Hypoglycemia is a condition in which there is a deficiency of glucose in the blood. The blood sugar falls below 70 mg/dL, that is, below the normal limits. This is very often seen in diabetics who have developed instability in their condition and the blood sugar levels swing wildly, that from being above normal to being below normal.

Normal blood sugar levels are defined as follows:

Fasting for 8 hours = less than 100 mg/dL
Two hours after a meal = less than 140 mg/dL

Causes of hypoglycemia in Diabetes  

Glucose obtained from our food is carried by the blood to the various body cells for their utilization. Any extra blood glucose is then stored in the liver and muscles in the form of glycogen and further, more of it is stored in the body in the form of fats.

When in between meals, energy is required by the body, glucagon, a hormone produced by the pancreas stimulates the liver to break down the glycogen into glucose and release it for the required energy for body use. Fats, if required, also provide energy. Glucose levels are thus maintained.

The pancreas thus performs both the functions of

lowering increased blood glucose levels by secreting insulin into the blood  and
increasing lowered blood glucose levels by secreting glucagon into the blood.
The pancreas, therefore, plays a very important role in maintaining normal blood glucose levels.

In diabetes type 1, the pancreas does not produce sufficient insulin because the insulin-producing beta cells of the pancreas are destroyed by the autoimmune system of the body.

In diabetes type 2, the body cells do not respond to the insulin and subsequently do not utilize the glucose in the blood.

In diabetes, the stimulation of glucagon is impaired, causing the blood glucose levels to fall. This can cause hypoglycemia.

However, there is a backup mechanism where hormones like adrenaline also raise the blood glucose levels, but with the diabetic treatment being taken with insulin or other pills that raise insulin blood levels, the glucose levels do not rise and start falling below the normal levels. These low blood glucose levels cause hypoglycemia.

Causes of hypoglycemia in non-diabetics

  • Due to certain drugs including insulin and other diabetic treatment drugs.
  • Increased physical activity
  • Long periods of fasting or untimely food habits
  • Heavy consumption of alcohol can prevent the liver from releasing the stored glucose into the blood.
  • Liver diseases like severe hepatitis
  • Kidney diseases can impair the excretion of medications causing them to build up in the blood
  • Adrenal insufficiency
  • Long-term starvation can cause a deficiency of substances needed for glucogenesis (glucose production). This can lead to hypoglycemia.
  • Cancer
  • Certain tumors like insulinoma which cause excessive production and secretion of insulin.

Symptoms and signs

Low blood sugar hypoglycemic symptoms are typical and mentioned below.

  • Excessive sweating
  • Shivering and a feeling of cold
  • Headache
  • Confusion,  irritability, and nervousness
  • Weakness
  • Slurred speech due to less sugar to the brain
  • In extreme cases, the patient may go into  hypoglycemic coma and may even die, if not attended to on time

Treatment and management

1) Prompt treatment for hypoglycemic attack

Prompt treatment is given when the patient is having the hypoglycemic attack and is conscious. This treatment consists of giving 3 to 4 glucose pills or glucose gel or glucose mixed in water or candy. you can also use two teaspoons of sugar or honey.

The idea is to administer sugar in any form which is immediately available. If the patient is unconscious, he has to be administered intravenous glucose as quickly as possible.

A diabetic patient, who is prone to hypoglycemic attacks, must always carry an identity card with him, mentioning this condition. He must always have in his possession, sugar packets or glucose gel, which he can take, should any of the symptoms show signs of appearing.

2)  Long-term treatment for hypoglycemia

If a  diabetic patient who is under treatment, develops hypoglycemia, he must regularly follow-up with his health provider. He or she may require a change either in his medication or in dosage to keep the blood sugar levels stable and within normal limits.

3) Hypoglycemic diet and foods 

The hypoglycemic diet should adhere to the following guidelines:

  • Have several small meals – say 4 to 5 during the day instead of 2 large meals.
  • Complex carbohydrates, because they are slower to be absorbed and thereby, fluctuation of blood sugar is avoided. Complex carbohydrates are found in whole grains, brown rice, cereals, vegetables, pasta, and legumes.
  • High fiber foods. Due to the presence of fiber in your diet, carbohydrates are absorbed at a slower rate, thereby preventing blood sugar fluctuation. High fiber foods are whole grains such as cereals, brown rice, wheat, and bread.
  • Vegetables like green leafy vegetables, cabbage, brussels, sprout, carrots, potatoes and beetroot
    Fruits like apples, bananas and citrus fruits like strawberries
  • Peas and dried beans.
  • Proteins can be obtained from fish, chicken, and turkey without skin, low-fat yogurt, and raw cheese.

4) Alcohol and hypoglycemia

Alcohol consumption causes blood sugar to fall and hence patients who have experienced hypoglycemic episodes should avoid alcohol consumption.

5) Hypoglycemia and exercise

  • Avoid heavy exercises. Stick to light exercises.
  • Always check your blood sugar regularly, before and after starting your exercises, initially. Do not exercise if your blood sugar levels are not within normal limits.
  • Always warm up before starting your exercise.
  • A small intake of rapidly absorbing carbohydrates is advised before starting exercises, especially if you are highly hypoglycemic.

6) Maintain an optimum weight

Foods to Avoid in Hypoglycemia

You should not eat the following foods if you suffer from hypoglycemia

  • Caffeine
  • Grapes
  • Prunes
  • Starchy foods


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