How Hypoglycemia Is Diagnosed

Diagnosing hypoglycemia when you have diabetes is simple: If your blood sugar is <70 milligrams per deciliter (mg/dL) or below as determined by your blood glucose meter, you need to treat it immediately with fast-acting carbohydrates. The American Diabetes Association defines severe hypoglycemia as a blood sugar level that's less than 54 mg/dL.

If you don't have diabetes, hypoglycemia is defined as a blood sugar level of 55 mg/dL or less. If you have symptoms of hypoglycemia, your healthcare provider will need to figure out the cause, starting with a blood test. Similar to when you have a fever, having low blood sugar is not a disease, it's a condition that indicates that something else is going on in your body.

Self-Checks/At-Home Testing

If you're a person with diabetes, especially when you're newly diagnosed and beginning treatment, you will likely encounter episodes of hypoglycemia on occasion.

Check your blood sugar with a blood glucose meter if you begin to experience any of the following symptoms of hypoglycemia:

• Shakiness
• Irritability
• Confusion
• Tachycardia (elevated heart rate)
• Hunger

Labs and Tests

If you do not have diabetes, schedule a visit with your healthcare provider if you keep having symptoms of hypoglycemia. Your healthcare provider will do a physical exam, medical history, and ask you questions about your symptoms.

Blood Tests

Your healthcare provider will need to see if your blood glucose level is low when you're having symptoms. If you have symptoms of hypoglycemia after you eat, your healthcare provider may have you come back after a meal to check your blood glucose. You may also need to have your blood drawn and sent to the lab to analyze your insulin levels and/or other substances in your blood.

Glucose enters cells with help from insulin and glucose transporters.

If you do have hypoglycemia, the cause can be as simple as a medication you're taking that can lead to low blood sugar, like the antibiotic Bactrim (sulfamethoxazole and trimethoprim), beta blockers, monoamine oxidase inhibitors (MAOIs), or Haldol (haloperidol), or the result of an alcohol binge.

If it's not due to medications or alcohol, your healthcare provider may do additional testing to find out what the underlying cause is, such as a hormonal deficiency or an illness like kidney disease or hepatitis.

Differential Diagnoses

If you don't have diabetes and you have symptoms of hypoglycemia yet your blood sugar levels are normal, there's something else going on. In fact, there's a long list of conditions that your symptoms could be attributed to.

The most common non-diabetes causes include:

• Liver, kidney, or cardiac disease
• Malnutrition
• Hormonal deficiencies
• Medication side effects
• A metabolic disorder like hyperthyroidism

Your healthcare provider may do additional testing to look for the cause of your symptoms depending on what they are and your family and medical history.

When you have repeated episodes of hypoglycemia, you can stop showing symptoms. In this case, the hypoglycemia commonly happens at night when you're unaware that your glucose levels have dropped.

If you are diagnosed with diabetes, starting continuous glucose monitoring, continuous subcutaneous insulin infusion, and/or automated insulin delivery soon after your diagnosis can be beneficial, depending on your needs and preferences.

A continuous glucose monitor can be helpful to detect hypoglycemia, especially at night, because it alerts you when your levels get too high or too low. Your healthcare provider will also work with you to get your levels under control so this stops happening. Even two to three weeks of avoiding hypoglycemia can restore your body's awareness.