What does hypoglycemia look like when you don’t have diabetes?

What is hypoglycemia?

Hypoglycemia is a medical condition in which the body’s blood sugar levels are low. If the blood sugar level is below 70 mg/dL, it is considered to be low. If it is below 54 mg/dL, then the symptoms of hypoglycemia start to manifest and it becomes a cause for immediate action.

Hypoglycemia: Quick Facts

• Hypoglycemia is fairly common in people with type 2 diabetes, especially those on insulin. But it is more frequent in people with type 1 diabetes.
• For example, in a random sample of 267 insulin-treated people, 94 with type 1 diabetes had a total of 336 hypoglycemic events (42.89 events per person-year), 9 of which were severe (1.15 events per person-year).
• On the other hand, 173 people with type 2 diabetes experienced 236 hypoglycemic events (16.37 events per person-year), 5 being severe (0.35 events per person-year)

Hypoglycemia vs. Hyperglycemia vs. Diabetes

Hypoglycemia, hyperglycemia, and diabetes are all diseases connected with your blood sugar levels. But there are some differences between them.

Hyperglycemia is the exact opposite of hypoglycemia— a medical condition in which the body’s blood sugar levels are very high. Fasting hyperglycemia (as observed after not eating or drinking for 8 hours) is a blood sugar level that is higher than 130 mg/dL. Postprandial or after-meal hyperglycemia is when the sugar level is higher than 180 mg/dL two hours after a meal.

Diabetes is a medical condition developing from the resistance of the body to insulin production or the lack of insulin production in the body. The lack of insulin leads to a higher blood sugar level. Hence, hyperglycemia is a symptom of moderate to severe diabetes. Though diabetes most often leads to hyperglycemia, it is not the only cause of hyperglycemia. Also, diabetes and hypoglycemia can co-occur. The reasons for this condition and how to manage it is also detailed later in this article.

Normal Blood Sugar Regulation in the Body

To understand how hypoglycemia happens, it helps to know how your body normally processes blood sugar. When you eat food—bread, pasta, etc., your body breaks down the carbohydrates present in them into your body’s main energy source, glucose.

What use is an energy source if it does not make it to the cells? Insulin, a hormone, is secreted by the beta cells in the pancreas when glucose levels rise. Insulin allows the glucose to enter your cells and provide energy. Excess glucose is then stored in your liver and muscles as glycogen.

But the pancreas does something else to help regulate blood sugar levels. Another hormone called glucagon secreted by the pancreas signals the liver to break down the excess glycogen into glucose. This happens between meals (unclear). This helps maintain a normal blood sugar level until the next time you eat.

But apart from the primary means of producing glucose in the liver, the body produces glucose in the kidneys also.

Cause of hypoglycemia in diabetics

Hypoglycemia or low blood sugar levels generally occur in people with diabetes when the body has too much insulin. This happens in diabetic patients when there is a very high intake of insulin to control the diabetic condition. Not exercising enough or not eating enough after taking insulin can have the same effect. The insulin reduces the sugar in the blood, bringing down blood sugar levels and causing hypoglycemia.

Sometimes, blood sugar levels fall sharply because the body produces too much insulin after a meal. This is referred to as reactive hypoglycemia and is an early warning sign for diabetes.

But hypoglycemia can occur without diabetes as well. This happens when the blood sugar level becomes dangerously low between meals. This is more likely in a person with a medical condition other than diabetes. These medical conditions are discussed in the next section. This kind of hypoglycemia is referred to as fasting hypoglycemia.

Other medical conditions that cause hypoglycemia

The medical conditions that can cause non-reactive, or fasting, hypoglycemia are discussed below

Alcoholism

When the blood sugar levels are low, the pancreas produces glucagon to help increase the levels. The glucagon then causes the liver to break down its stored energy and increase the glucose level in the blood. But alcohol impairs the functioning of the liver. The liver is not able to break down its stored energy and the glucose levels remain low.

Medications

Increasing the dosage of diabetic medicine or changing it can cause hypoglycemia. Other medications that cause it are:

• Malaria medications
• Certain antibiotics
• Pneumonia medications

The risk of medication-induced hypoglycemia is higher in people with kidney failure or in children.

Anorexia

An anorexic person will not be eating sufficient food to produce sufficient glucose, thereby leading to hypoglycemia.

Hepatitis

Hepatitis is a condition which causes inflammation of the liver. This affects its functioning. Since the liver is unable to produce or release glucose, blood sugar levels fall, leading to hypoglycemia.

Adrenal or Pituitary Gland Disorders

The adrenal and pituitary glands are involved in secreting the hormones that affect glucose production. When there is a disorder of the adrenal or pituitary gland, the glucose production drops, leading to hypoglycemia.

Kidney Failure

Kidney failure is another cause for hypoglycemia. The kidneys are responsible for discharging the excess medication from the bloodstream. If they fail, medication will build up and lead to hypoglycemia as mentioned earlier.

Pancreatic Tumors

Pancreatic tumors lead to an increase in the production of insulin. The increase in the production of insulin will then lead to a fall in the blood sugar levels.

Risk Factors for Hypoglycemia

Hypoglycemia can happen without diabetes in both children as well as adults. The following increase the risk of hypoglycemia in non-diabetics

• Stomach surgery
• Prediabetes
• Obesity

Symptoms of Hypoglycemia

Following are the symptoms for hypoglycemia:

• An irregular heart rhythm
• Hunger
• Fatigue
• Tingling sensation around the mouth
• Crying out during sleep
• Irritability
• Anxiety
• Sweating
• Pale skin
• Shakiness

As hypoglycemia worsens, signs and symptoms may include:

• Confusion and abnormal behavior that could lead to inability to perform routine tasks
• Blurred vision and other visual disturbances
• Seizures
• Loss of consciousness

People with severe hypoglycemia may appear intoxicated. They may have slurred speech and move clumsily.

When must you visit a doctor?

The following are cases when you must visit a doctor:

• If you are hypoglycemic and you do not have diabetes.
• If you are diabetic and your hypoglycemia isn’t responding to treatment or simple measures like eating candy or drinking juice to raise your sugar levels.

Treatment of Hypoglycemia

Treatment of hypoglycemia involves treatment of two major aspects of the condition.

Treatment of Immediate Symptoms

Early symptoms can usually be managed by the intake of 15-20 gm of a fast-acting carbohydrate. Foods that are easily converted into sugars in the body are called fasting carbohydrates. Examples are fresh juices with no added sugar, licorice, and glucose tablets. Avoid foods containing fat or protein as they affect the body’s absorption of sugar.

Recheck blood sugar levels within 15 minutes of this intake. If blood sugar levels are below 70 mg/dL, repeat the intake again. Recheck the blood sugar level after another 15 minutes. Repeat these steps until the blood sugar is above 70 mg/dL.

Have a snack or meal to stabilize the body’s blood sugar levels. This also helps the body restore the glycogen that was depleted during hypoglycemia.

If you are unable to consume food, then intravenous glucose injections may be administered. Do not give food or drink to an unconscious person as they may choke on it.

If you have severe episodes of hypoglycemia, the doctor may recommend a home glucagon kit. The home glucagon kit is now widely used by diabetics to manage emergencies of low blood sugar levels.

Treatment of Underlying Cause

Treatment of the underlying cause may involve one of the following:

• Medications: If the doctor identifies a new medication as the cause, he may adjust its dosage or schedule depending on its importance.
• Tumor: If the doctor identifies a tumor as the underlying cause, surgery may be required for its removal. In the case of the pancreas, he/she may partially remove the pancreas to lower the levels of insulin and thereby raise blood sugar levels.

Prevention of Hypoglycemia

For both diabetic and non-diabetic patients, reducing alcohol consumption can help treat hypoglycemia.

For Diabetic Patients

If you are diabetic, carefully follow the diabetes management plan your doctors have developed.  Always discuss with your doctor before adding a new medication, changing your eating or medication schedules, or adding an exercise. Ensure that it doesn’t affect your blood sugar level or your management of diabetes.

A continuous glucose monitor (CGM) helps those with hypoglycemic unawareness. These devices insert a tiny wire under the skin, which sends blood glucose readings to a receiver. Certain models of CGMs will alert you if blood sugar levels are falling low. There are also CGMs that are integrated with insulin pumps and help shut off the insulin pump and stop insulin delivery if blood sugar levels are too low.

Carry a fast-acting carbohydrate with you, like a juice or a glucose tablet, so that you can stop blood sugar levels from falling low.

For Non-diabetic Patients

If you are not diabetic, then taking small meals throughout the day can serve as a stopgap measure to prevent low blood sugar levels. This is not, however, a recommended long-term strategy. Consult a doctor to actually determine the cause for your hypoglycemia and start treatment for the underlying cause.

Diet for Managing Hypoglycemia

Breakfast

Try to have an early breakfast, as blood sugar levels would have dropped during the night and it is necessary to restore them soon.

Try to include fresh fruit juices in your diet. Fresh fruit juices ensure that there is no added sugar. Added sugar can make the blood sugar levels in your body unstable.

Some ideal breakfast choices include:

• Whole-grain toast and hard-boiled eggs.
• Greek yogurt with honey, oatmeal, and berries.
• Oatmeal with berries, cinnamon, agave, and sunflower seeds.

Lunch

Lunch must be a small meal packed with healthy fats and complex carbohydrates, and rich in proteins. Some good ideas for a lunch to treat hypoglycemia are:

• Chicken, tuna, or tofu sandwich using whole-grain bread and with leafy greens
• Grilled fish, baked sweet potato, and a salad
• Chickpea and vegetable salad

You must always pick foods with a low glycemic index (GI) and add it to your diet. A person with hypoglycemia must especially be aware of the GI in the food. In the above instance, sweet potato was selected because of its lower GI levels when compared to other kinds of potato.

Dinner

A light dinner with just enough protein and complex carbohydrates might be just what the nutritionist ordered.

Dinner ideas include:

• Salmon and steamed vegetables
• Chicken or tofu, brown rice, and vegetables
• Bean stew with kidney beans, lentils, tinned tomatoes, and chickpeas

Snacks

People with hypoglycemia must also try and include nutritious snacks in their diet between meals to make sure that their blood sugar levels remain normal. Eating a mid-morning, mid-afternoon and then a bedtime snack can help ensure the stability of blood sugar levels throughout the day. Some snack options are:

• An apple with a few slices of cheddar cheese
• A banana with some nuts and seeds
• A slice of wholegrain toast with mashed avocado or hummus
• Carrots, peppers, and cucumber dipped in hummus
• A vegetable smoothie

In Conclusion

Having a healthy diet helps manage hypoglycemia. So stick to those fast-acting carbohydrates only in cases that need immediate attention. Otherwise, always follow a balanced diet.

References

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