Diabetes is commonly recognized as a condition associated with high blood sugar levels, be it due to insulin resistance or deficiency. However, it is less widely known that these individuals are similarly susceptible to precipitous drops in blood sugar levels, owing to possibly reduced levels of glucagon, a hormone that acts as a counterbalance to hypoglycemia (low blood sugar). Despite this, hypoglycemia is no less troublesome for people with Diabetes and may even be more alarming in some cases than hyperglycemia, as it can cause acute harm and may even lead to falls, vehicular accidents, seizures, coma or sudden cardiac arrest.
Hypoglycemia is defined by the American Diabetes Association (ADA) as a blood sugar level of < 70 mg/dL. The ADA classifies hypoglycemia into 3 levels:
- Level I: Measurable glucose concentration <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L)
- Level II: Blood glucose concentration <54 mg/dL [3.0 mmol/L])
- Level III: A severe event characterized by altered mental and/or physical functioning that requires assistance from another person for recovery
The threshold blood glucose level of <70 mg/dL was chosen because below this value, people who do not have Diabetes already begin to experience symptoms of low blood sugar, while at blood glucose level <54 mg/dL, symptoms such as confusion and altered consciousness begin to emerge and require immediate treatment.
The frequency of hypoglycemia varies with several factors. People with Type 1 Diabetes experience, on average, two episodes of mild hypoglycemia per week. Those with Type 2 Diabetes may also experience low blood sugar levels, particularly those who are on insulin therapy or certain other drug classes (such as sulfonlyureas). Some may get used to frequent episodes of low glucose and develop blunting of typical signs and symptoms, in a phenomenon called “Hypoglycemia Unawareness”, which can be particularly perilous. Since these signs and symptoms of hypoglycemia are protective and are the body’s way of alerting the patient to dangerously low blood glucose levels, recognizing these signs is crucial to averting the potential complications of hypoglycemia.
7 Common Signs/Symptoms of “Sugar Crash” or Hypoglycemia
Typical hypoglycemia signs and symptoms include (but are not limited to) the following:
- Feeling anxious: May have nervousness and shaking/tremors
- Weakness: May also experience dizziness/lightheadedness/sleepiness/blurring of vision
- Hunger or nausea
- Skin manifestations: Sweating or chills/pale skin
- Increased heart rate and palpitations
- Increased blood pressure
- Confusion or irritability
These signs and symptoms are often present together during episodes of hypoglycemia. Therefore, in people with Diabetes, these strongly suggest low blood glucose levels.
Risk Factors for Hypoglycemia
Conventional risk factors for hypoglycemia include:
- Medications: Patients who are on insulin therapy or sulfonylureas may experience hypoglycemia due to ill-timed or excessive doses
- Food intake: Decreased glucose intake either due to illness or fasting with inappropriate dosage of medications may lead to hypoglycemia
- Physical activity: During exercise, there is increased glucose utilization, leading to a drop in blood sugar levels. If medications or food intake are not adjusted accordingly, hypoglycemia may ensue
- Alcohol: There is decreased glucose production by the body after alcohol intake. This can lead to hypoglycemia especially during sessions of alcoholic binge drinking
- Increased insulin sensitivity: People with Diabetes who lose weight or improve their fitness can have increased insulin sensitivity. If medications are not adjusted accordingly, hypoglycemia can occur.
- Decreased insulin clearance: Advanced Diabetes can cause kidney failure, which in turn can lead to lower blood glucose levels and necessitates adjustment of medications, in some cases even discontinuation of medications for blood sugar control
Tips to Avoid/Manage Hypoglycemia
Initial treatment of hypoglycemia requires intake of fast-acting carbohydrates. The ADA recommends the following “15-15” rule: Ingest 15 grams of carbohydrates and re-check in 15 minutes. If blood glucose is still < 70 mg/dL, ingest another 15 grams. These steps are repeated until blood glucose levels are > 70 mg/dL. Once at this level, eat a meal or snack to prevent further hypoglycemia. The carbohydrates may be in the form of the following:
- Glucose tablets
- Gel tube
- 4 ounces (1/2 cup) of juice or regular soda (not diet)
- 1 tablespoon of sugar, honey or corn syrup
- Hard candies, jellybeans or gumdrops
Avoid complex carbohydrates (ex. bananas, whole wheat bread or pasta, high fiber fruits) or food that contain carbs with fats (ex. chocolates) as they can slow absorption of glucose and will not quickly treat a low blood sugar level. Additionally, though injectable glucagon may be available and will be particularly helpful in people with severe hypoglycemia, calling 911 immediately for help in such cases may be the best course of action to take.
Good diabetes management is key to prevention of hypoglycemia episodes. Besides proper education and close coordination with health providers, regular and close monitoring of blood glucose levels is strongly recommended to avoid/prevent hypoglycemia. Frequent checking of blood glucose levels is ideal, such as before and after meals, before and after exercise, at bedtime, and in the early morning, especially if there is any change in physical activity or medications. This can be accomplished using capillary blood glucose monitors (SMBG) or continuous glucose monitors (CGM).
How DrKumo Remote Patient Monitoring Helps
This is where DrKumo Remote Patient Monitoring Technology for Diabetes Management comes in. With the rise of telehealth and remote patient monitoring (RPM), people with diabetes can avail of RPM devices such as glucometers and CGM that are connected to a cloud-based platform where health providers can view patients’ glucose levels in real-time. This can aid patients in closely monitoring their blood glucose levels, minimizing the risk of hypoglycemia, and allowing better coordination with their health providers, who can make more timely recommendations and adjustments to medications. This can then lead to achieving glucose targets safely without frequent hypoglycemia.
In people living with Diabetes, avoiding low blood glucose levels is just as important as controlling spikes in blood glucose. Achieving glucose targets without hypoglycemia is essential to optimal health outcomes, and DrKumo’s RPM platform of connected devices can play an important role in aiding patients with Diabetes manage their blood glucose levels effectively without complications.
- American Diabetes Association. (2019, January 1). 6. glycemic targets: Standards of medical care in diabetes-2019. Diabetes Care. Retrieved from https://care.diabetesjournals.org/content/42/Supplement_1/S61
- Elsevier. (n.d.). Williams Textbook of Endocrinology. Williams Textbook of Endocrinology – 14th Edition. Retrieved from https://www.elsevier.com/books/williams-textbook-of-endocrinology/bresnahan/978-0-323-55596-8
- Hypoglycemia (low blood glucose). Hypoglycemia (Low Blood Glucose) | ADA. (n.d.). Retrieved from https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia