Low Blood Sugar

(Written by Shirley Powell, PA-C)

What is Low Blood Glucose?

Low blood glucose (or hypoglycemia or insulin reaction) is when the blood glucose goes below 70 mg/dl. Symptoms may occur if the blood glucose is dropping quickly even though they may be in your target range. Hypoglycemia occurs when the body does not have enough glucose for energy. Untreated severe low blood glucose may be very serious.

Causes of low blood glucose

Meals or snacks that are late or missed
Extra exercise that used more glucose than usual
An insulin or oral medication dose that is too high
An insulin dose peaking at a different time than usual
Giving an injection into the muscle (increases the absorption of insulin)
Making a mistake with drawing up the insulin with the wrong dose or the wrong insulin
Taking a bath or shower (or hot tub) after taking an injection or bolus of insulin. (Wait 90 minutes)
Drinking alcohol without eating

Symptoms of low blood glucose (hypoglycemia)

Mild Hypoglycemia / Moderate Hypoglycemia / Severe Hypoglycemia

Shakiness
Nervousness
Sweating
Dizziness
Fast heart beat
Hungry
Tiredness, Fatigue
Weak
Pale
Numbness or tingling mouth or lips

Headache
Personality change
Lack of focus
Confused
Disoriented
Out of control
Poor coordination
Slurred or slow speech
Blurred vision

Loss of consciousness
Seizure

Helpful guidelines

Always carry hypoglycemia treatment food with you
Check you blood glucose before, during and after physical activity
Check you blood glucose before you drive or use heavy equipment
Wear identification such as a bracelet, stating that you have diabetes
Teach family, friends, coworkers to recognize the symptoms and treatments of low blood glucose
Teach family, friends and coworkers how to use glucagon in an emergency.

Treatment of low blood sugar (hypoglycemia)

15-15 Rule
Check blood glucose level
Give 15 grams of glucose or simple carbohydrate (sugary)
3 glucose tablets
½ of 1 tube instant glucose (1 tube equals 31 grams CHO)
1 small tube of cake gel (equals 12 grams CHO)
4 ounces of juice
½ cup of regular soft drink
10 oz glass of milk
6-7 jellybeans
6 Life savers
15 Skittles
8 pieces of Sweet Tarts
3 teaspoons sugar or honey
Rest for 15 minutes
Recheck blood glucose in 15 minutes (10-20 minutes)
If blood glucose is less than 70 mg/dl (or 80 mg/dl for some people) repeat the treatment of 15 gm carbohydrate of sugary food, repeat rest and repeat monitoring blood glucose
If blood glucose is greater than 70 mg/dl (or 80 mg/dl for some people) eat a solid snack

Other considerations for treatment of hypoglycemia
If a severe hypoglycemia reaction is occurring or the individual is unconscious or having a seizure place individual in a safe position and treat with glucagon.
Report severe low blood glucose events to the physician, physician assistant, or nurse
Evaluate any cause for the low blood glucose.
Carefully evaluate night time hypoglycemia
Consider post exercise hypoglycemia
Consider Insulin action
Know the different symptoms such as nightmares, night sweats, seizures and morning headaches
Do not eat candy bars or chocolate because the fat in these foods slow the rise of the blood sugar.
Do not eat a snack until the blood sugar has returned to greater than 80 mg/dl because the fat and protein will slow the rise in blood glucose
For children adjust the portion of the simple carbohydrates for age such as give a 2 year old 2 ounces of juice