When you have diabetes and take certain medications, your concern is not always that your blood sugar is too high -- your blood sugar can also dip too low, a condition known as hypoglycemia. This condition occurs when your blood sugar levels fall below 70 mg/dL.
While the only clinical way to detect hypoglycemia is to test your blood sugar, certain symptoms can signify that your blood sugar is too low. Early recognition of symptoms is critical because hypoglycemia can cause seizures or coma if left untreated. By learning to control your blood sugar, you can prevent hypoglycemic episodes. You also should take steps to ensure yourself and others know how to care for you if your blood sugar dips too low.
When you have diabetes, managing your blood sugar is a constant balance of diet, exercise, and medications, especially if you are on medications that increase the amount of insulin in your body.
Common causes of low blood sugar are:
- Skipping a meal or eating less than usual
- Exercising more than usual
- Taking more medication than usual
- Drinking alcohol, especially without food
A number of diabetes medications are associated with causing hypoglycemia. Only those medications that increase insulin production increase the risk for hypoglycemia. Medications that can cause hypoglycemia include:
- glimepiride (Amaryl)
- glipizide (Glucotrol, Glucotrol XL)
- glyburide (DiaBeta, Glynase, Micronase)
- nateglinide (Starlix)
- repaglinide (Prandin)
Combination pills that contain one of the medications above may also cause hypoglycemic episodes. Other injectable medications can lower the amount of other diabetes medications. This is why testing your blood sugar is so important, especially when making changes to your treatment plan.
People with diabetes are not the only people that experience low blood sugar. Weight-loss surgery patients, people with severe infections, or people who have a thyroid or cortisol hormone deficiency can also experience hypoglycemia.
Hypoglycemia affects people differently. However, being aware of your unique symptoms can help you treat hypoglycemia as quickly as possible.
Common symptoms of low blood sugar include:
- feeling as if you might faint
- heart palpitations
- loss of consciousness
- rapid heartbeat
- sudden changes in mood
- sweating, chills, or clamminess
If you suspect you may be experiencing a hypoglycemic episode, check your blood sugar immediately and initiate treatment, if necessary. If you don’t have a meter with you but believe you have low blood sugar, be sure to treat it.
Treating hypoglycemia depends upon the severity of your symptoms. If you have mild to moderate symptoms, you can self-treat your hypoglycemia. Initial steps include eating a snack that contains about 15 grams of glucose or quick digesting carbohydrates. Examples of such snacks include:
- a cup of milk
- three to four pieces of hard candy
- a half-cup of fruit juice, such as orange juice
- a half-cup of regular soda
- three to four glucose tablets
- half a package of glucose gel
- one tablespoon of sugar or honey
After you consume this 15-gram serving, wait for about 15 minutes and re-check your blood sugar levels. If blood sugar is at 70 mg/dl or above, you have treated your hypoglycemic episode. If it remains lower than 70 mg/dl, consume another 15 grams of carbohydrates to raise your blood sugar. Wait another 15 minutes and check your blood sugar again to ensure it has gone up.
Once your blood sugar is up, be sure to eat a small meal or snack if you are not set to eat within the next hour or so. If you continue to repeat these steps, yet cannot raise your blood sugar level, call 911 or have someone drive you to an emergency room. Do not drive yourself to the emergency room.
If you take the medications acarbose (Precose) or miglitol (Glyset), your blood sugar levels will not respond quickly enough when eating carbohydrate-rich snacks. This is because these medications slow the digestion of carbohydrates, so your blood sugar does not respond quickly. Instead, you must consume pure glucose or dextrose. This is available in tablets or gels and should be kept on-hand if you take either medication type.
If you experience mild to moderate hypoglycemic episodes several times in one week, or any severe hypoglycemic episodes, see your physician. You may need to adjust your meal plan or medications to prevent further episodes.
This information is a summary. Always seek medical attention if you are concerned you may be experiencing a medical emergency.
Severe blood sugar drops can cause you to pass out. This is more likely in people with type I diabetes, according to the National Diabetes Information Clearinghouse (2012). This can be a life-threatening occurrence. It is important that you educate your family, friends, and even co-workers on how to administer a glucagon injection if you should lose consciousness during a hypoglycemic episode. Glucagon is a hormone that stimulates the liver to break down stored glycogen into glucose for your body’s use. Talk to your healthcare provider to see if you may need a prescription for a glucagon emergency kit.
The best way to avoid hypoglycemia is by following your treatment plan. A diabetes control plan to prevent hypoglycemic and hyperglycemic episodes includes watching your diet, physical activity, and medication. If one of these is off balance, hypoglycemia can occur.
The only way to check blood sugar levels is to test your blood sugar. If you use insulin to control your blood sugar, you should check blood sugar levels four or more times per day. Your health care team will help you decide how often you should test.
If your blood sugar levels are not in the range that you and your health care team would like them to be, work with your team to change your treatment plan until your blood sugar levels are in their target range. This will help you identify what actions might lower your blood sugar suddenly, such as skipping a meal or exercising more than usual. You should not, however, make any adjustments without the advice and recommendation of your healthcare team.