousness (in severe cases)

Diagnosis

Hypoglycemia is diagnosed by measuring blood glucose levels using a blood glucose meter (capillary blood) or a laboratory blood test. To determine the underlying cause, additional tests may be required:

Fasting blood glucose and oral glucose tolerance test (OGTT)
Insulin and C-peptide levels
Hormonal tests (e.g., cortisol, growth hormone)
Imaging studies (e.g., MRI of the pancreas if insulinoma is suspected)

The classic Whipple triad serves as a key diagnostic criterion: symptoms consistent with hypoglycemia, a documented low blood glucose level, and resolution of symptoms after glucose administration.

Treatment

Mild to Moderate Hypoglycemia

If the person is conscious and able to swallow, the 15-15 rule is recommended:

Consume 15 grams of fast-acting carbohydrates (e.g., 150-200 mL of fruit juice, 3-4 glucose tablets)
Wait 15 minutes and recheck blood sugar
If blood sugar remains low, repeat the process

Severe Hypoglycemia

If the person is unconscious or unable to swallow, nothing should be given by mouth. Immediate medical intervention is required:

Glucagon injection (subcutaneous or intramuscular) administered by a caregiver or medical professional
Intravenous glucose (e.g., 40% dextrose solution) administered by medical personnel
Subsequent monitoring in a hospital setting

Long-Term Prevention

Preventing recurrent hypoglycemia involves regular blood glucose monitoring, appropriate adjustment of medication doses, consistent meal schedules, and thorough patient and caregiver education.

When to Seek Medical Advice?

Medical attention should be sought promptly in cases of recurrent or severe hypoglycemia, hypoglycemia without an identifiable cause (e.g., no diabetes or relevant medication use), or loss of consciousness. In emergencies, call the emergency services immediately.

References

American Diabetes Association - Standards of Medical Care in Diabetes (2024). Diabetes Care, 47(Suppl. 1).
Cryer PE, Axelrod L, Grossman AB et al. - Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 2009; 94(3): 709-728.
World Health Organization (WHO) - Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia. WHO Press, Geneva, 2006.

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