The Facts About Hypoglycemia

Hypoglycemia occurs when you have low blood sugar (glucose) levels. It's rare to experience hypoglycemia unless you have diabetes, but it's quite common if you do have diabetes, especially if you take insulin to manage the condition. You may hear hypoglycemia referred to as a "hypo."

You have hypoglycemia if your blood sugar levels drop below 72 milligrams per deciliter (mg/dL). Your body doesn't have enough energy to carry out its activities if your blood glucose drops too low, and the condition can be dangerous if left untreated.

The main causes of hypoglycemia, if you have diabetes, are:

• Intense exercise
• Not getting enough carbohydrates with your meals
• Skipping meals
• Taking medicine such as sulfonylureas, glinides or certain antivirals
• Taking too much insulin
• Drinking too much alcohol
• Unknown; sometimes it happens for no specific reason

Rarely, some people can experience hypoglycemia if they do not have diabetes. The causes of low blood glucose in people without diabetes tend to be malnutrition, binge drinking, gastric bypass surgery, specific conditions such as Addison's disease, and pregnancy complications.

Hypoglycemia can happen any time of day, but there are a couple of specific types to be aware of:

• Nocturnal hypoglycemia (low blood sugar at night). This condition can occur if you have a particularly active day, take too much insulin, drink alcohol at night or exercise close to bedtime. If low blood sugar at night is a problem, you can wear a continuous glucose monitor (CGM) with an alarm to alert you of low blood sugar while you're sleeping.
• Severe low blood glucose. This condition can make you confused, blur your vision, cause drowsiness and may lead to unconsciousness or fits. Severe low blood sugar is dangerous and it's important to recognize symptoms.

Symptoms can vary from person to person, but the most common symptoms of low blood sugar include:

• Blurred vision
• Disorientation
• Anxiousness or irritability
• Hunger
• Feeling tearful
• Fatigue
• Headache
• Night sweats
• Poor concentration
• Racing heartbeat (palpitations)
• Shakiness or trembling
• Slurred speech and clumsiness (a bit like appearing drunk)
• Sweating
• Tingly lips
• Turning pale

In severe cases of hypoglycemia, people may collapse, become unconscious, or have a seizure or fit.

An episode of hypoglycemia can happen quickly, which is why it's vital to know the signs. The early symptoms tend to be a racing heart, feeling shaky, sweating, anxiety, irritability, hunger and dizziness.

Problems can occur when you develop "hypoglycemia unawareness." When this happens, you do not experience any symptoms when your blood sugar is low, which puts you at risk of severely low glucose levels. If your doctor diagnoses you as having hypoglycemia unawareness, you may be instructed to monitor your blood sugar levels more often, during the day and night.

A healthy lifestyle is one of the key tools for managing hypoglycemia. Controlling blood sugar levels is an essential part of diabetes management, and eating a healthy diet can help. A diet that emphasizes whole foods and reduces processed foods is recommended.

The Mediterranean diet is often suggested. It focuses on the following:

• Less alcohol
• Less saturated fat from dairy and red meat 
• More oily fish
• Whole foods such as fruits and vegetables, whole grain bread, whole grain cereal, nuts, pulses, beans and seeds.

Several studies suggest that a Mediterranean diet assists with better glycemic control, reduces insulin resistance and is associated with lower postprandial glucose levels, that is, glucose in the blood after eating.

People with diabetes can take steps to help prevent episodes of hypoglycemia. These steps include:

• Always carry a sugary snack or drink with you (fruit juice or sweets).
• Be careful when drinking alcohol and avoid large quantities.
• Be careful when exercising. You may need to eat a carbohydrate-dense snack before exercise. Speak to your diabetes team about how best to manage exercise, especially if you exercise regularly or at intense levels.
• Check your blood sugar levels regularly.
• Do not skip meals.
• If you experience nocturnal hypoglycemia, eat a snack before bedtime, keep a sugary snack by your bed and check your blood sugar levels between 3 a.m. and 4 a.m.
• If your diabetes team has given you a glucagon injection kit, carry it with you at all times.
• Inform family and friends about the signs of hypoglycemia and how they can help you if you are having a hypo. Learn the symptoms of low blood glucose so you can treat it quickly.
• Wear a continuous glucose monitor to monitor your blood glucose levels.

When you begin to have symptoms of low blood glucose or you notice your levels are below 72 mg/dL, then have a sugary snack like a high-sugar fruit juice, a nondiet soda or a few candies. Wait 15 minutes and then retest your blood sugar.

If your blood sugar levels are back to normal and you feel better, either have a snack or your main meal (depending on time of day), and make sure it contains slow-release carbohydrates.

If there is no change to your blood sugar levels after 15 minutes, have another sugary snack and retest again 10 minutes later. If you are having regular attacks of hypoglycemia, speak to your diabetes team, as your medication might need to be adjusted. This is especially important if you have hypoglycemia unawareness and stop feeling symptoms.

You can manage mild episodes of hypoglycemia by following the steps above. However, if symptoms become more serious, you may need someone else to help you. It's important to share information with your family and friends regarding what they need to do if you become drowsy, unconscious or have a seizure.

Here is some advice for how other people can help you during a hypo attack. Take one or more of the following actions if someone is extremely drowsy or unconscious:

• Call 911 if the affected person is not carrying a glucagon kit or you don't know how to use one.
• If they had been drinking alcohol before the hypo, call 911.
• Never put anything in their mouth, to avoid choking.
• If they have a glucagon kit and you know how to use it, give them an injection immediately and wait 10 minutes.
• If, after a glucagon injection, the person does not wake up or improve, call 911.
• If they wake up after 10 minutes and are conscious enough to eat, give them a sugary snack.
• Ensure the person informs their diabetes team or goes to the hospital if they vomit or become hypoglycemic again.
• Put them in the recovery position if you know how.

When someone has a seizure due to hypoglycemia:

• Follow the same steps above.
• Stay with them and lie them down on something soft, away from anything dangerous, so they don't hurt themselves.

It's essential to be aware that you can trigger hypoglycemia by having sex, since it is a form of exercise. It's wise to check your blood sugar level before having sex. Keep a sugary snack nearby if you can so you can treat a hypo if you notice symptoms.

It's not unusual to worry about having a hypoglycemic attack during sex if you have regular hypos. If this is the case, speak with your diabetes team about the best way to manage hypos and sex. You can also explain your concerns to your partner so they know how to support you if signs and symptoms happen. This is an important step so both of you are relaxed and prepared, ensuring sex is something you can enjoy.

Diabetes presents some obstacles to sexual health. First, if you wear an insulin pump, you might be worried about what to do with it during sex. Do you leave it on? Or take it off? This is very personal, and you need to do whatever works best for you. Just remember, if you do remove it before sex, put it back on afterward.

Diabetes can lead to some sexual health problems, such as:

• Erectile dysfunction (ED)
• Reduced libido
• Vaginal dryness

If you experience any of these problems, chat with your diabetes team or healthcare provider. There are many ways to manage erectile dysfunction and low libido, and lubrication is a valuable aid in making sex comfortable if you have vaginal dryness.

Diabetes takes a lot of management. Depending on the type of diabetes you have, you may be constantly monitoring your food intake and glucose levels, and taking medication such as pills or injections, or using an insulin pump.

Diabetes can affect your energy levels and libido and potentially lead to sexual health problems. There is also an increased likelihood of urinary tract infections (UTIs) and candidiasis, a fungal infection from the yeast called Candida.

Navigating dating and diabetes can seem daunting. Prioritize your sexual health and body confidence. Stay on top of managing your diabetes to help reduce any sexual health symptoms. Be compassionate to yourself and understand having diabetes makes you no less sexy than anyone else.

When you feel comfortable, it helps to be open with your partner about your diabetes and how it affects you. Explain your glucose monitor, insulin pump and any other concerns you have that may get in the way of great sex. Being open and honest about your condition can help your partner support you, so both of you can enjoy a positive and loving sexual relationship.

A few useful resources to help you understand and manage hypoglycemia are:

• The American Diabetes Association
• The Centers for Disease Control and Prevention
• National Institute of Diabetes and Digestive and Kidney Diseases

What is the main cause of hypoglycemia?

Hypoglycemia (or low blood sugar) most commonly affects people who have diabetes. Taking too much insulin, skipping meals, exercising intensely or drinking too much alcohol can all lead to hypoglycemia if you have diabetes.

How do you know if you're hypoglycemic?

Early signs of hypoglycemia include a racing heart, feeling shaky, sweating, anxiety, irritability, hunger and dizziness. It's important to treat low blood sugar quickly to prevent symptoms from becoming more severe.

What are the main symptoms of hypoglycemia?

The main symptoms of hypoglycemia include: shakiness, disorientation, sweating, feeling anxious or irritable, turning pale, racing heartbeat (palpitations), tingly lips, blurred vision, feeling hungry, feeling tearful, feeling tired, headache, poor concentration, night sweats and slurred speech.