Should I be worried about hypoglycaemia?

Hypoglycaemia is defined as a condition where a person’s blood glucose levels are below the standard range.  Clinically, hypoglycaemia is when blood glucose levels are below 70 mg/dL (3.9 mmol/L). Hypoglycaemia is most commonly associated with diabetes treatment side effects but is not limited to diabetes medications. It can occur when one eats less than usual while taking their daily diabetes treatment, or they exercise more than they typically do.

Patients with type 2 diabetes are often prescribed antidiabetic medications such as metformin, sulfonylureas, meglitinides, and SGLT2 inhibitors. Type 1 diabetes patients are prescribed insulin. The goal of this medication is to lower the elevated blood glucose levels, which is the defining characteristic of diabetes.

Other causes of hypoglycaemia

Long-term starvation – hypoglycaemia can occur in a state of starvation when the body is not getting enough food, and the glycogen reserves used to generate glucose are depleted. An example is a condition called anorexia nervosa.

Excessive alcohol intake – high alcohol intake without eating can prevent the liver from breaking down glycogen and releasing glucose.

Overproduction of insulin – a rare, typically benign tumor of the pancreas called insulinoma results in the overproduction of insulin, which leads to hypoglycaemia.

Medications – medications such as quinine (used for malaria) have been linked to hypoglycaemia, particularly in children or people with kidney failure. Hypoglycaemia can arise when a non-diabetic person takes diabetes medication.

Certain conditions – severe illnesses the likes of cirrhosis, hepatitis, kidney disease, and severe infection may lead to hypoglycaemia.

Symptoms of hypoglycaemia

• Headache

• Fatigue

• Dizziness or light-headedness

• Difficulty concentrating

• Pale skin

• Hunger or nausea

• Irritability or anxiety

• Blurry vision or tunnel vision

Severe hypoglycaemia may cause loss of consciousness, coma, seizures, and death.

Treatment

If you experience hypoglycaemia symptoms, do the following:

Drink or eat between 15 and 20 grams of fast acting carbohydrates – this can be a sugary drink or food without protein or fat that your body can easily convert to glucose. Examples include fruit juice, honey, glucose tablets, candy, and regular soda.

Monitor your blood glucose levels after 15 minutes following treatment (consumption of a sugary drink or food) – if your blood glucose readings remain below 3.9 mmol/L, eat or drink another sugary substance and measure your blood glucose levels after 15 minutes. Repeat this until your blood glucose readings are above 3.9 mmol/L.

In the event of severe hypoglycaemia (when one cannot eat or drink).

A glucagon injection or intravenous glucose is used. People with diabetes on insulin treatment should always have a glucagon emergency kit nearby. Their family and friends should always be aware of their location, and they must have easy access to the glucagon kit in case of an emergency. When attempting to assist someone who is unconscious, don’t try and give that person food or drink. If there is no glucagon kit available or you do not know how to use it, call for emergency medical help.

Prevention

It is important to keep track of your blood glucose level, particularly if you have been diagnosed with diabetes and are currently on treatment. You can monitor your blood glucose levels with either a continuous glucose monitor or a glucose meter. Times to monitor your blood glucose levels are before and after meals, before and after physical activity, before bed, and in the middle of the night. For non-diabetic people, it is generally recommended that they get their blood glucose levels tested every three years. One should aim to have a consistent and well-distributed meal plan consisting of a balanced diet. Avoid alcohol, especially on an empty stomach, as alcohol can lead to dangerously low blood glucose levels resulting in severe hypoglycaemia.

Conclusion

Awareness of hypoglycaemia and its effects is very important for diabetic patients and those around them. In the severe cases hypoglycaemia can lead to a coma or even death. Hypoglycaemia is easily managed and treated; one just must be aware. Health care professionals should routinely counsel patients regarding hypoglycaemia.  As with most things with regard to hypoglycaemia prevention is better than cure.

References

1 Diabetes treatment: Medications for type 2 diabetes. (n.d.). Mayo Clinic. Retrieved 3 July 2025, from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-treatment/art-20051004

2 Güemes, M., Rahman, S. A., & Hussain, K. (2016). What is a normal blood glucose? Archives of Disease in Childhood, 101(6), 569–574. https://doi.org/10.1136/archdischild-2015-308336

3 Hypoglycemia (Low Blood Sugar). (n.d.). WebMD. Retrieved 3 July 2025, from https://www.webmd.com/diabetes/diabetes-hypoglycemia

4 Hypoglycemia—Symptoms and causes. (n.d.). Mayo Clinic. Retrieved 3 July 2025, from https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685

5 MD, R. H. S. (2021, June 11). Is blood sugar monitoring without diabetes worthwhile? Harvard Health. https://www.health.harvard.edu/blog/is-blood-sugar-monitoring-without-diabetes-worthwhile-202106112473

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