Hypoglycemia
Blood sugar - low; Low blood sugar
Signs and Symptoms
Since glucose (sugar) is the brain's primary fuel, your brain feels the majority of the effects of hypoglycemia:
- Headache
- Excessive sweating
- Blurred vision, dizziness
- Trembling, lack of coordination
- Depression, anxiety
- Mental confusion, irritability
- Heart palpitations
- Slurred speech
- Seizures
- Fatigue
- Coma
What Causes It?
The following conditions can cause hypoglycemia:
- Taking too much insulin, skipping a meal, exercising too strenuously, drinking too much alcohol (in people with diabetes)
- Critical organ failure (kidney, heart, or liver)
- Hormone deficiencies
- Tumors
- Fasting
- Inherited abnormalities
- Lack of an appropriate diet, especially with a critical illness
- Strenuous exercise
- Recovery from gastrointestinal surgery
- Certain medications, including quinolones, pentamidine, quinine, beta blockers, angiotensin-converting enzyme agents and IGF
- Autoimmune disorders
- Prolonged illness
What to Expect at Your Doctor's Office
If your symptoms are not severe, your health care provider will order a blood test called a glucose tolerance test, the same test used to diagnose diabetes. If your levels are only slightly below normal, diet and lifestyle changes may be sufficient. If your symptoms are severe, you will get glucose in either an oral or injectable form to bring your blood sugar level back to normal as quickly as possible. Additional tests may determine the cause of your low blood sugar.
Treatment Options
It is important to treat low blood sugar immediately to avoid long term serious effects. Hypoglycemia resulting from exercise several hours after a meal rarely produces serious symptoms. A glass of orange juice and a piece of bread can correct your blood sugar levels within minutes. However, in people with underlying diseases, fluctuating blood sugar levels are more serious and must be treated with oral or injectable forms of glucose. You can take oral glucose if you are able to swallow. If not, your doctor can give you an injection.
Drug Therapies
- Oral glucose for people who are able to swallow (10 to 20 g carbohydrate)
- Intravenous glucose for people who are unable to swallow
- Inhaled glucose, for people who are unable to swallow and want to avoid injections.
- Subcutaneous or intramuscular injection of glucagon is an alternative to the above treatments, but the individual must also eat because the effect of glucagon is short
- Intravenous mannitol and glucocorticoids may be used to treat an individual who remains in a coma after glucose levels return to normal
Complementary and Alternative Therapies
Long-term treatment is aimed at the cause of the hypoglycemia, but alternative therapies may also be useful in regulating blood sugar in the short term. Nutritional support should be part of treatment. Inform your physicians about all complementary and alternative treatments. Some of these treatments can interfere with conventional medical therapies. Work with a doctor who is knowledgeable in complementary medicine to find the right mix of treatments for you.
Nutrition and Supplements
Following these nutritional tips may help reduce symptoms:
- Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your doctor may want to test you for food allergies.
- Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), fresh vegetables, and sea vegetables.
- Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper).
- Avoid refined foods, such as white breads, pastas, and sugar, unless you need them for an immediate blood sugar increase.
- Soluble fiber, such as flaxseed and pure oat bran, can slow the rate at which dietary sugars enter the blood and help regulate blood sugars throughout the day. Consume 1 to 3 tsp. of either of these fiber sources before meals with a full glass of water. Talk to your doctor first if you have a history of digestive disorders.
- Some doctors may suggest a high protein diet, although evidence is mixed on the benefits. A "Zone"-style diet combines proteins, fats, and carbohydrates in a 30/30/40 ratio and can be very helpful in maintaining stable blood sugar throughout the day. Eat lean meats, preferably those that do not contain hormones or antibiotics. Cold-water fish or beans can also be used for protein. Limit the intake of processed meats, such as fast foods and lunch meats.
- Use healthy cooking oils, such as olive oil or coconut oil.
- Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid alcohol and tobacco. Lower caffeine intake, as caffeine impacts several conditions and medications.
- Exercise, if possible, 30 minutes daily, 5 days a week. Light exercise may be advisable at first until you learn to control your blood sugar and manage your diet to tolerate higher intensity exercise.
You may address nutritional deficiencies with the following supplements:
- A daily multivitamin. Containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
- Omega-3 fatty acids, such as fish oil. To help reduce inflammation and help with immunity. Omega-3 fatty acids can have a blood-thinning effect. If you take blood-thinning medications, speak to your doctor before taking omega-3 fatty acids.
- Vitamin C. As an antioxidant and for immune support.
- Alpha-lipoic acid. For antioxidant support. Alpha-lipoic acid can potentially interact with certain chemotherapy medicines.
- Magnesium, for nutrient support. If you are taking blood pressure medication or other heart medication, speak to your doctor before taking magnesium. Magnesium can interfere with certain medications, including some antibiotics and biphosphate medication.
- Chromium. For blood sugar regulation. If you have liver or kidney issues, or a history of psychiatric issues, talk to your doctor before starting chromium supplements.
- Probiotic supplement (containing Lactobacillus acidophilus). When needed for maintenance of gastrointestinal and immune health. If you are immune compromised, or on immunosuppressive drugs, speak to your doctor before taking probiotics. Some acidophilus products may need refrigeration -- read labels carefully.
Herbs
Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures singly or in combination as noted. If you are pregnant or nursing, talk to your doctor before using any herbal products.
- Green tea (Camellia sinensis). For antioxidant effects. You may also prepare teas from the leaf of this herb. Caffeine-free products are available and preferable.
- Holy basil (Ocimum sanctum). For stress balance. You can also prepare teas from the plant. Holy basil may slow blood clotting and therefore increase the effect of blood-thinning medicines, such as warfarin (Coumadin). There may be an interaction with Phenobarbitol.
Acupuncture
Acupuncture may decrease stress, increase coping skills, and regulate hormone function.
Following Up
Any underlying condition that may be causing your hypoglycemia must be aggressively treated so that your episodes do not recur. If you have hypoglycemia when you exercise, carry a healthy snack with you. hypoglycemia causes a cascade of effects that may induce stress and cardiac arrhythmias (irregular heart beat), contribute to sudden cardiac death, and cause bleeding in the brain. Speak to your doctor.
Special Considerations
DO NOT ignore the signs and symptoms of hypoglycemia. Untreated, it can cause irreversible brain damage, coma, or even death.
Supporting Research
Alagiakrishnan K. Approach to managing hypoglycemia in elderly patients with diabetes. Postgrad Med. 2010;122(3):129-37.
Bergqvist AG, Schall JI, Gallagher PR, et al. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia. 2005;46(11):1810-9.
Campbell-Tofte JI, Mølgaard P, Josefsen K, et al. Randomized and double-blinded pilot clinical study of the safety and anti-diabetic efficacy of the Rauvolfia-Citrus tea, as used in Nigerian traditional medicine. J Ethnopharmacol. 2011;133(2):402-11.
Chen XW, Serag ES, Sneed KB, et al. Clinical herbal interactions with conventional drugs: from molecules to maladies. Curr Med Chem. 2011.
Choudhary P. The use of technology to reduce hypoglycemia. Pediatr Endocrinol Rev. 2010;7 Suppl 3:384-95.
Dailey G. Assessing glycemic control with self-monitoring of blood glucose and hemoglobin A(1c) measurements. Mayo Clin Proc. 2007;82(2):229-35; quiz 236.
De Feo P, Di Loreto C, Ranchelli A, et al. Exercise and diabetes. Acta Biomed. 2006;77 Suppl 1:14-7.
Finfer S, Liu B, Chittock DR, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med. 2012;367(12):1108-18.
Frier BM. Managing hypoglycaemia. Practitioner. 2005;249(1673):564, 566, 568 passim. Review.
Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016.
Guettier J, Gorden P. Hypoglycemia. Endocrinology and Metabolism Clinics. 2006;35(4).
Hsu PF, Sung SH, Cheng HM, et al. Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study. Diabetes Care. 2013;36(4):894-900.
Husband AC, Crawford S, McCoy LA, Pacaud D. The effectiveness of glucose, sucrose, and fructose in treating hypoglycemia in children with type 1 diabetes. Pediatr Diabetes. 2010;11(3):154-8.
Jeschke MG, Pinto R, Herndon DN, Finnerty CC, Kraft R. Hypoglycemia is associated with increased postburn morbidity and mortality in pediatric patients. Crit Care Med. 2014;42(5):1221-31.
LeRoith D, Smith DO. Monitoring glycemic control: the cornerstone of diabetes care. Clin Ther. 2005;27(10):1489-99.
McCall AL, Insulin therapy and hypoglycemia. Endocrinol Metab Clin North Am. 2012 Mar;41(1):57-87.
McCoy RG, Van Houten HK, Ziegenfuss JY, Shah ND, Wermers RA, Smith SA. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care. 2012;35(9):1897-901.
McTavish L, Wiltshire E. Effective treatment of hypoglycemia in children with type 1 diabetes: a randomized controlled clinical trial. Pediatr Diabetes. 2011;12(4 Pt 2):381-7.
Mowery NT, Gunter OL, Kauffmann RM, Diaz JJ, Collier BC, May AK. Duration of time on intensive insulin therapy predicts severe hypoglycemia in the surgically critically ill population. World J Surg. 2012;36(2):270-7.
Murad MH, Coto-Yglesias F, Wang AT, et al. Clinical review: Drug-induced hypoglycemia: a systematic review. J Clin Endocrinol Metab. 2009;94(3):741-5.
Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, et al. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care. 2008;31(1):9-14.
Pearson T. Glucagon as a treatment of severe hypoglycemia: safe and efficacious but underutilized. Diabetes Educ. 2008;34(1):128-34.
Renard E. Monitoring glycemic control: the importance of self-monitoring of blood glucose. Am J Med. 2005;118(Suppl 9A):12S-19S.
Roche-Recinos A, Charlap E, Markell M. Management of glycemia in diabetic patients with stage IV and V chronic kidney disease. Curr Diab Rep. 2015;15(4):25.
Rowden A, Fasano C. Emergency management of oral hypoglycemic drug toxicity. Emergency Medicine Clinics of North America. 2007;25(2).
Santos Cavaiola T, Edelman S. Inhaled insulin: a breath of fresh air? A review of inhaled insulin.Clin Ther. 2014; 36(8):1275-89.
Shaw KM. Overcoming the hurdles to achieving glycemic control. Metabolism. 2006;55(5 Suppl 1):S6-9.
Sumida KD, Hill JM, Matveyenko AV. Sex differences in hepatic gluconeogenic capacity after chronic alcohol consumption. Clin Med Res. 2007;5(3):193-202.