Blood Glucose Management: Hypoglycemia
~ by Jo Jordan
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Hypoglycemia - which means low blood glucose (sugar) - is a condition that occurs when blood sugar levels fall too low. Sometimes a complication from diabetes, low blood sugar can also be caused by critical illness, endocrine deficiencies, heavy alcohol consumption, etc.
Balance is key in managing hypoglycemia. If you have diabetes-related hypoglycemia, for example, it is vital not to over-treat the condition because blood sugar levels may rise too high. Conversely, ignoring hypoglycemic symptoms can result in losing consciousness, seizures, and death.
How Are Blood Sugar Levels Regulated?
During the digestion process, carbohydrates from the foods we eat are broken into different types of sugar molecules. Glucose, the body's main source of energy, is absorbed into the bloodstream after meals. Glucose needs insulin - a hormone secreted by the pancreas - in order to enter the cells of most body tissues.
Our bodies regulate blood sugar production, absorption, and storage. When the level of glucose in the bloodstream increases, pancreatic cells are signaled to release insulin, enabling the glucose to enter the cells, and provide them with the fuel they need to function. Extra glucose is stored in the liver and muscles in the form of glycogen, lowering the amount of glucose in the bloodstream. This process prevents glucose from reaching high levels.
After several hours without food, the blood sugar level drops. At this point, the hormone glucagon will signal the liver to break down stored glycogen, and release it back into the bloodstream. The process keeps blood sugar levels within a normal range until the next meal.
What Causes Hypoglycemia?
Various conditions cause low blood glucose:
Diabetic causes
- Insulin's effects are decreased because the pancreas doesn't produce a sufficient amount of it (type 1 diabetes) or because the cells are less responsive to it (type 2 diabetes), resulting in the build-up of higher than healthy levels of glucose.
- One of the most common causes of hypoglycemia is as a side effect of diabetes medications. If too much insulin is taken, compared to the amount of glucose in the bloodstream, there can be a decrease in blood sugar levels resulting in the onset of hypoglycemia.
- If less glucose is ingested (less food) after taking diabetes medication or if there is an increase in the level of exercise (using more glucose), hypoglycemia may result.
Non-diabetic causes
There are two types of non-diabetic hypoglycemia:
- Fasting hypoglycemia, also referred to as post-absorptive hypoglycemia, is often related to an underlying disease
- Reactive hypoglycemia, also referred to as post-prandial hypoglycemia, usually occurs within four hours after meals
While hypoglycemia in people without diabetes is much less common than it is in those with diabetes, there are various risk factors associated with both fasting and reactive hypoglycemia:
Fasting hypoglycemia
Causes of fasting hypoglycemia include,
- Conditions occurring in infancy and childhood such as a brief intolerance to fasting, often during an illness; hyperinsulinism (the overproduction of insulin); enzyme deficiencies; and hormonal deficiencies such as lack of pituitary or adrenal hormones
- Critical illness: severe illnesses of the heart and/or liver (such as drug-induced hepatitis); disorders of the kidney, which can affect glucose levels; long-term starvation, such as that experienced with anorexia nervosa sufferers; and sepsis (an overwhelming infection)
- Heavy alcohol consumption without eating can block the liver from releasing stored glucose into the bloodstream
- Hormonal/endocrine deficiencies: certain disorders of the adrenal and pituitary glands can result in a deficiency of glucose regulating hormone production
- Increased physical activity
- Insufficient, delayed, or missed meals or snacks
- Medications such as pentamidine (for treating pneumonia), quinine (for treating malaria and leg cramps), salicylates (including aspirin), and sulfa medications (for treating bacterial infections)
- Rare tumors of the pancreas (insulinoma) may cause overproduction of insulin, resulting in hypoglycemia
Reactive hypoglycemia
There is much debate about the exact cause(s) of reactive hypoglycemia. Some researchers suggest that deficiencies in glucagon secretion might result in reactive hypoglycemia; others believe that some people are more sensitive to the body's release of the hormone epinephrine.
A few causes of reactive hypoglycemia are certain, though uncommon:
- Gastric bypass surgery: people who've undergone this procedure are at risk of developing hypoglycemia due to the rapid passage of food into the small intestine
- Rare, early life enzyme deficiencies such as hereditary fructose intolerance
Symptoms of fasting and reactive hypoglycemia are similar to diabetes-related hypoglycemia.
Hypoglycemia Signs and Symptoms
Symptoms of low blood glucose include,
- Abnormal behavior (i.e. the inability to complete routine tasks)
- Anxiety
- Confusion
- Difficulty speaking
- Dizziness
- Double vision and/or blurred vision
- Heart palpitations
- Hunger
- Light-headedness
- Loss of consciousness (uncommon)
- Nervousness
- Seizures (uncommon)
- Shakiness
- Sleepiness
- Sweating
- Tremors
- Weakness
The above symptoms could be brought on by a variety of conditions. In order to confirm that hypoglycemia is the cause, it is necessary to have blood sugar levels measured when symptoms present themselves.
Hypoglycemia can also occur during sleep. Symptoms include,1
- Crying out in the night, or having nightmares
- Feeling tired, irritable, or confused upon waking
- Finding pajamas or sheets damp from perspiration
Diagnosing Hypoglycemia
The Whipple's triad is a diagnostic approach used to make a determination of hypoglycemia. It includes the collection of three criteria:
- Symptoms likely to be caused by hypoglycemia: It may be necessary to fast overnight or undergo an extended fast in a hospital setting. If symptoms present themselves after a meal, your health care provider will need to test glucose levels after your meals.
- Low glucose levels measured at the time of presenting symptoms from a drawn blood sample.
- The disappearance of symptoms when glucose level is raised to normal will confirm a diagnosis of hypoglycemia.
Your health care provider will also need to do a physical history to determine the underlying cause, including compiling a list of current medications, noting alcohol consumption, and documenting any critical illnesses.
Prevention and Treatment of Hypoglycemia
Hypoglycemia treatment is twofold; it involves the immediate, initial treatment to raise blood sugar levels, and the identification of the underlying condition / cause in order to prevent reoccurrences.
Prevention
Being prepared for hypoglycemia is a vital part of prevention and treatment, especially for those who use insulin or take an oral diabetes medication:
- Have a plan in place in case severe hypoglycemia develops
- Keep a blood glucose meter handy for frequent glucose level testing
- Keep several servings of quick-fix foods or drinks nearby
- Learn low blood glucose triggers
- Tell family, friends, and co-workers about the symptoms of hypoglycemia and how they can help
- Wear a medical identification bracelet
People with diabetes should include the following factors when considering preventatives:
Diabetes medications: Have a health care provider discuss medications that can cause hypoglycemia, as well as how and when to take medications. Recommended doses and times ought to be adhered to.
A meal plan: Eating regular meals, having enough food at each meal, and trying not to skip meals or snacks are vital steps for those with diabetes. A registered dietitian can assist in designing a customized plan, which ought to be carefully followed.
Monitoring daily activity: It may be desirable to
- check blood glucose levels before any physical activity, and have a snack if the level is below 100 milligrams per deciliter (mg/dL);
- adjust medication before engaging in physical activity; and
- check blood glucose after physical activity
Alcohol use: Alcoholic beverages can trigger hypoglycemia, and can be dangerous for those taking insulin or medications that encourage insulin production. Consumption of alcohol should always be accompanied by a snack or meal.
Treatment
Early symptoms can often be treated through the consumption of quick-fix sugar foods to raise blood sugar levels. Several pieces of hard candy, four ounces of fruit juice, one cup of milk, glucose tablets, glucose gel, or one tablespoon of honey will help raise levels that have fallen below 70 mg/dL.
For more severe symptoms, intravenous glucose or an injection of glucagon may be necessary. People who are prone to severe hypoglycemic episodes would be well advised to ask their health care provider about a home glucagon kit.
Fifteen minutes after the ingestion of a quick-fix food, recheck blood glucose levels to ensure it has reached 70 mg/dL. If it's still low, another quick-fix food should be consumed. Repeat this process until blood sugar level is 70 mg/dL or higher.
Normal and Target Blood Glucose Ranges2
Normal Blood Glucose Levels in People Who Do Not Have Diabetes:
Upon waking (fasting): 70 to 99 mg/dL
After meals: 70 to 140 mg/dL
Target Blood Glucose Levels in People Who Have Diabetes:
Before meals: 70 to 130 mg/dL
One to two hours after the start of a meal: below 180 mg/dL
Managing Hypoglycemia
If blood sugar control is maintained, you will feel better. And studies indicate that with proper management of blood glucose levels, the possibility of delaying and/or preventing the development of complications from diabetes - such as blood vessel, eye, kidney, and nerve damage - is increased.
Eating small meals and snacks every three or four hours goes a long way toward maintaining healthy glucose levels. Consumption of a variety of foods is highly recommended. Include fish, meat, poultry, or non-meat sources of protein; starchy foods such as potatoes, rice, and whole-grain bread; fruits and vegetables; and dairy products in your diet.
Limiting high-sugar foods, especially on an empty stomach, is also recommended, along with an adequate amount of physical activity.
Other Considerations in the Management of Hypoglycemia
Various minerals and vitamins affect insulin function and the metabolizing of glucose.3 Research shows that a large percent of people who have diabetes are deficient in nutrients and micronutrients.4 Multi-vitamin supplementation can fill in the nutritional gaps commonly present in pre-diabetics and diabetics. Look for a multi-vitamin that contains,
- Calcium
- Chromium
- Folic acid
- Magnesium
- Vanadium
- Vitamin A/Beta-carotene
- Vitamin B6
- Vitamin C
- Vitamin D
- Vitamin E
- Zinc
Sufficient fiber intake may reduce diabetes risk by improving blood sugar control, and promoting weight loss. Adequate fiber levels are also linked to decreasing heart disease risk. High-fiber foods include beans, fruits, nuts, seeds, vegetables, and whole grains.5
Whole grains help to maintain healthy blood sugar levels. Foods made from whole grains include breads, cereals, and pasta products. Check the label to ensure wheat content is whole grain.
The Glycemic Index: Foods that Act Like Sugar6
Healthy eating is one of the basic management tools for hypoglycemia. When considering what to eat in order to stay healthy if you are prone to hyporglycemia and/or have diabetes, it's important to know that there are many foods that behave the same way sugar does once they're in our system.
Dr. Scott Olson has written an insightful book about sugar addiction; Sugarettes examines the way in which we eat, how (and why) it is literally killing us, and what we can do about it. Dr Olson presents the Glycemic Index, a measure of how much certain foods increase blood sugar levels.
Click here to read an excerpt from Dr. Olson's book. A comprehensive, printable, Glycemic Index chart - which lists various foods and the level to which they increase blood sugar levels - is included. Read what Dr. Olson has to say about how to survive in the sugar-filled world we live in.
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Notes:
1. National Diabetes Information Clearinghouse (NDIC), "Hypoglycemia," http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/index.htm
(accessed May 19, 2009).
2. Ibid.
3. Tufts Ebcam: Tufts University Program in Evidence-based Complementary and Alternative Medicine, "Multivitamins and Type 2 Diabetes," http://www.tufts.edu/med/ebcam/nutrition/multi-diabetes.html (accessed April 1, 2009).
4. Melissa Diane Smith, "The Importance of a Daily Multivitamin and Mineral Supplement For People with Diabetes and Prediabetes," Diabetes in Control.com, June 21, 2005, Issue 26, http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=2865 (accessed April 1, 2009).
5. Mayo Foundation for Medical Education and Research (MFMER), "Diabetes: Prevention," http://www.mayoclinic.com/health/diabetes/DA99999 / (accessed April 1, 2009).
6. Dr. Scott Olson, Sugarettes, 2008, http://olsonnd.com/sugarettes/.
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