Hypoglycemia

Hypoglycemia
Other names	Hypoglycaemia, hypoglycæmia, low blood glucose, low blood sugar
Hypoglycemia (left) and normal blood sugar concentration (right)
Specialty	Endocrinology
Symptoms	Headache, blurred vision, shakiness, dizziness, weakness, tiredness, sweating, clamminess, fast heart rate, pounding heartbeat, nervousness or anxiety, hunger, nausea, pins and needles sensation, difficulty talking, confusion, unusual behavior, lightheadedness, pale skin color, seizures[1][2][3][4][5]
Complications	Loss of consciousness, death
Usual onset	Rapid[1]
Causes	Medications (insulin, glinides and sulfonylureas), sepsis, kidney failure, certain tumors, liver disease[1][6]
Diagnostic method	Whipple's triad: Symptoms of hypoglycemia, serum blood glucose level <70 mg/dL (3.9 mmol/L), and resolution of symptoms when blood glucose returns to normal[2]
Treatment	Eating foods high in simple sugars
Medication	Glucose, glucagon[1]
Frequency	In type 1 diabetics, mild hypoglycemia occurs twice per week on average, and severe hypoglycemia occurs once per year.[3]
Deaths	In type 1 diabetics, 6–10% will die of hypoglycemia.[3]

Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L).^[1][3] Whipple's triad is used to properly identify hypoglycemic episodes.^[2] It is defined as blood glucose below 70 mg/dL (3.9 mmol/L), symptoms associated with hypoglycemia, and resolution of symptoms when blood sugar returns to normal.^[2] Hypoglycemia may result in headache, tiredness, clumsiness, trouble talking, confusion, fast heart rate, sweating, shakiness, nervousness, hunger, loss of consciousness, seizures, or death.^[1][3][2] Symptoms typically come on quickly.^[1]

The most common cause of hypoglycemia is medications used to treat diabetes such as insulin, sulfonylureas, and biguanides.^[3][2][6] Risk is greater in diabetics who have eaten less than usual, recently exercised, or consumed alcohol.^[1][3][2] Other causes of hypoglycemia include severe illness, sepsis, kidney failure, liver disease, hormone deficiency, tumors such as insulinomas or non-B cell tumors, inborn errors of metabolism, and several medications.^[1][3][2] Low blood sugar may occur in otherwise healthy newborns who have not eaten for a few hours.^[7]

Hypoglycemia is treated by eating a sugary food or drink, for example glucose tablets or gel, apple juice, soft drink, or lollies.^[1][3][2] The person must be conscious and able to swallow.^[1][3] The goal is to consume 10–20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dL (3.9 mmol/L).^[3][2] If a person is not able to take food by mouth, glucagon by injection or insufflation may help.^[1][3][8] The treatment of hypoglycemia unrelated to diabetes includes treating the underlying problem.^[3][2]

Among people with diabetes, prevention starts with learning the signs and symptoms of hypoglycemia.^[3][2] Diabetes medications, like insulin, sulfonylureas, and biguanides can also be adjusted or stopped to prevent hypoglycemia.^[3][2] Frequent and routine blood glucose testing is recommended.^[1][3] Some may find continuous glucose monitors with insulin pumps to be helpful in the management of diabetes and prevention of hypoglycemia.^[3]