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Hypoglycemia (Low Blood Sugar)

Hypoglycemia occurs when your body’s blood sugar drops too low. It’s a serious condition that may have lasting complications if not treated immediately. Diabetes, certain medications and other lifestyle or health factors can cause low blood sugar. Learn the symptoms and causes of hypoglycemia along with prevention and treatment methods.

Last Modified: April 18, 2024
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What Is Hypoglycemia?

Hypoglycemia, also called low blood sugar, is a serious condition that occurs when the body’s blood glucose drops to critical levels. Low blood sugar is most common in people with diabetes, but non-diabetics can also experience the condition if they have certain lifestyle risk factors or health issues or take certain medications.

The body uses the sugar glucose as its primary source of fuel. It gets this fuel by converting food into energy (glucose) and then releasing it into your bloodstream. The body requires about 70 mg/dL or 4 mmol/l to maintain normal function, but it’s important to speak with your doctor to determine your proper numbers. Elevated levels of glucose in the blood signal the pancreas to release insulin. This is the hormone that allows the cells of the body to use glucose as energy.

People with diabetes either don’t make enough insulin, or their bodies don’t respond to it correctly, leading to increased blood sugar levels. They typically use insulin or another medication to control their blood sugar, but taking too much medicine or even making changes to their normal diet or exercise routine can cause hypoglycemia to occur. This means people with diabetes must closely monitor their blood sugar and medication schedule and dosage. Hypoglycemia in non-diabetics is a rare condition, but it can happen if blood sugar drops below 55 mg/dL.

Serious and lasting health issues may occur if you don’t take action to correct low blood sugar immediately. Dangerous consequences of untreated hypoglycemia include seizures, losing consciousness and even death. Anyone prone to hypoglycemia must learn to recognize the signs and take fast action to bring their blood sugar back up to a safe level to protect their health.

Symptoms of Hypoglycemia

The type and severity of hypoglycemia symptoms may vary depending on how far the condition has progressed. Early hypoglycemia symptoms are typically mild. These include weakness, behavioral changes and other early warning signs.

Mild Symptoms of Hypoglycemia
  • Anxiety
  • Dizziness
  • Fatigue
  • Headache
  • Hunger
  • Irritability
  • Nausea
  • Numb or tingling skin
  • Pale skin
  • Rapid heartbeat
  • Shakiness
  • Sweating

If low blood sugar persists, more serious symptoms may occur.

Moderate Symptoms of Hypoglycemia
  • Confusion and changes in behavior
  • Lost coordination
  • Slurred speech
  • Nightmares while sleeping
  • Vision changes like blurriness or tunnel vision

When hypoglycemia becomes severe, you may develop advanced symptoms.

Serious Symptoms of Hypoglycemia
  • Cardiac arrest
  • Loss of consciousness
  • Organ failure
  • Permanent brain damage
  • Seizures

Untreated hypoglycemia can lead to life-altering complications. These include coma and even death.

If you have diabetes and experience mild symptoms, you can treat them by eating or drinking something high in sugar, or by taking medication. Non-diabetics who experience hypoglycemia symptoms and diabetics who have worsening symptoms that don’t respond to early self-treatment should seek emergency medical help.

Hypoglycemia only gets worse if left untreated. It’s critical to take all symptoms seriously and take steps to prevent low blood sugar. Recurring episodes of hypoglycemia can cause hypoglycemia unawareness, where the body stops producing early warning signs, increasing the likelihood of having life-threatening consequences. Using a continuous glucose monitor is one way to avoid serious symptoms by receiving low blood sugar alerts.

Causes of Hypoglycemia

The majority of people who experience hypoglycemia have diabetes, particularly Type 1. Diabetes drugs causing low blood sugar as a side effect are the most common cause of hypoglycemia.

After you eat, the body triggers insulin production to help glucose enter the cells to provide an energy source. When your blood sugar drops after going several hours without eating, your body stops insulin production and switches to breaking down glycogen, which is extra glucose stored in the muscles and liver, into glucose until your next meal, when it begins to produce insulin once again.

The bodies of people with Type 1 diabetes don’t make insulin, while those with Type 2 diabetes don’t respond to it correctly. Instead, these patients take insulin or another medication to lower the build-up of glucose. However, taking too much insulin or medication can cause hypoglycemia if blood sugar levels drop too much. Diabetes may also experience hypoglycemia when they take their normal medication dose but eat less food, or if they exercise more than usual. Non-diabetic triggers for hypoglycemia differ from diabetic triggers and are much less common.

Non-Diabetic Hypoglycemia Triggers
Malnutrition, starvation and the eating disorder anorexia can deplete glycogen stores and cause hypoglycemia. Eating too few carbs, timing insulin with carb intake, and the fat, protein and fiber composition of the meal can also affect glucose levels.
Excessive Alcohol Consumption
Heavy drinking without eating food can prevent the liver from releasing stored glycogen and lead to low blood sugar.
Hormone Imbalances
Pituitary tumors or adrenal gland disorders can interrupt hormone production responsible for producing glucose.
Illness and Infection
Some serious illnesses like liver infection, cirrhosis, hepatitis, heart disease and kidney disease may cause hypoglycemia.
Certain medications like beta-blockers, indomethacin and SGLT2 inhibitors may cause low blood sugar, as can mistakenly taking diabetic medication not prescribed to you.
Physical Activity
Exercise can trigger low blood sugar. The risk varies depending on timing, intensity and duration.
People who have had certain surgeries, particularly stomach bypass, can experience unusual stomach function that causes reactive hypoglycemia or postprandial hypoglycemia after eating a meal.
Tumor of the Pancreas (Insulinoma)
This tumor causes an overproduction of insulin.

Once you understand what causes hypoglycemia, you can take steps to prevent it. Be particularly careful if you take a medication linked to hypoglycemia.

Medications Associated with Hypoglycemia

Various diabetes medications can cause hypoglycemia by altering insulin sensitivity, stimulating insulin production or disrupting glucose metabolism. While the majority of medications that can cause low blood sugar are diabetes drugs, some other medications also pose a risk, especially if taken with diabetes drugs.

Diabetes Medications That May Cause Hypoglycemia
  • Alpha-glucosidase inhibitors work to lower glucose by improving digestion and carb absorption.
  • DPP-4 inhibitors are an oral medication that increases the amounts of insulin released by the pancreas.
  • Glinides (nateglinide, repaglinide) taken orally stimulate insulin production in patients with Type 2 diabetes.
  • GLP-1 receptor agonists like Ozempic (semaglutide) treat Type 2 diabetes by increasing insulin production and slowing digestion to prevent blood sugar spikes. Mounjaro (tirzepatide) injections lower blood sugar by mimicking the digestive hormones GLP-1 and GIP.
  • Insulin is the medication associated with the highest risk of low blood sugar, most commonly because of a miscalculated dose.
  • Meglitinides are another Type 2 diabetes treatment that stimulates insulin production.
  • Metformin (when used with sulfonylureas) helps to restore your body’s correct response to insulin.
  • Pramlintide is an injection that slows digestion to prevent spikes in blood sugar.
  • SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin and ertugliflozin) don’t stimulate insulin. Instead, they work to lower blood glucose.
  • Sulfonylureas (glipizide, glimepiride, glyburide) are another type of oral drug that increases insulin from the pancreas.
  • Thiazolidinediones in combination with sulfonylureas (pioglitazone, rosiglitazone) treat Type 2 diabetes mellitus by improving insulin resistance.

People with diabetes are more likely to get low blood sugar from a medication, whether it’s a diabetes drug or another. Other medications not intended to treat diabetes can also lead to hypoglycemia, although occurrences are less common.

Other Medications That May Cause Hypoglycemia
  • ACE inhibitors improve blood flow and pressure by relaxing blood vessels and helping them stay open.
  • Some antibiotics (gatifloxacin, levofloxacin, trimethoprim/sulfamethoxazole) used to treat infections can cause low blood sugar.
  • Beta-blockers (atenolol, propranolol) lower blood pressure and heart rate by blocking adrenaline hormone from bonding with beta receptors.
  • Heart arrhythmia medications (cibenzoline and quinidine) treat an irregular, fast or slow heartbeat by influencing the electrical current responsible for your heart beating.
  • NSAIDS (indomethacin, mainly in large doses) can reduce pain, inflammation or fever.
  • SSRIs (fluoxetine, sertraline) treat depression and other mental health issues.
  • TCAs (doxepin, imipramine, nortriptyline) are an older class of antidepressants that have higher rates of side effects.
  • MAOIs (selegiline, rasagiline) are another class of medication for depression that affect the brain’s neurotransmitters.

Non-diabetics more susceptible to developing hypoglycemia include children, pregnant women, seniors and people with liver or kidney problems.

Some people who use certain medications for off-label use may have a higher risk of experiencing side effects or adverse reactions. Ongoing Ozempic lawsuits and Mounjaro lawsuits stem from people having adverse reactions to taking these injectable Type 2 diabetes medications, some for weight loss instead of the FDA-approved use. It’s important to speak with your doctor before taking any medicines and to follow dosage instructions exactly.

Hypoglycemia Treatment & Management

Hypoglycemia management and treatment focuses on getting your blood sugar to normal levels. There are two main ways to do this. The first is the 15-15 rule. Consume 15 grams of carbohydrates, then wait for 15 minutes. Check your glucose and eat another 15 grams if your blood sugar is still under 70 mg/dL. The second is taking a glucagon shot if your doctor prescribed it for you.

Test your blood sugar after either treatment to make sure it worked. Another important management and treatment tool is training and education to recognize the symptoms of hypoglycemia, along with the steps necessary to treat it and when to seek emergency help.

Regular glucose monitoring is an important management technique and the best way to know when you need to take fast action to bring your levels back up to normal. For example, Type 1 diabetes patients can use insulin pumps with automatic sensors to treat their condition. These pumps monitor your blood sugar levels and deliver regulated amounts of insulin based on the readings. Insulin delivery stops whenever blood sugar levels dip, which can prevent many instances of hypoglycemia.

Talk to your doctor to develop a personalized management strategy that meets your needs.

Managing Hypoglycemia Risk on Medications

If you experience episodes of low blood sugar, adjusting your insulin or oral medications can help you better manage your hypoglycemia risk. Changing the insulin or medication dosage with your doctor is an important management step. Adjusting when you take the medication, when you exercise, or the timing and type of foods you eat can also lessen your risk of experiencing hypoglycemia while taking a medication.

Never adjust your medication dosage or schedule without first consulting your health care provider. It’s helpful to keep a detailed record of your glucose levels, medication, exercise and food log to track and understand blood sugar lows. Together, you can discuss your lifestyle, medications and other risk factors to find the treatment plan that is best for you.

Preventing Hypoglycemia

It’s possible to prevent hypoglycemia if you know the underlying cause. Your doctor might recommend eating more meals and snacks during the day along with frequently checking your blood sugar and taking medication as directed. Some people may need an insulin pump or benefit from a continuous glucose monitor, which signals an alarm if the numbers drop too low.

Don’t make changes to your medication, diet or exercise routine without first discussing it with your doctor, as any of these factors can affect your blood sugar. Exercise is generally good for blood sugar management but can sometimes spike insulin, especially intense workouts. Discuss your activity level with your doctor in detail so they can prescribe the correct amount of insulin.

Another way to lower your risk of hypoglycemia is by learning the signs and symptoms of low blood sugar so you can treat it quickly. It’s important to carry glucose tablets, hard candies, juice or another high-sugar carb to have what you need on hand.

Non-diabetics should see their health care provider to determine the cause of hypoglycemic episodes. Whether you have diabetes or not, stay proactive in managing your condition. Seek professional advice from your doctor and attend follow-up appointments to monitor your condition and adjust your treatment as needed.

Please seek the advice of a medical professional before making health care decisions.