Hypoglycemia Explained

Feeling lightheaded, shaky, or irritable after skipping a meal? You might be experiencing hypoglycemia, the medical term for low blood sugar. While it's most common in people with diabetes, hypoglycemia can affect anyone and if left untreated, it can become dangerous.

What Is Hypoglycemia?

Hypoglycemia occurs when the level of glucose (sugar) in your bloodstream drops too low generally below 70 mg/dL. Since your brain and body rely on a steady supply of glucose for energy, even a brief drop can cause noticeable symptoms.

More serious episodes, where blood sugar dips below 54 mg/dL, are considered severe and can become life-threatening without prompt treatment.

Common Symptoms of Hypoglycemia

Symptoms vary based on how low your blood sugar gets, but early signs often include:

• Shakiness or trembling

• Dizziness or lightheadedness

• Sweating

• Hunger

• Irritability or anxiety

• Headache

• Palpitations

• Confusion or mental fog

• Blurred vision

In severe cases (typically below 54 mg/dL), you may experience:

• Loss of coordination

• Seizures

• Loss of consciousness

• Coma (in extreme, untreated cases)

Nocturnal hypoglycemia, which occurs at night, may cause nightmares, night sweats, or waking up disoriented or extremely tired.

What Causes Hypoglycemia?

While diabetes is the most common cause especially in people who take insulin or certain oral medications hypoglycemia can also affect people without diabetes. Some potential causes include:

1. Skipping meals or fasting

2. Over-exercising without adequate fuel

3. Drinking alcohol on an empty stomach

4. Taking too much insulin or other diabetes medications

5. Certain metabolic or hormonal disorders, such as:

   • Adrenal insufficiency

   • Congenital hyperinsulinism

   • Glycogen storage diseases

6. Sudden changes in altitude, weather, or hormone levels (like during menstruation)

Reactive hypoglycemia, also called postprandial hypoglycemia, happens when blood sugar drops a few hours after eating, often due to exaggerated insulin responses.

Hypoglycemia vs. Hyperglycemia

It’s important to distinguish between hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar):

Both can be dangerous, but hypoglycemia often requires faster, more immediate intervention.

How to Check for Hypoglycemia

To confirm low blood sugar, use:

• A blood glucose meter (finger prick)

• A continuous glucose monitor (CGM), which tracks blood sugar levels 24/7 and sends alerts if your levels dip too low

These tools are especially helpful for people with diabetes, but anyone experiencing unexplained symptoms should speak with a healthcare provider about glucose testing.

Treatment for Hypoglycemia

For mild to moderate hypoglycemia (blood sugar between 55–69 mg/dL), follow the 15-15 rule:

1. Eat or drink 15 grams of fast-acting carbs:

   • 4 oz fruit juice

   • 1 tablespoon honey or sugar

   • 3–4 glucose tablets

2. Wait 15 minutes and recheck your blood sugar

3. If still low, repeat the steps

For severe hypoglycemia (below 54 mg/dL), you may need:

• Glucagon injection: A prescription emergency medication used by friends or family

• Emergency medical attention: Call 911 if the person is unconscious or having a seizure

If hypoglycemia happens frequently, especially while on insulin or other diabetes meds, talk to your healthcare provider. A medication adjustment may be necessary.

Lifestyle Tips to Prevent Hypoglycemia

Keeping your blood sugar stable throughout the day often comes down to simple, consistent habits:

• Eat regularly: Avoid skipping meals or going long periods without food

• Balance your meals: Include carbs, protein, fiber, and healthy fats

• Monitor exercise: Fuel before and after workouts, and don’t overdo it without proper preparation

• Avoid excess alcohol, especially on an empty stomach

• Know your triggers, especially if you have reactive hypoglycemia or are prone to lows at night

If you have diabetes, work with your provider to tailor your insulin and meal timing to your lifestyle. Medications like metformin are less likely to cause hypoglycemia, which may be helpful in some cases.

When to See a Healthcare Provider

You should speak with a healthcare provider if:

• Your symptoms persist despite following treatment steps

• You frequently experience unexplained episodes of low blood sugar

• You’ve had a severe episode requiring assistance or medical care

• You need help adjusting your medication or diet

Routine monitoring and preventive care can help you manage hypoglycemia safely and reduce your risk of serious complications.

The Bottom Line

Hypoglycemia isn’t always caused by diabetes and it’s not something to ignore. Learning to recognize the early symptoms, treat them quickly, and prevent future episodes can protect your health and improve your quality of life.

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