Do you worry about the dangers of low blood sugar, also known as hypoglycemia? Get ready for some good news. "The relative frequency of having severe hypoglycemia, even for people who take insulin, is exceedingly low," says William Polonsky, Ph.D., CDE, co-founder and president of the Behavioral Diabetes Institute in San Diego and author of Diabetes Burnout (American Diabetes Association, 1999).
However, even mild or moderate hypoglycemia can be unsettling and should be treated. By understanding how hypoglycemia occurs, you'll know the fastest ways to treat it or prevent it from occurring in the first place.
Time to brush up with a little Hypoglycemia 101. Note: It's a good idea to share hypoglycemia information with family members, friends, and coworkers, in case you experience symptoms and need help.
Hypoglycemia technically occurs when blood glucose dips below 70 mg/dl (3.9 mmol/l).
Symptoms of low blood sugar can include, but aren’t limited to:
• Pale skin
• Clumsy or jerky movements
• Sudden moodiness or behavior change
• Difficulty focusing
• Tingling around the mouth
However, similar symptoms can occur when your blood glucose isn't low.
"You can experience the symptoms of hypoglycemia at higher blood glucose readings if your body isn't used to lower numbers or if your blood glucose drops rapidly," says Karen Bolderman, R.D., CDE, who's had type 1 diabetes for more than 40 years.
Three Phases of Hypoglycemia
There are three phases of hypoglycemia or low blood sugar:
Mild hypoglycemia: At this phase, you're usually able to recognize the symptoms and treat yourself.
Moderate hypoglycemia: Symptoms are more pronounced at this level. Your thinking might be impaired, so you may need help from someone else to get and consume some form of carbohydrate to raise your blood sugar level.
Severe hypoglycemia: Symptoms are even more pronounced, and you may become unconscious or have a seizure. The hallmark of severe hypoglycemia is that a person needs assistance from another person or emergency personnel to help stabilize them and bring blood sugar back up.
The Causes of Hypoglycemia
Hypoglycemia occurs when the amount of glucose in your blood isn't enough to supply your body and brain with energy to function properly. This can happen when you:
• Don’t eat enough after taking a blood glucose-lowering medication that can cause low blood sugar (see list of medications below).
• Allow too much time between taking medication and eating.
• Skip a meal or snack.
• Are more physically active but don't adjust by snacking or taking less blood glucose-lowering medication to compensate for burning extra glucose.
• Take too much of a blood glucose-lowering medication that can cause hypoglycemia.
Drugs that Can Cause Hypoglycemia
Blood glucose-lowering medications in the following categories can cause hypoglycemia or low blood sugar:
• Sulfonylureas: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Diabeta, Micronase), others
• Meglitinide (Prandin)
• Nateglinide (Starlix)
• Insulin (all types)
If one or more of your blood glucose-lowering medications can cause hypoglycemia, pay close attention to the directions for when to take it in relation to eating. Always carry your blood glucose meter and a source of pure glucose, such as glucose tablets or candies.
Drugs that Don't Cause Hypoglycemia
Blood glucose-lowering medications in the following categories generally do not cause hypoglycemia (unless they are taken with a medication that can cause low blood glucose):
• Metformin (Glucophage, Glumetza)
• Glitazone (Actos, Avandia)
• Alpha-glucosidase inhibitor: acarbose (Precose)
• DPP-4 inhibitors: sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta)
• SGLT-2 inhibitors: canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance)
• Injectable exenatide (Byetta; twice daily), (Bydueron; weekly)
• Injectable liraglutide (Victoza; once daily)
• Injectable pramlintide (Symlin). Intended for use with rapid-acting insulin; when pramlintide is prescribed, insulin doses need to be lowered to prevent hypoglycemia.
Again, pay close attention to the directions for when to take your diabetes medications in relation to eating. Always carry your blood glucose meter and a source of pure glucose, such as glucose tablets or candies.
Note: There are combination medications and more are on the way. These combinations may contain medications that can cause hypoglycemia and medications that do not. Ask your health care providers or pharmacist about the possible side effects of the combination drug(s) you take and the risk for low blood sugar.