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Hypoglycemia - Everything you need to know

Hypoglycemia is one of the most common and serious complications of diabetes. Let's get to know it so we can treat it properly, without putting our lives or the lives of our loved ones at risk.

What is hypoglycemia?

According to the guidelines of the Hellenic Diabetes Society (2018), hypoglycemia is defined as the condition in which blood sugar levels fall below 70 mg/dl, with or without symptoms.
Our brain cells are mainly "fed" by glucose, which when not available in sufficient quantities, causes dysfunction. Thus, in a state of hypoglycemia, low blood sugar levels deprive the brain of the energy it needs to function properly.

Types of hypoglycemia

  • Mild/Mild Hypoglycemia: When glucose value is ≤70 mg/dl. Immediate correction with rapid carbohydrate intake is required.
  • Clinically significant hypoglycemia: A drop in glucose below 54 mg/dl that requires immediate treatment
  • Severe hypoglycemia: This is life-threatening and requires assistance from a third party. Glucagon, which can be given subcutaneously or intramuscularly, should always be available. If not treated immediately, the person may lose consciousness and fall into a coma.
  • Nocturnal hypoglycemia: Occurs during sleep, when blood sugar is not being monitored. Symptoms: restless sleep, nightmares, morning headache, fatigue upon awakening, drowsiness, sweating

Causes of hypoglycemia

The most common causes are:

  • Overdose of antidiabetic drugs
  • Insulin overdose
  • Interaction with other drugs (e.g. beta-blockers)
  • Skipping or delaying meals
  • Less food than usual
  • Drinking alcohol without food
  • Intense or prolonged exercise without dose adjustment or additional carbohydrates
  • Kidney or liver failure
  • Advanced age
  • Weight loss without medication dose adjustment
  • Infections or other conditions that alter insulin needs

Symptoms of hypoglycemia

The symptoms of hypoglycemia vary with age. Also, the perception of the symptoms of hypoglycemia can be influenced, hindered or modified by various factors such as sleep, distraction (for example during the person's work), posture, medications, alcohol, psychological factors or ignorance of the symptoms of hypoglycemia. Finally, it is very important to mention that the symptoms of hypoglycemia vary not only from person to person but also from hypoglycemic episode to hypoglycemic episode and, of course, change over time, the duration of diabetes and repeated episodes of hypoglycemia.

The most common symptoms are:

  • Dizziness, headache (due to lack of glucose in the brain)
  • Confusion, difficulty concentrating or speaking
  • Blurred vision
  • Irritability, behavioral changes
  • Convulsions
  • Loss of consciousness or coma (in severe hypoglycemia)
  • Heavy sweating
  • Tremor, nervousness
  • Tachycardia
  • Hunger
  • Paleness
  • Injuries due to fainting

Long-term consequences of hypoglycemia

  • Reduced ability to recognize symptoms as the body "gets used to" low values
  • Absence of warning signs (tremor, sweating)
  • Increased risk of serious episodes (fainting, seizures)
  • Neurological damage (mainly in severe/prolonged hypoglycemia)
  • Memory and concentration problems
  • Mood disorders
  • Cardiac arrhythmias
  • Anxiety or fear of new episodes
  • Brain damage or death in extreme cases if severe hypoglycemia is not treated immediately

Chronic recurrent hypoglycemia does not directly damage organs like hyperglycemia, but it increases the risk of accidents and serious complications.

Treating hypoglycemia

Treatment must be immediate to avoid endangering the life of the person with diabetes:

  • Confirmation of hypoglycemia by blood sugar measurement
  • Consumption of rapidly absorbed carbohydrates, e.g. glucose liquids
  • 15 gram glucose rule:
    • 3–4 glucose tablets
    • 1 tablespoon sugar or honey
    • Half a glass of orange juice or sugary soft drink
    • One packet of glucose jelly
  • Recheck after 15 minutes. If the value remains low, the download is repeated.
  • When blood sugar returns, a snack with complex carbohydrates is consumed (e.g. bread, crackers, fruit)
  • If the person is unconscious or unable to swallow, no oral feedings — intramuscular glucagon or immediate transport to hospital is required

Common mistakes

  • Use of solid or fatty foods (e.g. chocolate) — they delay glucose absorption
  • Insufficient glucose intake (<15 g)
  • Lack of available injectable glucagon
  • Failure to communicate with the treating physician for treatment adjustment

Prevention of hypoglycemia

  • Frequent and small meals (5–6/day) adapted to the individual's needs
  • Preference for complex carbohydrates for gradual glucose release
  • Correct dose of insulin or medication, with adjustments when necessary
  • Avoiding delayed meals
  • Regular measurements or use of a continuous glucose monitoring (CGM) system
  • Avoiding excessive physical fatigue
  • Informing family and colleagues about the symptoms and the correct response.

Hypoglycemia does not have to be an obstacle to the daily life of a person with diabetes.
With proper knowledge, prevention and timely treatment, you can manage it effectively and continue your life with safety and a better quality of life.

You can do it — and you definitely deserve it!

Written by Marianna Metaxa
Educator, Author of the books "My Sweet Kelly" and the fairy tale "Melita and Zacharoulis" and lyricist of the song "Listen to My Heart" which was set to music by Sofia Grammenou

Sources:

  • Hellenic Diabetes Society: Guidelines for the Management of Individuals with Diabetes Mellitus
  • Panagiotis Halvatsiotis, Physician – Associate Professor of Pathology & Diabetes
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