All of us know that high blood sugar levels are bad, but what about low blood sugar? Low blood sugar/ hypoglycemia can happen suddenly in an individual. Majority of the times it is usually mild, and can be treated quickly and easily by eating or drinking a small amount of glucose-rich food. However, if left untreated, it can get worse and cause confusion, or fainting. In severe cases, it can lead to coma, and even death. Similar to fever, hypoglycemia is not a disease by itself; but rather a sign of an underlying health problem.

After we eat, food is broken down into simple sugars. These are absorbed in the bloodstream as glucose. The body requires glucose (sugar) as this is the main source of energy. If we have eaten more sugar than required, the extra sugar gets stored in the muscle and liver. When our blood sugar begins to fall, a hormone tells our liver to release glucose and this raises our blood sugar levels under normal circumstances. If this does not happen, our blood sugars can go seriously low resulting in a condition known as hypoglycemia.

There are several reasons why hypoglycemia may occur in an individual. Hypoglycemia is commonly seen at some point of time in almost all persons with diabetes, and occurs as a side effect of drugs used for the treatment.

Insulin is a hormone produced by the pancreas in our body when blood sugar levels are increased. Insulin moves sugar out of the blood and into the body's cells, where it's used as energy. If a person with diabetes takes too much insulin or does not eat enough food to balance the effects of insulin, a drop in blood sugar occurs resulting in hypoglycemia.

There are a few causes of hypoglycemia. They are:

  • Strenuous exercises
  • Psychological disturbances
  • Alcohol consumption
  • Eating adequately
  • Insulin-producing cancer in the pancreas
  • Poisoning or accidental consumption of certain drugs

In non-diabetics, hypoglycemia related to eating rarely occurs in teenagers and adults, unless the starvation is severe.

Each person responds in a different way when experiencing low blood sugar, so it is important to be aware of the different possible symptoms of hypoglycemia and respond to them without delay. The person may have the following hypoglycemia symptoms:

  • Pale and sweaty skin
  • Hunger
  • Shakiness
  • Anxiety
  • Fast pounding heartbeat

The brain is the organ that suffers most significantly and most rapidly, when there's a drop in blood sugar as enough glucose does not go to the brain. These symptoms include:

  • Headache
  • Blurry or double vision
  • Fatigue
  • Weakness

When this is severe, short supply of glucose flow to the brain can cause the following signs:

  • Confusion
  • Seizures
  • Loss of consciousness

These signs and symptoms are not exclusive of hypoglycemia and can be due to other causes. Therefore, the only way to be sure of hypoglycemia is measurement of the blood sugar level at the time when symptoms appear.

People with diabetes and early signs of hypoglycemia should seek immediate help if symptoms do not improve with eating or taking glucose tablets.

The doctor will take a detailed medical history, diet history, and timing of the symptoms (whether they occur after eating high-sugar meals/if the symptoms go away quickly after eating sugar).

In addition to this physical examination and blood tests will be done to measure blood sugar levels and insulin levels.

The correct diagnosis of hypoglycemia can be made only by testing the person’s blood sugar when he/she has the symptoms. If such a test shows that the blood sugar is actually low, the doctor may order for further specific tests to diagnose specific diseases that can cause hypoglycemia.

The treatment of hypoglycemia must be immediate with an aim to raise the blood sugar levels to the normal range. When an individual feels his/her blood glucose is too low, then blood sugar must be checked using a glucometer (device to measure blood sugar).

If the sugar levels are below 70 mg/dL, then about 10–15 grams of carbohydrate should be adequate to raise the sugar levels. That can be half a cup of any fruit juice, half a can of regular soda, 2 tablespoons of raisins, a glass of milk or 5 to 6 pieces of hard candy. Other quick-fix foods such as 1 tablespoon of sugar or honey, 3 or 4 glucose tablets, or 1 serving of glucose gel also works well.

The person will feel better in 10–15 minutes. After that blood sugar levels need to be rechecked in 15 minutes to ensure it is 70mg/dl and above. If it’s still too low, another serving of a quick-fix food should be eaten.

These steps should be repeated until the blood glucose level is 70 mg/dL or above. If the next meal is after an hour or more a snack should be eaten once the blood glucose level are raised to 70 mg/dL or more.

If the symptoms are severe and the person cannot take sugar by mouth, he/she may require intravenous glucose. However, long-term treatment for hypoglycemia requires identifying and treating the underlying cause.

It is important to ensure that whenever a person with diabetes changes his/her meal schedules or activity levels and medications, the monitoring of the blood sugar levels is a must as subsequent dose adjustments of blood sugar-lowering medications may be needed to be done.

He/she needs to discuss these changes with the health care team. An individual with diabetes can stabilize his/her blood glucose levels by having small well balanced healthy meals regularly with not more than three to four hours between snacks and avoid overeating.

An adequate supply of snacks must be readily available to eat every few hours. He/she also need to refrain from eating sugary meals and alcohol on empty stomach. Also it is important to make sure that body weight does not increase or decrease rapidly. As caffeine triggers the pancreas to secrete more insulin it is best to avoid coffee, tea, cola-based drinks.

If the person suffers from type1 diabetes it is essential to check glucose level periodically to detect hypoglycemia during sleep, and make adjustments to prevent its reoccurrence.

It is also strongly recommended that an individual with diabetes check his/her blood sugar before driving a car or engaging in other potentially dangerous activities.

If the person does not have diabetes but has repeated attack of hypoglycemia, eating frequent small meals throughout the day will help in preventing blood sugar levels from getting too low. However, as a long term strategy it is advisable to always work with the doctor to identity and treat the underlying cause of hypoglycemia.