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Hypoglycemia in Diabetes Mellitus

Hypoglycemia in Diabetes Mellitus

(Low Blood Glucose) 

Insulin is a hormone produced by the pancreas to help our body utilize sugar and other starches. In diabetes, blood glucose (BG) levels are high because of absence of insulin production (type 1 diabetes) or deficiency of insulin plus insulin resistance (type 2 diabetes).  Diabetes is managed by dietary changes, increase in activity level and medications including insulin.  Depending on the type of diabetes, severity of diabetes and certain other conditions which may coexist, insulin therapy is needed in many patients with diabetes.  The goal is to keep BG levels in the normal range (80 to 180 mg/dL; depending on time of the day and fasting versus fed state). 

There may be times when your BG levels may drop too low (called hypoglycemia).  For most people, BG <70 mg/dL is considered low BG.  Generally, hypoglycemia is considered serious and blood glucose is less than 55 mg/dL or the patient has altered consciousness along with low blood glucose readings.  If untreated or prolonged, this may lead to brain damage or even death.  Hypoglycemia may occur with certain diabetes medications (particularly sulfonylureas – such as glyburide, glimepiride, or glipizide) and/or insulin therapy.  Hypoglycemia may occur in patients with diabetes, when: 

  • You have skipped or delayed meal 
  • You have not eaten enough carbohydrates 
  • You have increased activity, compared to your normal activity 
  • You are sick 
  • You had consumed alcohol, without eating enough food 

Hypoglycemia is very uncommon in patients without diabetes.  Potential causes include reactive hypoglycemia (which may occur in those individuals who have prediabetes or are at risk of developing type 2 diabetes), alimentary hypoglycemia (which may occur in patients who have undergone bariatric surgery) or insulinoma (very rare and usually benign tumours composed of β cells in the pancreas – the cells which normally make insulin) 

If your blood glucose is too low, you may feel 1 or more of the following symptoms: 

  • Shaky 
  • Sweaty 
  • Hungry 
  • Dizzy 
  • Weak 
  • Nervous 
  • Anger 
  • Confusion 
  • Headaches 
  • Unconsciousness 

Low BG symptoms and when they occur, may vary from person to person and may change over time in the same person as well.  Sometimes, there may be no symptoms at all.  This is more common in patients with long-term diabetes with a history of recurrent hypoglycemia and could be quite dangerous. 


Eat or drink 15 g of carbs right away. 

 (e.g. 4 ounces (1/4 cup) of regular fruit juice, 4 ounces of regular soda pop (0.5 can), 4 glucose tablets, one tube of glucose gel etc). 

Wait 15 minutes and then check your BG again.  If BG is still <70 mg/dL, eat or drink another 15 grams of carbs.  Repeat the above steps until your blood glucose is back to normal. 

If your next meal is > 1 hour away, eat a snack to maintain the glucose in the normal range until you eat. 

If hypoglycemia is severe (usually < 55mg/dL & associated with altered consciousness), instead of giving glucose orally, an emergency medicine called glucagon (intravenously or subcutaneously or via nasal route) can be administered by a family member.  Glucagon is a naturally occurring hormone which causes the release of glucose from the liver within a minute or 2 and can be extremely useful in treating severe hypoglycemia. 

This information is for general knowledge & is not a substitute for medical advice your doctor  


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