Low blood sugar also known as hypoglycemia is a common reoccurring issue with diabetics that must receive immediate attention. Low blood sugar can be confirmed using a blood test and is treated by consuming rapid acting sugars. In this article we look at causes, symptoms, treatments, and tricks to survive low blood sugar.
The onset of a low blood sugar should be treated seriously because left untreated the low blood sugar could become a loss of consciousness or cause serious permanent damage. Because of the loss of physical and mental abilities during a low blood sugar the patient should not drive or operate heavy machinery during the onset of hypoglycemia.
The advice in this document is information that has not been reviewed by a real medical doctor so should not be used to make treatment decisions. Please consult a real medical doctor before following any advice here.
Cause and Prevention
Blood sugar is affected by food, long and short-term insulin, activity, stress, health and other things the best thing is to regularly review your blood sugar results with a qualified medical Dr. to fine tune your insulin regimen. (We do not recommend changing the settings without getting approval from a MD first).
That being said, many common things can create an acute low blood sugar:
- Over dosing insulin. Too much insulin or not enough food.
- Forgetting to eat or waiting too long to eat after an insulin dose.
- Activity. Activity increases insulin sensitivity so it’s usually good to eat a snack or reduce insulin during activity. If you had a large amount of activity the change can happen over a longer period of time. People doing multiple daily injections have fewer options here, so they need eat more snacks and beware of night-time lows. Insulin pump users can do temporary basal pattern to reduce the insulin after exercise.
- Over correcting a high blood sugar
- Failing to account for the amount of active insulin in your body when calculating a second insulin dose. For example if you did a corrective dose for a high blood sugar then 2 hours later did a second corrective dose (since the insulin is still in your body from the first dose).
- Incorrect Insulin sensitivity factor on an insulin pump. If you find you are over correcting on high blood sugars the Incorrect Insulin sensitivity factor my be set incorrectly. Talk to your doctor to ensure the insulin pump settings are correct.
- Incorrect carb ratio on an insulin pump. If you find you are over dosing on mealtime insulin the carb ratio may be set wrong. Talk to your doctor to ensure the insulin pump settings are correct
- Incorrect insulin action time on an insulin pump. Most insulin pumps take into account the “insulin action time” but this value needs to be set per person per insulin type. A typical insulin action time is 4-6 hours for rapid acting insulin. Talk to your doctor to ensure this insulin action time is set correctly.
- Basal rate too high. If the blood sugar slowly creeps down during periods of fasting and rest the basal rate may be too high. Talk to your doctor to ensure the insulin pump settings are correct.
- Alcohol has a complex effect on blood sugar especially when consumed in larger quantities. Beware of low blood sugars after consumption and keep an eye out for a delayed low blood sugar effect during the night or many hours after consumption. Researchers are aware of the phenomenon but it is not well understood. Diabetes patients are often not aware of the risk. (See The Effect of Evening Alcohol Consumption on Next-Morning Glucose Control in Type 1 Diabetes by Turner Et Al. in Diabetes Care 2001)
- Weight change or large diet change. If your weight changes significantly your insulin regimen will likely need an adjustment to account for your body’s new needs. Also if you are diet changes significantly ( for example going to a low carb diet from a high carb diet), your insulin may need changing. Talk to your doctor to ensure the insulin pump settings are correct.
Symptoms of Low Blood Sugar
Some people do not have symptoms of low blood sugar or only notice the symptoms when it is too late. It is important to check your blood sugar or use a CGM device to monitor the blood sugar levels to avoid the problem.
- early symptoms include
- weakness, shakiness, twitching
- tremor
- blurred vision
- light headed, loss of focus
- sleepiness, or yawning
- unusual emotional responses, irritation
- sweaty, tingling sensation
- disrupted or jumbled speech pattern
- severe symptoms include
- confusion, disorientation
- loss of motor skills, inability to walk
- seizure, loss of consciousness
Left untreated the low blood sugar could become a loss of consciousness or cause serious permanent damage. Low blood sugar should be treated like an emergency, ke orange juice, glucose tablets, candy, or regular soda. Basic causes of low blood sugar can be eating too little compared to the amount of insulin taken or having a too high basal insulin rate, over correcting insulin, not accounting for exercise, over alcohol consumption, stress, or sickness.
Low blood sugar is treated in two ways:
- If the person is experiencing early symptoms and is able to swallow, consuming rapid acting sugary foods is the best route:
- Glucose tablets or glucose gel
- Orange Juice
- Regular Sugary Soda like Coke or Pepsi (Diet Coke will not work)
- Candy
- Sugar
- If the person is unable to swallow or is experiencing severe symptoms like disorientation or loss of consciousness call the emergency hotline. If available the fastest treatment is a glucagon emergency kit. This is administered as a shot that causes the liver to release glucose after 10-15 minutes.
The typical advice for a mild low is treating with a 3 glucose tablets equating to about 15 carbs or rapid acting sugar. Then waiting 12 minutes before testing and treating again if needed. However if the blood sugar is seriously low or dropping very fast, or you are experiences more serious symptoms a larger response is needed. Taking much more glucose or calling for emergency help or even using glucagon may be needed.
Surviving an emergency:
Because low blood sugars often happen at inconvenient times you must be ready to fight for survival. Time is not on your side and immediate action must be taken prevent loss of consciousness. Here are a few tips that I have learned for when you are experiencing a sever low blood sugar or are having problems obtaining sugar.
- Always have candy or glucose tablets on you at all times. And replace it immediately after consumption. Make sure to have extra on long trips. If you will be separated from your primary bag, make sure to take the glucose tablets!
- Make sure to tell the people you are with about your condition. Tell your teachers, co workers, friends, and family.
- Have no shame about your condition.
- If you are in a store and going to buy candy or food. Just eat it. Don’t wait to pay for it. You can pay for the candy wrapper later. The author had a situation where he was trying to buy glucose and the line was so long he lost awareness of the situation and eventually passed out. He should have consumed the sugar and alerted staff of the emergency first, then pay after he was safe.
- Ask for help, scream for help but don’t let people slow you down from eating. Most people are happy to help you find sugar or candy if you tell them it is an emergency. Because low blood sugar symptoms can be confused with being drunk, you need to make sure people understand that it is a medical problem. But you must stay focused on finding sugar.
- Don’t rely only on CGM data for blood sugar monitoring. The author experienced a serious low blood sugar once where the CGM was reporting normal blood sugar. A finger stick measurement can be trusted more than CGM data.
- If you are on an insulin pump and you are feeling like you will pass out, one low tech trick is to unclip the infusion from your body. This stops the flow of insulin. Although you may still pass out, you will at least not be receiving any more insulin.
- If you feel like you are on the brink of passing out, you should be screaming for help. If you have a medical alert, make sure it is visible. In the absence of a medical alert you can tie your insulin pump around your neck so if medical people find you unconscious they will know what is going on. If you are wobbly and have difficulty standing, lower yourself to the ground to prevent falling and hitting your head. I also recommend not lying down on your back because if you vomit during unconsciousness you can suffocate.
- Know how to communicate low blood sugar and help and diabetic in multiple languages. The author was in a scary situation where he was trying to order a candy bar during a low blood sugar at an airport overseas. Because of the language barrier, he was desperately trying to come up with a word for candy or sugar and eventually he screamed help. A customer thought the author was suffocating and literally performed the Heimlich maneuver multiple times. Eventually a medic showed pushed the customer off of the author and then performed the Heimlich maneuver again but much harder, causing pain that lasted weeks! Learn how say at least Sugar, Candy, and Diabetic in any language you will be immersed in when traveling so you will be able to get help when you need it and not be confused with a drunk or choking person!
Conclusion
The best is to keep good control of your diabetes and have the discipline to be aware of your blood sugar and prepared to treat oncoming low blood sugars. However low blood sugars often hit us when you are breaking from your typical life pattern and thus your typical safeguards may not be in place. Therefore be ready to act quickly when caught unprepared in an emergency situation and to have the tenacity to do whatever you need to do to get your blood sugar back up before loosing consciousness.
The advice in this website is information that has not been reviewed by a real medical doctor so should not be used to make treatment decisions. Please consult a real medical doctor for treatment advice.
