For those living with diabetes, the possibility of hypoglycemia or hypoglycemia (sugar) levels can always be a concern. If a diabetic patient cannot detect a lower blood glucose level, or a condition known as hypoglycemia, an extra layer of complexity is added.
It is more common and potentially dangerous than most people think.
In this article, we will explain what you need to know about hypoglycemia, how to treat it, and what you need to know about the steps you can take to prevent it.
What is hypoglycemia?
Hypoglycemia, known as hypoglycemia, occurs when glucose levels in the bloodstream fall below normal levels. This is often the result of an imbalance between factors that increase blood sugar, such as food intake, and factors that lower that, such as insulin and other glucose-lowering drugs.
While everyone with diabetes can experience hypoglycemia levels, people who use insulin generally experience episodes of hypoglycemia more frequently.
What is considered hypoglycemia varies from person to person based on your health history, health goals, and blood sugar levels you and your health provider deemed to be the best for your target range.
The US Centers for Disease Control and Prevention (CDC) describes hypoglycemia levels as below 70 mg/dL (3.9 mmol/L) in people with diabetes.
Severe hypoglycemic levels are thought to be below 54 mg/dL (3.0 mmol/L). This requires immediate treatment with either rapid glucose or glucagon (if the person is unable to chew or swallow).
For more information about hypoglycemia, see below. Symptoms of hypoglycemia (hypoglycemia).
What are the symptoms of hypoglycemia?
Common symptoms of hypoglycemia include:
- Shakakkes
- Dizziness
- Fatigue/Warriness
- sorrow
- confusion
- sweating
- Rapid heart rate
- Nervous
- Hungry
- It’s hard to concentrate
- I’m irritated
Symptoms of severe hypoglycemia include:
- Unclear speech
- Confused thoughts
- Loss of consciousness
- Crucifixion
- Panel
- In rare cases, death
If a person is unable to chew or swallow, glucagon management is unavailable or ineffective. I’ll call 911 immediately.
Read more about hypoglycemia symptoms: Symptoms of hypoglycemia (hypoglycemia).
What is hypoglycemia?
Hypoglycemia is a condition in which someone does not get the normal physical warning sign of low blood sugar levels.
It is much more common than many people think, and is estimated to affect around 40% of people with type 1 diabetes. It also affects 10-15% of people with type 2 diabetes who use a class of medications known as insulin or sulfonylurea. Both can cause hypoglycemia.
Taking insulin increases the risk of lowering blood glucose levels and frequently lowers hypoglycemia levels. It increases the risk of developing perception of hypoglycemia.
The discomfort of hypoglycemia significantly increases the risk associated with hypoglycemia episodes by impairing the ability of a person to recognize and respond to early warning signs of hypoglycemia.
This can lead to severe hypoglycemia due to lack of consciousness. Without prompt treatment, it can lead to acute complications such as loss of consciousness, seizures and, in extreme cases, life-threatening consequences.
Furthermore, episodes of severe hypoglycemia recurrence can contribute to long-term complications such as cardiovascular and cognitive issues.
The risk and incidence of severely experiencing hypoglycemia levels increases dramatically for people who are not aware of hypoglycemia.
What are the risk factors for recognition of hypoglycemia?
There are several known risk factors for developing hypoglycemia discomfort, including:
- Long-term use of insulin. Studies have shown that the risk of developing hypoglycemia increases with the duration of insulin treatment. For example, in one study, about half of people who used insulin for more than 20 years had no recognition of hypoglycemia, but only about 20% of people who took insulin for less than 10 years experienced it.
- History of recent and/or recurrent hypoglycemic events (such as low nights when low ones may not be detected or treated).
- Older.
What causes hypoglycemia recognition?
The exact cause of hypoglycemia is not fully understood. However, several important factors are thought to contribute to its development.
- Frequent episodes of hypoglycemia can lead to a condition known as hypoglycemia-related autonomic neuropathy (HAAF), which reduces the sensitivity of the body’s normal alert system to hypoglycemia. Essentially, the body and brain begin to adapt to hypoglycemic levels, reducing the perception of hypoglycemic symptoms.
- While important glycemic control is important to manage diabetes and prevent long-term complications, it can paradoxically increase the risk of hypoglycemia recognition. This is because aiming for hypoglycemic targets can lead to more frequent episodes of hypoglycemia, which can increase the likelihood of HAAF.
Not everyone taking insulin is aware of hypoglycemia, but the chances increase over time someone has diabetes. Those who live with diabetes for a long period, especially those who consistently aim for very tight glycemic control, are at a higher risk of developing this condition.
Can the drug cause non-recognition of hypoglycemia?
Certain drugs, including beta blockers, can hide symptoms of hypoglycemia, such as heart motion pits and trembling, making it difficult to detect low levels of approaching. This is because they block the action of adrenaline.
These drugs treat conditions such as angina pectoris (a type of chest pain), heart failure, and hypertension, but this effect on adrenaline can make it more difficult to detect early signs of hypoglycemia.
Selective serotonin reuptake inhibitors (SSRIs) used to treat depression can also mask low symptoms, but the impact is less clear.
Additionally, alcohol can interfere with blood glucose regulation and hide the worst symptoms. This substance can also have double problems as it may increase the likelihood of lowering.
Are there any complications due to the recognition of hypoglycemia?
Having a perception of hypoglycemia significantly increases the risk of both short-term and long-term complications.
Without the typical early warning signs of hypoglycemia, the situation is more likely to become aware and become serious by the time treatment is attempted. These severe lows can impair critical functions, make it difficult to carry out daily activities such as driving, reading, and working, and cloud judgment and recognition of clouds.
If hypoglycemia is not treated quickly enough, it can cause more serious complications, such as loss of consciousness, seizures, coma, and brain damage. Over time, recurrent severe hypoglycemia can also contribute to cardiovascular complications and cognitive decline.
How can I prevent hypoglycemia?
If you notice that you no longer detect symptoms of hypoglycemia, talk to your healthcare provider.
Most people with diabetes should be able to experience hypoglycemia levels when they reach 70 mg/dL (3.9 mmol/L), but this level can vary depending on people with a history of frequent lows.
If a person with diabetes is not aware of hypoglycemia, there are formal programs to improve blood glucose recognition. Additionally, healthcare providers can discuss potential ways to become more sensitive to lower blood sugar levels.
Healthcare providers may suggest lowering daily insulin doses, slightly increasing the target’s blood glucose level, or modifying their physical activity routines to prevent hypoglycemic levels in the first place.
You may also be able to catch hypoglycemia faster by checking your blood glucose levels more frequently or wearing a continuous glucose monitor (CGM). If it’s severely low, it’s also recommended to carry rapidly acting carbohydrates with you for immediate treatment, just like the glucagon kit is on hand (glucagon is a hormone that helps you increase your glucose levels).
For some people, diabetes alert dogs (DADs) may provide an additional layer of safety by alerting them of hypoglycemia. However, this option requires consideration of the training and commitments involved.
Additionally, some people found that switching to slow-acting insulin is useful when experiencing persistent hypoglycemia awareness. These insulins have slower release times and provide a more predictable lower blood glucose effect, which may help prevent severe low levels.
For those with access to technology, automated insulin delivery (AID) systems can greatly help prevent hypoglycemia.
These systems use values from the CGM and run through an algorithm to determine the amount of insulin delivered through the pump. Insulin decreases or pauses as blood glucose levels drop, helping to prevent hypoglycemia.
Several aid systems are available in the US, including the Medtronic Minimed 770G system, the Medtronic Minimed 780G system, the Slim X2 with tandem diabetes care T: Control-IQ technology, and the Omnipod 5 automatic insulin delivery system.
You may not always be able to reverse hypoglycemia, but you can increase your sensitivity primarily by avoiding hypoglycemia levels for a while.
Work closely with your physician to tailor these approaches to your specific needs and situation.
Tips for preventing hypoglycemia
Although hypoglycemia cannot be prevented in all cases, the following strategies can minimize the frequency of experiencing them:
- See your doctor or endocrinologist regularly for medication adjustments.
- Consider using food scales for a more accurate carbohydrate count.
- Eat meals and snacks on a schedule.
- Avoid exercise with blood glucose below 100 mg/dL (5.6 mmol/L) or even taking insulin recently to reduce the risk of exercise-induced hypoglycemia.
- Avoid falling asleep with blood sugar levels below 100 mg/dL (5.6 mmol/L) to reduce the risk of overnight hypoglycemia.
- Take all prescribed insulin and other medications.
- If you want to prepare a certain number of carbohydrates, eat all the carbohydrates you administered.
- Drink moderate alcohol, even if you have one.
- Avoid drinking alcohol with blood sugar levels below 100 mg/dL (5.6 mmol/L).
- Always carry quick glucose with you to treat low levels.
- Consider wearing CGM.
- Set CGM low and predictive low alerts to “ON”.
- Treat hypoglycemia early before it becomes potentially dangerous.
Final Thoughts
Managing hypoglycemia requires a variety of strategies. Regular monitoring of blood glucose levels, especially with the help of CGM devices, plays an important role in early detection and management of hypoglycemic episodes.
Talking with healthcare professionals to adjust your insulin dose and treatment plan can also help reduce the risks associated with hypoglycemia.
Lifestyle changes such as dietary planning, careful monitoring of physical activity, and responsible alcohol consumption are even more important to manage and avoid lowering blood sugar levels. In some cases, diabetes alert dog support can provide an additional layer of safety by detecting hypoglycemia even when it is not possible.
If you are experiencing hypoglycemia awareness, it is important to talk to your healthcare provider and explore strategies tailored to your specific needs. The right combination of medical feedback, self-care and support tools can effectively manage this condition and reduce the risk of serious complications.
