Hypoglycemia: What It Is, Its Causes, Symptoms, and Treatment

Low blood sugar (hypoglycemia) is a dangerous and important health condition that requires attention. People whose blood sugar drops excessively are often those with diabetes. The cause of this condition is related to the medications used in diabetes treatment, which either contain insulin directly or increase the effectiveness of the hormone.

Excessive medication use, skipping meals, eating less than usual, or engaging in prolonged physical activity can also lead to the development of hypoglycemia. Glucose, commonly known as blood sugar, is the main source of energy in the body. The building blocks of carbohydrates found in food, including glucose, are found in high amounts in rice, potatoes, bread, cereals, fruits, vegetables, and dairy products.

After eating, food is broken down into its components by the digestive system and these substances are then absorbed into the bloodstream. The increase in blood sugar levels stimulates the pancreas to release a hormone called insulin. Insulin allows the cells to absorb the sugar from the bloodstream and use it for energy production.

If an excessive amount of sugar is consumed through food, this extra sugar is converted into fat by skeletal muscle and liver cells to be stored as energy for future use. On the other hand, insufficient levels of sugar in the body can negatively affect many of its functions.

What Is Hypoglycemia?

Hypoglycemia refers to a condition where the amount of glucose (sugar) in a person's bloodstream falls below 70 milligrams per deciliter. The symptoms and signs of this condition typically appear when the blood sugar level drops below 55. Glucose is normally the primary energy source used by brain cells. Unlike many other organs in the body, the amount of glucose that reaches the brain is strictly regulated and limited.

Between meals, the body can produce sugar from proteins and fats through a biochemical process called gluconeogenesis, to maintain stable blood sugar levels when necessary. The storage form of glucose in the body is glycogen. Glycogen, which consists of many glucose molecules, is primarily stored in muscle and liver cells. When blood sugar levels drop, glycogen undergoes a process called glycogenolysis, where it is broken down into its building blocks and released into the bloodstream to help regulate blood sugar levels.

What Are the Symptoms of Hypoglycemia?

The body can respond to low blood sugar in different ways. There are many symptoms and signs that can be associated with hypoglycemia:

• Dizziness
• Extreme hunger
• Headache
• Confusion
• Loss of concentration
• Sweating
• Shaking
• Blurry vision
• Personality changes
• Pale skin
• Sudden irritability
• Increased heart rate
• Sleep problems

In some cases, no symptoms may appear after the development of hypoglycemia, so caution should be exercised.

What Causes Hypoglycemia?

Hypoglycemia is primarily classified as either reactive or non-reactive, and these conditions can occur due to various reasons, especially diabetes.

Reactive Hypoglycemia
Reactive hypoglycemia is a drop in blood sugar that occurs several hours after a meal. It happens when the body produces an excessive amount of insulin in response to food intake. While not definitive, reactive hypoglycemia is often considered a sign that a person may be at risk of developing diabetes in the future.

Non-Reactive Hypoglycemia
Non-reactive or non-reactionary hypoglycemia is a drop in blood sugar that is not related to food intake but instead occurs due to other medical conditions. This type of hypoglycemia can be seen after the use of certain medications prescribed for kidney failure in both adults and children, during the course of heart, liver, or kidney diseases, in individuals with eating disorders like anorexia, and in pregnant women.

Though rare, a pancreatic tumor known as insulinoma is also a cause of hypoglycemia. In this condition, abnormal pancreatic cells constantly produce excessive amounts of insulin.

Another cause of hypoglycemia is dumping syndrome. This occurs, particularly in individuals who have had stomach and intestinal surgery for various reasons, and is triggered by a diet rich in carbohydrates.

How Is Hypoglycemia Diagnosed?

When you experience symptoms of hypoglycemia, it is crucial to measure your blood sugar level at that time for an accurate diagnosis. People with diabetes who are taking medication for their condition should be particularly mindful of their blood sugar levels.

It is recommended that individuals who frequently experience symptoms of hypoglycemia seek help from healthcare providers. Doctors approach the diagnosis of hypoglycemia by evaluating the patient's medical history, eating habits, and symptoms related to hypoglycemia. During a physical exam, the doctor will look for the presence of three signs known as the Whipple triad:

The first part of the Whipple triad involves investigating whether the patient has experienced hypoglycemic symptoms. To identify these signs, doctors may limit the intake of fluids and solid foods for a specific period of time.
Once symptoms of hypoglycemia appear, the second stage of the Whipple triad is identifying low blood sugar levels through tests. Blood glucose levels can be measured through biochemical analysis in laboratories.
The final stage of the Whipple triad is when the person's blood sugar level rises after consuming glucose-containing foods, leading to the improvement of the symptoms and signs caused by hypoglycemia.
Doctors may recommend small devices, such as blood glucose meters, for these patients. With these devices, individuals can regularly monitor their blood sugar levels at home. Blood glucose levels should be monitored regularly, especially after waking up and following meals.

How Is Hypoglycemia Treated?

Hypoglycemia is a life-threatening condition that can progress to a coma, making its diagnosis and treatment crucial. In cases of dangerously low blood sugar, solutions containing sugar can be administered intravenously. For patients who can take oral medication, foods that are quickly absorbed and contain carbohydrates, such as fruit juices, are given as the first step in treatment. For patients who cannot eat orally, glucagon injections may be administered into the muscle.

Non-medical control of hypoglycemia can be achieved by educating the patient and making various lifestyle changes. It is recommended that individuals with hypoglycemia wear alert bracelets to notify others and carry necessary carbohydrate sources with them to consume at the onset of symptoms.

Various diabetes organizations recommend that individuals consume at least 15-20 grams of carbohydrates when symptoms of hypoglycemia appear. Snacks containing this amount of carbohydrates include bars, fruits, fruit juices, crackers, and biscuits.