What Is Hypoglycemia + How to Treat It

Hypoglycemia is also known as low blood sugar. 

If you live with diabetes and take any form of blood-sugar-lowering medication, whether oral or injected, you should be aware of the risks of hypoglycemia and how to recognize early symptoms.

Unfortunately, low blood sugar is an unavoidable part of diabetes management, but there are ways you can manage it better. Being aware could save your life!

How do I know if I have hypoglycemia?

Hypoglycemia happens when there is too much insulin or too little sugar in your body. Technically, it is any blood sugar level at or below 70 mg/dL (3.9 mmol/L). Severe low blood sugar levels begin when your blood sugar drops below 55 mg/dL (3.1 mmol/L).

Symptoms of hypoglycemia include:

• Blurred vision
• Cold sweats
• Confusion
• Cool, pale skin
• Difficulty concentrating
• Drowsiness
• Excessive hunger
• Feeling anxious
• Fast heartbeat
• Headache
• Nausea
• Nervousness
• Nightmares
• Restless sleep
• Shakiness
• Slurred speech
• Sudden changes in behavior—either aggressive or goofy (in adults, they might seem drunk without drinking)
• Unusual tiredness or weakness

If hypoglycemia is left untreated, it can quickly go from bad to worse. If your blood sugar levels plummet from the standard to the severe low range and are left untreated, you are at risk for seizures or unconsciousness. In some cases, severe lows can even be life-threatening.

Luckily, there is a lot you can do before your blood sugar levels put you at risk.

What causes hypoglycemia?

First, it’s important to understand what causes hypoglycemia—not to avoid these activities, but to figure out how to manage them with your healthcare team so diabetes doesn’t hold you back. This isn’t about fear-mongering—it’s about overcoming low blood sugar fears through awareness.

Some activities, behaviors or situations that cause hypoglycemia include:

• Exercising with too much insulin on board (IOB). Insulin on board means the insulin that is still working in your body from a past dose
• Having too much insulin on board, period
• Insulin stacking—which refers to a buildup of rapid-acting insulin doses in the body that were given close together
• Skipping meals
• Not eating enough food for the insulin you have on board
• Rage-bolusing—which refers to an impulsive series of rapid-acting insulin doses given close together to correct a stubborn high blood sugar
• Exercising a lot
• Drinking alcohol on an empty stomach

Wearing a continuous glucose monitor (CGM) can help you see how your diabetes patterns, behavior, habits and management style affect your blood sugar levels. They may even help you get ahead of lows. Regardless of the technology you use to manage your blood sugar levels with diabetes—whether a blood glucose meter (BGM) or CGM—it’s critical to be aware of your body’s low blood sugar warning signs.

How do you treat hypoglycemia?

Treating hypoglycemia depends on two important factors:

• What is the severity of your low?
• Are you alert to treat it?

As a general guideline, if you are awake, start treating your low blood sugar with 15g of fast-acting carbohydrates. Wait 15 minutes. If your blood sugar is still not up, repeat the cycle. It can be hard to wait, but do your best, because overtreating lows can send your blood sugar soaring in the opposite direction!

Examples of fast-acting carbs to treat hypoglycemia

Common ways people with diabetes treat hypoglycemia include:

• Glucose tablets: 4 tablets usually equal 15g of carb
• Glucose gel: Usually, 1 tube
• Glucose powder: Usually, 1 packet
• Regular soda: 4 ounces or a half cup
• Juice: 4 ounces or a half cup
• Granulated sugar: 4 teaspoons

Always check the nutrition label on the back of your low blood sugar treatment to be sure, as carbohydrate grams vary among products.

If you are not alert enough to treat your severe low, someone will need to use an emergency glucagon on you. Make sure those you trust and see often know how to use it. Train them proactively. Hopefully, they’ll never have to do it, but it’s good to be informed just in case.

If you are treating a person’s severe low blood sugar on their behalf because they are not awake to do so themselves, use emergency glucagon and call emergency services right away.

Treating rebound highs after low blood sugar corrections

High blood sugar can happen again after treating low blood sugar. This often occurs if you over-correct, but don’t worry—most people with diabetes experience this. When you see low blood sugar, it can feel scary, especially if it’s very low.

Fear can lead to over-treatment, causing blood sugar to rise too high. Remember, over-correcting is normal and not your fault. It happens because you’re impatient or scared while waiting for your blood sugar to go back up. Trust your plan—you are capable of managing this.

Take a deep breath. Be patient with the rise. Use this time to see where your blood sugar settles. Then, decide on the right insulin treatment. Always check with your healthcare team to stay on top of rebounds.

If you’re at risk of hypoglycemia, get emergency glucagon

It’s important for anyone taking a blood-sugar-lowering medication to also have emergency glucagon on hand, which can save your life in a low blood sugar emergency.

Glucagon is a hormone that tells your liver to release its stored sugar (also known as glycogen) into your bloodstream. Emergency glucagon treatments can raise your blood sugar during severe hypoglycemia.

Emergency glucagon options

For decades, there was only one option, and it was complicated to use. Fortunately, there are now many new and improved options available today. Your insurance plan may prefer you to use one option over another. If your preferences don’t match, you may need to apply for prior authorization with your health care team to get it approved.

Here are some emergency glucagon options to explore:

• Nasal glucagon—Baqsimi®: This is an emergency glucagon that’s administered through your nose.
• Glucagon pen—Gvoke HypoPen®: This is a premixed glucagon injection that you press against your thigh. The auto-inject device makes it quick and easy to use. It is also available in a prefilled syringe (PFS).
• Glucagon Prefilled Syringe—Gvoke Kit®: This is a premixed glucagon vial with a syringe, allowing you to draw up the dose manually and inject it directly into your thigh.
• Glucagon pen—Zegalogue®: Also a premixed glucagon, available as an easy-to-use auto-inject device. It is also available in a prefilled syringe (PFS).

Frequent lows? Talk to your doctor

Frequent hypoglycemia (aka chronic low blood sugar) is not uncommon, but it also isn’t something you should settle for. 

Long-term chronic low blood sugar levels can lead to:

• Cognitive dysfunction (i.e. trouble with memory, attention, learning, decision-making or language)
• Dementia
• Cardiovascular disease
• Brain damage
• Hypoglycemia unawareness (aka no low blood sugar warning symptoms)
• Increased cardiovascular risk: stroke, arrhythmia and cardiac arrest

Talk to your doctor if you are experiencing frequent lows without relief. Together, you can adjust your medication plan to bring your blood sugar levels back to a stable, more comfortable range.

Living with diabetes and experiencing blood sugar swings can feel isolating, but you’re not alone! A supportive community is ready for you on our apps.