Low Blood Sugar Symptoms and Ranges

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuideBlood Sugar Swings: Tips for Managing Diabetes & Glucose Levels

Blood Sugar Swings: Tips for Managing Diabetes & Glucose Levels

What are the symptoms and signs that my blood sugar levels are too low?

The normal range of glucose in the bloodstream is from 70 to 100 mg/dL when the individual is fasting (that is not immediately after a meal). The body's biochemical response to hypoglycemia usually starts when sugars are in the high/mid 70's. At this point, the liver releases its stores and the hormones mentioned above start to activate. In many people, this process occurs without any clinical symptoms. The amount of insulin produced also declines in an attempt to prevent a further drop in glucose.

While there is some degree of variability among people, most will usually develop symptoms suggestive of low blood sugar when blood glucose levels are lower than 50 mg/dL. The first set of symptoms are called adrenergic (or sympathetic) because they relate to the nervous system's response to hypoglycemia. Patients may experience any of the following:

In most people, these symptoms are easily recognizable. The vast majority of individuals with diabetes only experience this degree of hypoglycemia if they are on medications or insulin. People (with diabetes or who have insulin resistance) with high circulating levels of insulin who fast or change their diet to lower their carbohydrate intake drastically should also be cautioned. These individuals may also experience modest hypoglycemia.

People being treated for diabetes who experience the condition may not experience symptoms as easily as people without diabetes. This phenomenon has been referred to as hypoglycemic unawareness. This can be dangerous as blood sugars may approach extremely low levels before any symptoms are perceived.

Anyone who has experienced an episode of hypoglycemia describes a sense of urgency to eat and resolve the symptoms. And, that's exactly the point of these symptoms. They act as warning signs to tell the body to consume more fuel. At this level, the brain still can access circulating blood glucose for fuel. The symptoms provide a person the opportunity to raise blood glucose levels before the brain is affected.

If a person does not or cannot respond by eating something to raise blood glucose, the levels of glucose continue to drop. With further drops in blood glucose, patients progress to neuro-glyco-penic ranges (meaning that the brain is not getting enough glucose). At this point, symptoms progress to confusion, drowsiness, changes in behavior, coma, and seizure.

How is low blood sugar treated?

The acute management of low blood sugar involves the rapid delivery of a source of easily absorbed sugar. Regular soft drinks, juice, lifesaver candies, table sugar, and the like are good options. In general, 15 grams of glucose is the dose that is given, followed by an assessment of symptoms and a blood glucose check if possible. If after 10 minutes there is no improvement, another 10-15 grams should be given. This can be repeated up to three times. At that point, the patient should be considered as not responding to the therapy and an ambulance should be called.

The equivalency of 10-15 grams of glucose (approximate servings) are:

  • Four lifesavers
  • 4 teaspoons of sugar
  • 1/2 can of regular soda or juice

Many people like the idea of treating low blood sugar with dietary treats such as cake, cookies, and brownies. However, sugar in the form of complex carbohydrates or sugar combined with fat and protein are much too slowly absorbed to be useful in acute treatment.

Once the acute episode has been treated, a healthy, long-acting carbohydrate to maintain blood sugars in the appropriate range should be consumed. Half a sandwich is a reasonable option.

If the hypoglycemic episode has progressed to the point at which the patient cannot or will not take anything by mouth, more drastic measures will be needed. In many cases, a family member or roommate can be trained in the use of glucagon. Glucagon is a hormone that causes a rapid release of glucose stores from the liver. It is an injection given intramuscularly to an individual who cannot take glucose by mouth. A response is usually seen in minutes and lasts for about 90 minutes. Again, a long-acting source of glucose should thereafter be consumed to maintain blood sugar levels in the safe range. If glucagon is not available and the patient is not able to take anything by mouth, emergency services (for example 911) should be called immediately. An intravenous route of glucose administration should be established as soon as possible.

With a history of recurrent hypoglycemic episodes, the first step in treatment is to assess whether it is related to medications or insulin treatment. Patients with a consistent pattern of the condition may benefit from a medication dose adjustment. It is important that people with diabetes who experience low blood sugar to check blood glucose values multiple times a day to help define whether there is a pattern related to meals or medications. Some people who experience recurrent episodes will benefit from changes in when and what they eat, for example, eating multiple small meals and frequent small snacks throughout the day rather than three larger meals.

What else can I do to control my blood sugar levels?

Yes. People with diabetes should wear identification stating they have diabetes and whether they have recurrent low blood sugar. Those at risk for the health condition should be counseled on checking blood sugars before they drive a car, operate heavy machinery, or do anything physically taxing. In addition, it is important to carry a quick-acting glucose source (such as those mentioned above) at all times, and keep a source in their car, office, and by their bedside. Efforts should be made to minimize the hypoglycemic effects of drug regimens and to avoid variable surges in exercise, activity, and drinking alcohol.

REFERENCE:

MedscapeReference. Hypoglycemia.

Medically Reviewed by a Doctor on 2/24/2017

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