Past Feature Article

Hypoglycemia (Low Blood Sugar)

By: Michael Grimes, PharmD
Rite Aid Pharmacist and Diabetes Care Specialist at Store 1094 in Pittsburgh, PA

Hypoglycemia or low blood sugar is commonly defined as any blood sugar less than 70 mg/dL. Hypoglycemia can be dangerous if left untreated. For this reason, people with diabetes should be familiar with the symptoms of hypoglycemia, its causes, and how to prevent and treat it. It is important to note that you may have symptoms with a blood sugar level higher than 70mg/dL if your blood sugar is changing quickly.

Common Signs of Mild/Moderate Hypoglycemia

Fatigue
Sweating
Dizziness
Pale skin color
Sudden mood changes/irritability
Hunger
Confusion
Increased heart rate
Blurred vision

Signs of Severe Hypoglycemia

More severe hypoglycemia may result in slurred speech, seizures and/or unconsciousness. Different people may experience different symptoms. Let your family and friends know what symptoms you typically experience.

Causes of Hypoglycemia

Missing meals
Taking too much medication or insulin
Exercising
Drinking alcohol, especially on an empty stomach

Prevention

What steps can you take to prevent hypoglycemia?

Eat meals and snacks on a regular schedule.
Test glucose (blood sugar) levels frequently.
Take your medications/insulin at its prescribed dosage and time unless otherwise instructed by your healthcare provider.
Monitor blood glucose levels to determine the effects exercise has on you. You may need to plan on a snack prior to or during exercise.
Limit alcohol intake. If consuming an alcoholic drink, be sure to eat.

Treatment

What can you do to treat hypoglycemia? If possible, you should first check your blood sugar. If you can’t check it, treat the situation as a confirmed low blood sugar just in case. Eating a snack containing about 15 grams (g) of carbohydrates should help bring your blood sugar back up.

Foods that contain 15 g of carbohydrates include:

3-4 glucose tablets
6oz (about ½ can) of regular soda (not diet)
1 cup of skim milk
1/2 -3/4 cup of fruit juice
6 jelly beans
1 tablespoon of sugar
1-2 tablespoons of honey

Limiting the serving size to 15 g of carbohydrates helps to prevent over treating and running your blood sugar too high. After having the snack, you should wait 15 minutes and then check your blood sugar again. If the reading is still low, repeat the process.

You may want to have another snack or a meal in the near future to avoid recurrence of the low. If you experience hypoglycemia often, carry a quick-acting source of carbohydrates like glucose tablets with you at all times.

Caution

If you do not have glucose tablets or other simple sugar foods available, choose your treatment carefully. Chocolate and other foods high in fat or protein can slow down how quickly the carbohydrates enter the body. Therefore, treating with these foods may result in you feeling bad for longer and your blood sugar not rising as quickly.

If you take the medications acarbose (Precose®) or miglitol (Glyset®) to help control your blood sugars, use only simple sugars like glucose tablets to treat hypoglycemia. These medications slow/block the absorption of more complex carbohydrates into the body, so snack options that do not contain simple sugars would not work properly.

People who have frequent hypoglycemic episodes, especially individuals who have had diabetes for a long time, may develop hypoglycemia without any warning signs. A person could pass out with little or no signs that his/her blood sugar is dropping. For this reason, frequent blood sugar monitoring is important, and a low blood sugar should be treated, even if you don’t experience any symptoms.

Severe Hypoglycemic Reactions

If you experience severe low blood sugar reactions, you should consider discussing glucagon with your physician. Glucagon is an injection available by prescription that makes the liver release sugar into the bloodstream. If you became unconscious, you wouldn’t be able to drink juice or chew glucose tablets, so a glucagon injection becomes necessary. Emergency help should be contacted in these circumstances. Be sure to educate family and friends on the appropriate use of a glucagon injection. After regaining consciousness, fruit juice or another quick carbohydrate source, as well as a snack or meal, may be required to maintain goal blood sugar levels. After an incident like this you should also contact your healthcare provider. A medical ID for diabetes should be worn to help medical personnel clarify emergency situations and make appropriate treatment decisions.

Remember . . .

Your health care team, including your Rite Aid pharmacist, can help answer your questions. Talk to your diabetes care team about an action plan for you. Eat regular meals/snacks consistent with an appropriate meal plan, monitor your blood glucose levels regularly, evaluate your potential causes of hypoglycemia and take the appropriate steps to prevent these episodes. If you experience severe low blood sugar reactions, be prepared with glucagon and make sure those around you know how to use it.

You are not alone in managing your diabetes. Work with your diabetes care team, including your Rite Aid pharmacist, to develop the best action plan for you.