Hypoglycemia
What is Hypoglycemia?
Hypoglycemia happens when your blood sugar drops too low. Your body uses glucose as its main fuel source. When levels fall below normal, you can feel shaky, dizzy, or confused.
Most people associate low blood sugar with diabetes medications like insulin. But hypoglycemia can affect anyone. It may happen when you skip meals, exercise intensely without eating, or drink alcohol on an empty stomach. Some health conditions can also cause your blood sugar to drop unexpectedly.
Your blood sugar is considered too low when it falls below 70 milligrams per deciliter. At this level, your body releases stress hormones to try to raise it back up. Severe hypoglycemia below 54 milligrams per deciliter requires immediate treatment. Understanding what triggers your low blood sugar is the first step toward prevention.
Symptoms
- Shakiness or trembling hands
- Sweating even when not hot
- Rapid heartbeat or pounding pulse
- Dizziness or lightheadedness
- Hunger or nausea
- Confusion or difficulty concentrating
- Irritability or mood changes
- Pale skin color
- Headache
- Blurred vision
- Weakness or fatigue
- Anxiety or feeling nervous
Some people experience hypoglycemia unawareness, especially if they have had diabetes for many years. They may not feel symptoms until blood sugar is dangerously low. Others may only notice symptoms during certain times of day, like overnight or after exercise.
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Causes and risk factors
Hypoglycemia has many possible triggers. For people with diabetes, taking too much insulin or certain medications can lower blood sugar too much. Skipping meals or eating less than usual after taking diabetes medication is another common cause. Intense exercise burns glucose quickly, sometimes faster than your body can replace it. Drinking alcohol interferes with your liver's ability to release stored glucose into your bloodstream.
Non-diabetic hypoglycemia is less common but can happen. Certain tumors can produce too much insulin, driving blood sugar down. Liver disease prevents your liver from making enough glucose. Hormone deficiencies involving cortisol or growth hormone affect blood sugar regulation. Some medications, infections, and kidney disease can also cause low blood sugar. Reactive hypoglycemia happens when blood sugar drops a few hours after eating high-carbohydrate meals.
How it's diagnosed
Diagnosing hypoglycemia starts with measuring blood glucose during symptoms. Your doctor will check if your blood sugar is below 70 milligrams per deciliter when you feel unwell. They will also see if symptoms go away when blood sugar returns to normal. This is called Whipple's triad and helps confirm true hypoglycemia.
Blood tests reveal why your blood sugar drops. Glucose testing measures your current blood sugar level. Insulin and free insulin tests show if your body makes too much insulin. C-peptide testing helps determine if excess insulin comes from your pancreas or from injected insulin. Estimated average glucose, or eAg, gives a picture of your glucose levels over time. Rite Aid offers add-on testing for hypoglycemia through Quest Diagnostics at over 2,000 locations nationwide.
Treatment options
- Eat 15 grams of fast-acting carbohydrates immediately when blood sugar drops below 70 milligrams per deciliter
- Good options include 4 glucose tablets, half cup of juice, or 1 tablespoon of honey
- Wait 15 minutes and recheck blood sugar to see if it reaches 70 or higher
- Eat small, frequent meals throughout the day to prevent drops
- Include protein and healthy fats with carbohydrates to slow glucose absorption
- Adjust diabetes medications with your doctor if lows happen often
- Carry glucose tablets or fast-acting sugar with you always
- Limit alcohol or drink only with food
- Check blood sugar before, during, and after exercise
- Treat underlying conditions like liver disease or hormone deficiencies
- Consider continuous glucose monitoring if you have hypoglycemia unawareness
- Work with a registered dietitian to plan balanced meals
Need testing for Hypoglycemia? Add it to your panel.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
Blood sugar below 70 milligrams per deciliter is considered hypoglycemia. At this level, most people start feeling symptoms. Blood sugar below 54 milligrams per deciliter is severe hypoglycemia and needs immediate treatment.
Yes, non-diabetic hypoglycemia can happen but is less common. It may be caused by certain medications, alcohol, liver disease, kidney disease, or tumors that produce too much insulin. Reactive hypoglycemia occurs when blood sugar drops a few hours after eating high-carbohydrate meals.
Treat low blood sugar immediately when it drops below 70 milligrams per deciliter. Eat 15 grams of fast-acting carbohydrates like glucose tablets or juice. Wait 15 minutes, then recheck to make sure it has risen to 70 or higher.
Nighttime hypoglycemia often happens when you take diabetes medication before bed without eating enough. Exercise late in the day can also lower blood sugar overnight. Your body naturally needs less glucose while sleeping, so insulin or medications may have a stronger effect during these hours.
Glucose testing measures your current blood sugar level. Insulin and C-peptide tests show if your body produces too much insulin. Free insulin testing measures the active form of insulin in your blood. These tests help your doctor understand why your blood sugar drops too low.
Hypoglycemia unawareness means you do not feel symptoms when blood sugar drops low. This happens most often in people who have had diabetes for many years or who have frequent low blood sugar episodes. Without warning signs, blood sugar can drop to dangerous levels before you notice.
Eat balanced meals with protein, healthy fats, and fiber instead of high-carbohydrate meals alone. This slows down glucose absorption and prevents blood sugar spikes followed by crashes. Avoid sugary drinks and simple carbohydrates on an empty stomach.
Yes, check your blood sugar before exercise and eat a snack if it is below 100 milligrams per deciliter. Exercise burns glucose quickly and can drop blood sugar for hours afterward. Carry fast-acting carbohydrates with you during long or intense workouts.
Stress itself does not usually cause hypoglycemia. In fact, stress hormones typically raise blood sugar. However, stress may cause you to forget meals or take medications incorrectly, which can lead to low blood sugar in people with diabetes.
See a doctor if you have frequent episodes of low blood sugar, especially if you do not have diabetes. Get immediate medical help for severe hypoglycemia that causes confusion, seizures, or loss of consciousness. Your doctor can run blood tests to find the underlying cause and adjust your treatment plan.