Recognising the Symptoms of Hypoglycemia in Diabetes

Navigating life with diabetes requires constant vigilance, especially in recognising and managing fluctuations in blood sugar levels. While the management and prevention of high blood sugar is often a primary focus in this chronic disease, preventing low blood sugar is equally as important. Hypoglycemia, a condition characterised by abnormally low blood sugar levels, is a critical concern for the health of those living with diabetes. This comprehensive guide aims to empower individuals with diabetes to identify the symptoms of hypoglycemia and understand effective management strategies.

In this article you will learn:

• Understanding Hypoglycemia
• Causes of Hypoglycemia in Diabetes
• Identifying Symptoms of Hypoglycemia
• Steps to Take During a Hypoglycemic Episode
• Preventive Measures

Hypoglycemia, commonly known as low blood sugar, is a condition that poses a significant risk for individuals with diabetes, especially those using insulin or certain oral diabetes medications. Normal blood sugar levels typically range from 4.0 to 7.8 mmol/L, and levels below 4.0 mmol/L are considered hypoglycemic. (1) This condition can develop quickly and requires immediate attention.

For people with diabetes, maintaining blood sugar levels within a target range is a delicate balance. Hypoglycemia can come about when this balance is disrupted, often due to factors like excessive insulin dosage, insufficient food intake, or unexpected and unplanned physical exertion. Sometimes this even occurs without any warning signs. (2) Because the body and brain rely on blood sugar or glucose as their primary and preferred energy source, low levels can impair a range of bodily functions.

Recognising the early signs of hypoglycemia is vital, as delayed treatment can lead to severe and unwanted complications, including loss of consciousness, seizures, and in extreme cases, death. (3) That’s why understanding the causes and symptoms of hypoglycemia is the first step in effective management and prevention.

Diabetes hypoglycemia can be triggered by several factors, which means awareness of the factors is crucial. Here are some of the most common causes:

• Medications: Insulin and certain diabetes medications, like sulfonylureas, increase the risk of hypoglycemia. These medications can lower blood sugar levels, sometimes excessively, especially if the dose does not suit the individual’s needs anymore because of changes in weight, meal patterns or exercise. (2)
• Meal Patterns: Skipping meals, delaying eating, or consuming less food than usual without making the necessary adjustment to diabetes medications can cause a drop in blood sugar levels. It’s crucial for people living with diabetes to have consistent meal times and to be mindful of their carbohydrate intake to prevent sugars from becoming too low. (4)
• Physical Activity: Exercise is beneficial for managing diabetes, but it can also cause blood sugar levels to drop, especially if it’s more intense, longer than usual or unplanned. Monitoring blood glucose before, during, and after exercise is important, as is adjusting food intake or medication as needed. (4)
• Alcohol Consumption: Drinking alcohol, especially on an empty stomach, can interfere with the liver’s ability to release glucose, increasing the risk of hypoglycemia. I advise that individuals with diabetes monitor their alcohol intake and consume it with food to mitigate this risk. (1)

Understanding these triggers is essential for individuals with diabetes to prevent hypoglycemic episodes and manage their condition effectively.

The symptoms of hypoglycemia can vary from person to person. They can be one, or a mix of physical, emotional and cognitive signs, typically including the following:

• Physical Symptoms: Common initial signs of hypoglycemia include shaking, sweating, rapid heartbeat, hunger, and dizziness. These symptoms occur as the body’s response to falling blood sugar levels, triggering the release of adrenaline.
• Emotional Symptoms: People may experience sudden mood changes such as irritability, anxiety, or nervousness. These emotional responses can sometimes make it harder for others to recognise that the person is experiencing hypoglycemia as they’re something every person experiences from time to time.
• Cognitive Symptoms: As hypoglycemia progresses, it can affect brain function, leading to symptoms like confusion, difficulty concentrating, blurred vision, and slurred speech. In severe cases, the person may have difficulty performing routine tasks or appear disoriented. (5)

As discussed earlier in this blog, early recognition and treatment of these symptoms is crucial for preventing severe health consequences like loss of consciousness and seizures. That’s why it’s so important that not only you, but your friends and family, understand the symptoms of hypoglycemia.

Quick and immediate action is required to reverse the effects of low blood sugar, raising it back to a safe range. If you or someone you know is experiencing symptoms of hypoglycemia, follow these steps:

1. Check Blood Glucose Levels: If possible, verify that it is hypoglycemia with a blood glucose test.
2. Consume Fast-Acting Carbohydrates: Ingest 15-20 grams of fast-acting carbohydrates, such as glucose tablets, half a glass of fruit juice, 6- 7 jelly beans or 150mLs of regular soft drinks. These food items are quickly absorbed by the body and will help to raise blood sugar levels efficiently.
3. Recheck Blood Glucose: After consuming fast-acting carbohydrates, it’s important to recheck blood sugar levels after about 15 minutes. If the levels are still below 4 mmol/L, an additional 15-20 grams of fast-acting carbohydrates should be consumed.
4. Seek Medical Assistance if Necessary: If symptoms persist or if you’re unable to raise your blood sugar, seek medical help immediately. Severe hypoglycemia may require emergency treatment with glucagon or intravenous glucose. (5)

Carrying some form of quick-acting carbohydrate is advisable for individuals with diabetes, especially those at risk of hypoglycemia. It’s also important for them to wear medical identification and to educate family, friends, and colleagues about how to assist in case of a hypoglycemic emergency.

Preventing hypoglycemia is much nicer than treating it. To do so effectively, this involves a combination of regular monitoring of blood sugars, dietary management, medication adjustment, and education:

• Regular Blood Sugar Monitoring: Frequent blood glucose checks allow individuals to understand how different factors like food, activity, and medication affect their own blood sugar levels. Continuous glucose monitoring (CGM) systems can provide real-time feedback and trends, helping to prevent hypoglycemia.
• Balanced Diet and Regular Meals: Eating balanced meals and snacks at regular intervals helps maintain stable blood sugar levels. For people living with diabetes, we encourage them to include a variety of foods, including carbohydrates, protein, and healthy fats, in the diet.
• Medication Management: Working closely with healthcare professionals to adjust diabetes medication is crucial, especially when there are changes in routine, diet, or health status. Dosage and timing of medication may need to be modified to prevent hypoglycemia.
• Education and Awareness: Understanding the risks and management of hypoglycemia is essential for individuals with diabetes. They should also educate those around them about their condition and how to assist in an emergency. This includes instructions on the use of glucagon kits, which can be life-saving in cases of severe hypoglycemia. (6)

By adopting these preventive strategies, individuals with diabetes can significantly reduce the risk of hypoglycemia and maintain better control over their condition.

After reading this article, you should understand that recognising and managing the symptoms of hypoglycemia is a crucial aspect of living with diabetes. By understanding the causes, identifying the early signs, and knowing the appropriate actions to take, individuals with diabetes can effectively manage hypoglycemia and maintain their health and safety. Regular consultations with healthcare professionals and staying informed about diabetes management are key to navigating this condition successfully.