If you have diabetes, talk to your healthcare team about hypoglycemia

Work with your doctor to monitor your glucose and change your treatment to prevent the extreme lows you are experiencing.
— Ashley

There are some essential questions you can ask your healthcare team when you’re discussing the risks, symptoms and treatment of hypoglycemia (low blood sugar).

What is hypoglycemia?

Hypoglycemia is the technical term for blood glucose (sugar) levels that are lower than 4 mmol/L. Hypoglycemia is more common in people with type 1 diabetes (an autoimmune disease that causes the pancreas stops producing insulin), but it can also happen to people with type 2 diabetes (a disease that occurs when the body does not use insulin properly).


What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia include:

  • Feeling shaky, light-headed

  • Headache or nausea

  • Feeling nervous, irritable, anxious or confused

  • An inability to concentrate 

  • Feeling hungry 

  • A fast heart rate 

  • Feeling sweaty, weak or drowsy 

  • Having numbness or tingling on the tongue or lips 


What can cause hypoglycemia?

Hypoglycemia can happen for a number of reasons, including:

  • Exercising more than usual

  • Taking too much diabetes medication 

  • Not eating on time, or eating less food than usual

  • Skipping a meal

  • Drinking alcohol


What medications can cause hypoglycemia?

Some diabetes medications can actually cause low blood sugar levels, because they stimulate the release of insulin. The medications that are known to cause hypoglycemia include:

  • Insulin

  • Sulfonylureas, including glimepiride and glyburide 

  • Meglitinides, such as repaglinide and nateglinide (if you take these medications without eating a meal) 

How can hypoglycemia be prevented?

There are a number of things that people with diabetes can do to prevent hypoglycemia:

  • Don’t skip or delay meals or snacks.Be consistent about the amount you eat and the timing of your meals and snacks.

  • Test your blood sugar regularly.Depending on your diabetes treatment plan, check and record your blood sugar level as recommended by your diabetes healthcare team. Careful monitoring is the best way to ensure that your blood sugar levels remain within your target range.

  • Take your medications as prescribed, and take them on time.Always take your medication exactly as recommended by your healthcare team.

  • Adjust your medication or eat a snack if you increase your physical activity.The food and medication adjustments depend on your blood sugar level before and after exercise, and the type and duration of the activity you’ll be doing. Your healthcare team can help you figure out how to adjust your medications or food intake in relation to different physical activities.

  • Discuss medication options with your diabetes healthcare teamIf you are experiencing frequent episodes of unexplained hypoglycemia, you might consider switching your diabetes medications. Some drugs are less likely to cause hypoglycemia than others. 

  • If you have an alcoholic beverage, eat a meal or snack at the same time.This will help your body absorb the alcohol more slowly, and lower your risk of hypoglycemia. It is important to know that alcohol can cause delayed hypoglycemia, which means you could still be at risk of hypoglycemia the next morning or up to 24 hours after consuming alcohol. 


How is hypoglycemia treated?

The first thing you should do when experiencing low blood sugar is to eat or drink 15 grams of a fast-acting carbohydrate. Choices of carbohydrate include: 

  • 3 glucose tablets (5 grams each)

  • 15 millilitres (1 tablespoon) or 3 packets of sugar dissolved in water

  • 5 cubes of sugar

  • 150 millilitres (⅔ cup) of fruit juice or regular soft drink

  • 6 Life Savers

  • 15 millilitres (1 tablespoon) of honey

After eating or drinking 15 grams of carbohydrate, wait 15 minutes and check your blood sugar again. If it is still low, then treat again with 15 grams of carbohydrate, wait another 15 minutes and recheck your blood sugar. Repeat these steps until your blood sugar is above 4 mmol/L.

Hypoglycemia can be a frightening and dangerous experience, which is ultimately a major obstacle in achieving your blood glucose targets. It’s therefore important to talk to your diabetes healthcare team about hypoglycemia so you become better prepared to recognize and manage it.

For more information on hypoglycemia, as well as additional information and resources to help you live well with diabetes, visit Diabetes Care Community.