Management of Hypoglycemia

Hypoglycemia is not a disease, but it can lead to severe problems. To get a basic idea of hypoglycemia (or low blood sugar), read this article.

What is hypoglycemia?

Hypoglycemia is a medical condition where the blood sugar level of a person is abnormally low. Blood sugar level below 70 mg/dL is considered as low blood sugar or hypoglycemia.

Hypoglycemia is common in people with diabetes.

Management of hypoglycemia

How is it caused by diabetes mellitus?

diabetes mellitus

People who have diabetes have high blood sugar levels. To manage and control it, diabetes patients take insulin injections or medications.

In the course of diabetes treatment, if a person takes too much insulin or diabetes medications, it might lead to hypoglycemia or low blood sugar. Other possible causes of diabetic hypoglycemia are:

  • Skipping or postponing a meal (less intake of glucose)
  • Performing too much physical activity (without adjusting the medications)
  • Consumption of alcohol (which prevents the liver from producing glucose)

Why is Hypoglycemia common in people with type 2 diabetes?

Why is Hypoglycemia common in people with type 2 diabetes

Insulin treatment and certain diabetes medication (which enhance insulin production) can cause hypoglycemia. Such medications include:

  • Glimepiride (Amaryl)
  • Glipizide (Glucotrol, Glucotrol XL)
  • Glyburide (DiaBeta, Glynase, Micronase)
  • Nateglinide (Starlix)
  • Repaglinide (Prandin)
  • Chlorpropamide (Diabinese)
  • Tolazamide (Tolinase)

Therefore, it is necessary to perform a blood sugar test while making changes in the diabetes treatment plan.

Causes of fasting hypoglycemia

Fasting hypoglycemia is caused due to an underlying disease or medication. This includes:

  • Medicines like aspirin and sulfa drugs
  • Excessive consumption of alcohol 
  • Any disease affecting the kidneys, liver, heart, and pancreas
  • Eating disorders such as anorexia
  • Hormone deficiency 
  • Tumor of the pancreas (as it triggers excessive insulin production)

Signs and symptoms

Hypoglycemia signs and symptoms

The signs of Hypoglycemia can be reflected through two responses:

  • Adrenergic – Adrenergic physiological response focuses on increasing the secretion of counterregulatory hormones (such as norepinephrine) to resist the blood-glucose-lowering action of insulin.  This response serves as the early warning signs of hypoglycemia. Those signs include dizziness, hand tremor, anxiety, hunger, tachycardia (increased heart rate), diaphoresis (too much sweating), and headache.
  • Neuroglycopenic – Neuroglycopenic response occurs due to a deficiency of glucose within the brain and results in rapid CNS dysfunction. The initial signs of this response include headache, lethargy, confusion, disorientation, blurred vision, and speech impairment. 

However, if the initial signs are ignored, the condition might worsen and reach the medullary phase. This phase is indicated by seizures, deep coma, bradycardia (slow heart rate), shallow breathing, and pupillary dilatation.


If you are suffering from diabetes, you are more likely to have low blood sugar levels (hypoglycemia). If you notice signs or symptoms of hypoglycemia, check your blood sugar level using a blood glucose meter right away. If the blood glucose reading is 70 mg/dL or below, treat it with fast-acting carbohydrates.

(For eg, by eating 2 tablespoons of raisins, 5-6 lifesaver candies or by drinking 4-6 ounces regular soda)

If you don’t have diabetes but you keep having symptoms of hypoglycemia, consult a doctor. Your doctor will try to figure out the cause by examining your medical history and ask questions related to your symptoms. In order to check if the blood sugar level is low, the doctor will perform the blood tests. 

If you are diagnosed with hypoglycemia, the doctor may perform additional tests to find out its underlying cause (such as hepatitis, deficiency of hormones).


How to treat early symptoms of hypoglycemia?

In the initial stages, you can treat hypoglycemia by the 15-15 rule. Consume 15 grams of fast-acting carbohydrate to level up your blood sugar level. Check your blood sugar level again after 15 minutes. If it is still below 70 mg/dL, eat or drink another 15 grams of carbohydrate.

Repeat these steps until your blood sugar is back to normal. Fast-acting carbohydrate includes:

  • Glucose tablets or glucose gel
  • ½ cup (4 ounces) of juice or non-diet (regular) soda
  • 1 tablespoon of honey or corn syrup
  • Gumdrops, jellybeans (keep a check of the quantity)


  1. Avoid consumption of complex carbohydrates or chocolates.
  2. Consult a doctor to fix the amount of carb intake for young children as they usually require less than 15 grams.

Once your blood sugar returns to the normal level, eat a meal or snack to ensure the stability of the blood sugar level.

How to treat severe hypoglycemia?

In severe cases, the blood sugar level is too low to be treated by the 15-15 rule. The patient may be too confused to eat or even develop seizures. 

In case of such an emergency, the person must receive glucagon treatment. Glucagon is a hormone that stimulates the liver to release stored glucose in the bloodstream, and thereby help in raising the blood sugar level.

Your family members or friends must be instructed on how to use a glucagon kit in emergency situations.


Hypoglycemia Prevention

To prevent hypoglycemia, follow these steps:

  • Monitor your blood glucose level several times a week or twice a day.
  • Avoid postponing or skipping a meal or snack. Follow a proper meal plan.
  • Measure the dose of medicines carefully, and take it on time.
  • In case of increased physical activity, adjust your medications and meals depending on the requirement.
  • Carry a medical identification bracelet to help others know that you have diabetes, in case of emergency.

Last but not least

To safeguard yourself from the unpleasant symptoms and negative consequences of hypoglycemia, follow the two simple rules:

  • Practice good diabetes management.
  • Monitor your blood sugar level as often as possible.

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