Hypoglycaemia: The Shocking Truth About Low Blood Sugar

Low blood sugar may sound like a small issue, but for someone living with diabetes — or even certain non-diabetic conditions — it can quickly turn into a medical emergency.

Hypoglycaemia (also spelled hypoglycaemia) refers to a condition where blood glucose levels fall below normal. Glucose is the primary source of energy of body, significantly for the brain. When glucose levels drop too low, the body and brain begin to struggle.

For some people, it causes mild shakiness. For others, it can lead to confusion, unconsciousness, or even seizures. The key difference between a manageable episode and a dangerous one is early recognition and timely action.

What Is Hypoglycaemia?

It is generally defined as:

• Blood glucose below 70 mg/dL (3.9 mmol/L)

However, symptoms may begin even slightly above this level in some individuals, especially if their body is used to higher glucose levels.

Clinically, it is classified into three levels:

• Level 1: Glucose < 70 mg/dL (warning stage)
• Level 2: Glucose < 54 mg/dL (clinically significant)
• Level 3: Severe hypoglycaemia requiring assistance

The brain depends heavily on glucose. Unlike muscles, it cannot store energy for long. That is why low sugar affects mental function quickly.

Why Does Hypoglycaemia Happen?

1. In People with Diabetes

This is the most common scenario.

• Excess insulin dose
• Skipping meals after taking insulin
• Taking sulfonylureas (like glimepiride)
• Delayed meals
• Intense exercise without adjustment
• Alcohol consumption

Insulin lowers blood sugar. If too much insulin is present compared to available glucose, sugar levels fall rapidly.

2. In Non-Diabetic Individuals

Less common but possible:

• Prolonged fasting
• Severe infections
• Liver disease
• Hormonal deficiencies (e.g., adrenal insufficiency)
• Rare insulin-producing tumors (insulinoma)

Early Warning Signs: Listen to Your Body

The body gives signals before things get severe. These early symptoms occur due to activation of stress hormones like adrenaline.

Autonomic (Early) Symptoms:

• Shaking
• Sweating
• Palpitations
• Anxiety
• Hunger
• Tingling sensation

Neuroglycopenic (Brain-related) Symptoms:

• Confusion
• Dizziness
• Blurred vision
• Slurred speech
• Irritability
• Difficulty concentrating

If untreated, symptoms may progress to:

• Seizures
• Loss of consciousness
• Coma

Hypoglycaemia Unawareness: A Silent Risk

Some people, especially those with long-standing diabetes, stop feeling early warning symptoms. This condition is called hypoglycaemia unawareness.

It increases the risk of severe episodes because the person does not get an early alert from the body.

This is why structured glucose monitoring and medication adjustment are essential.

How Is Hypoglycaemia Diagnosed?

Diagnosis involves three components (known as Whipple’s triad):

1. Symptoms of low blood sugar
2. Confirmed low glucose reading
3. Relief of symptoms after glucose correction

Blood Tests

• Capillary blood glucose (glucometer)
• Laboratory plasma glucose
• In rare cases: insulin levels, C-peptide (if tumor suspected)

For doctors and pharmacists, medication history review is critical.

Immediate Treatment: The 15–15 Rule

For conscious patients:

1. Take 15 grams of fast-acting carbohydrates, such as:

• 3–4 glucose tablets
• Half a glass of fruit juice
• 1 tablespoon sugar dissolved in water

2. Regular (non-diet) soft drink

3. Wait 15 minutes.

4. Recheck blood sugar.

After recovery, eat a small snack containing carbohydrates + protein to prevent recurrence.

Severe Hypoglycaemia Management

If the person is unconscious:

• Do NOT give food or liquids by mouth
• Administer glucagon injection (if available)
• Seek emergency medical help immediately

In hospital settings:

• IV dextrose (25–50 mL of 50% dextrose)
• Continuous glucose monitoring
• Electrolyte monitoring

Role of Pharmacists

Pharmacists play a crucial preventive role:

• Counselling patients on insulin timing
• Explaining dose adjustments
• Warning about drug interactions
• Educating about alcohol risks
• Teaching proper glucometer use

Community pharmacists are often the first healthcare contact during mild episodes.

Role of Doctors

For clinicians, management includes:

• Reviewing insulin regimens
• Adjusting sulfonylurea doses
• Identifying high-risk patients
• Considering continuous glucose monitoring (CGM)
• Evaluating recurrent unexplained episodes

Personalized glycaemic targets are important — especially in elderly patients.

Long-Term Prevention Strategies

1. Regular Monitoring

Frequent glucose checks reduce unexpected episodes.

2. Meal Consistency

Avoid skipping meals after insulin.

3. Exercise Planning

Adjust insulin or carbohydrate intake before intense activity.

4. Alcohol Awareness

Alcohol can cause delayed hypoglycaemia, especially overnight.

5. Medication Review

Some drugs increase risk — regular review prevents complications.

Special Populations

Elderly Patients

Higher risk of severe episodes due to:

• Impaired awareness
• Multiple medications
• Cognitive decline

Children

Symptoms may appear as irritability or unusual behaviour.

Pregnant Women

Tighter glucose control increases risk; close monitoring required.

When Should You Seek Medical Help?

Immediate care is needed if:

• Repeated episodes occur
• Loss of consciousness happens
• Seizures occur
• It happens without clear cause

Frequent low sugar episodes indicate that treatment adjustment is necessary.

Why Hypoglycaemia Matters More Than You Think

Many people fear high blood sugar, but severe low blood sugar can be equally or sometimes more dangerous in the short term.

Repeated episodes may:

• Increase cardiovascular risk
• Cause cognitive decline
• Reduce quality of life
• Create fear of insulin therapy

Balanced glucose control is the goal — not just low numbers.

Frequently Asked Questions