Johns Hopkins Health Alert
Recognizing and Treating Hypoglycemia
Extreme hypoglycemia is a medical emergency and should be treated immediately.
Patients with diabetes who take insulin are susceptible to hypoglycemia (low blood glucose) when they administer too much insulin, delay or miss a meal, exercise without first eating a snack or drink alcohol on an empty stomach.
But insulin treatment isn’t the only cause of hypoglycemia. Hypoglycemia can also result from treatment with the oral sulfonylureas, repaglinade and nateglinide. Unfortunately, unexplained “lows” frequently occur even in people who carefully control their medications and regularly monitor their blood sugar levels. That’s why it’s important to recognize the early signs of hypoglycemia, and know what to do when hypoglycemia occurs.
There are two types of hypoglycemic symptoms, adrenergic and neurologic:
Without treatment, extreme hypoglycemia can cause seizures, coma and, in rare cases, permanent brain damage and death. If you are taking insulin or an oral diabetes drug that can cause hypoglycemia, your doctor or diabetes educator will train you (and family members or friends who would be available to help you) on how to give a glucagon injection, which can rapidly raise your blood glucose level and prevent disaster. It’s easy to do, because you can inject glucagon almost anywhere (abdomen, thigh, buttocks, upper arm), and it’s nearly impossible to take an overdose. You’ll need a prescription to buy a pre-filled glucagon syringe to keep on hand at all times. It should be kept cool, but need not be refrigerated, and should be replaced on the expiration date. If glucagon is unavailable or its use does not achieve consciousness, an ambulance must be called immediately.
- Adrenergic hypoglycemia symptoms. Sweating, heart palpitations, nervousness, hunger, faintnessand weakness are the earliest signs that you have hypoglycemia and that your blood sugar has dropped below about 60 mg/dL. When your blood glucose is this low, a hormone called epinephrine is released into the bloodstream, triggering the liver to increase its glucose production and the pancreas to release glucagon, another hormone that increases blood glucose. These unpleasant adrenergic symptoms are actually advantageous, because they warn you that you must immediately eat or drink something with sugar to raise your blood glucose level. The best choices are sugars that are rapidly absorbed into the bloodstream, such as 4 oz. of orange juice, 6 oz. of non-diet soda, 5–7 hard candies, or 2–5 glucose tablets.
- Neurologic hypoglycemia symptoms. If your blood sugar drops to below 40 mg/dL, you may develop severe neurological symptoms such as headache, lack of coordination, double vision, slurred speech confusion and numbness in your fingers and around your mouth. This can happen if you are taking beta-blocking drugs (heart medication) or have diabetes-related nerve damage. It can also happen if you have had diabetes for 5–10 years, because the body’s response to hypoglycemia, particularly the release of glucagon, may no longer occur.
Posted in Diabetes on May 3, 2007
Reviewed June 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
Notify Me
Would you like us to inform you when we post new Diabetes Health Alerts?
Comments
Health Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the Johns Hopkins editors cannot be answered in this space.
The views expressed here do not constitute medical advice, and do not represent the position of Johns Hopkins Medicine or Remedy Health Media, LLC, which has no responsibility for any comments posted on this site.
Post a Comment
Already a subscriber?
Login
New to Johns Hopkins Health Alerts?
