Symptoms of Hypoglycemia

If you have diabetes, you may very well be familiar with the types of symptoms a blood glucose reading 70 milligrams per deciliter (mg/dL) or below causes. The most common symptoms of hypoglycemia include shakiness, a fast heartbeat, anxiety, and hunger. If your blood sugar gets dangerously low, you may have symptoms like confusion, vision difficulties, behavioral changes, seizures, or even loss of consciousness.

Hypoglycemia can occur in those without diabetes as well. Fortunately, eating or drinking some simple carbohydrates can usually provide a quick fix—but to do that you need to be able to identify the symptoms of hypoglycemia.

Frequent Symptoms

The symptoms of hypoglycemia tend to follow a pattern that you'll probably very quickly learn to recognize if you have diabetes. Common symptoms include:

• Shakiness
• Hunger
• Fast heartbeat
• Anxiety or panic
• Tingling feeling around your mouth
• Sweating
• A headache
• Tiredness
• Inability to concentrate
• Dilated pupils
• Irritability
• Restlessness
• Nausea
• Dizziness
• Weakness
• Loss of muscle control

Severe Symptoms

When your blood sugar becomes dangerously low (The American Diabetes Association defines severe hypoglycemia as blood sugar less than 54 mg/dL), you may have any of these symptoms as well:

• Confusion
• Behavioral changes
• Slurred speech
• Clumsy movements, as if you're intoxicated
• Blurry or double vision

• Seizures
• Loss of consciousness

Nocturnal Symptoms

During the night, you may have hypoglycemic episodes and not be aware of them. This is extremely common if you have type 1 diabetes and somewhat common in people with type 2 diabetes. Your body produces two hormones, glucagon, and epinephrine, that help keep your blood sugar at normal levels.

When you sleep, glucagon production generally decreases. Added to this, type 1 diabetes tends to also disrupt glucagon production, and glucagon decreases with every episode as well.

If you're diabetic, watch for nocturnal symptoms of hypoglycemia such as:

• Night sweats
• Nightmares
• Talking or shouting in your sleep
• Restlessness
• A headache
• Not feeling well rested when you wake up
• A glucose level that's higher than normal in the morning

If you notice these symptoms, talk to your doctor. Untreated nocturnal hypoglycemia can become dangerous, leading to life-threatening hypoglycemia, which can result in the severe symptoms listed above.

To help prevent nocturnal hypoglycemic episodes, try eating a bedtime snack of complex carbohydrates such as granola, oatmeal, or dried fruit. Be sure to try to keep your dietary, exercise, and medication routines consistent in the afternoon and evening as well. Also, be careful not to overdose on your insulin in the evening, which can lead to hypoglycemia.

Hypoglycemia Unawareness

When you have diabetes and you have repeated episodes of hypoglycemia, your brain can become less able to recognize that you're hypoglycemic because your body stops showing symptoms. This is known as hypoglycemic unawareness and it often happens at night while you're sleeping.

It's more common in type 1 diabetes than in type 2. Your blood sugar levels can become dangerously low if this continues, leading to a coma or even death. If you have chronic episodes of hypoglycemia, be sure to talk to your doctor right away so you can get it under control.

Complications

If hypoglycemia remains untreated, it can lead to any of the severe symptoms mentioned above, such as seizures, unconsciousness, and, eventually, death. This is why it's critical to treat low blood sugar immediately, no matter the cause. Hypoglycemia can also be a contributing factor in accidents such as falls, motor vehicle accidents, and injuring yourself.

Because hypoglycemia in and of itself is not a disease but an indication of another problem, similar to when you have a fever, it's extremely important that you and your doctor figure out the cause of your low blood sugar, especially if you're not diabetic or you're diabetic and keep having episodes of hypoglycemia.

When to See a Doctor

If you're not diabetic and you have symptoms of hypoglycemia, you should see your doctor right away, even if you're able to get your symptoms to subside by consuming simple carbohydrates such as 4 ounces of juice or non-diet soda, a serving of jellybeans as detailed by the package, a banana, 8 ounces of milk, 1 tablespoon of honey or corn syrup, or 2 tablespoons of raisins.

Being hypoglycemic means that something else is going on and you need to find out what that is so it can be treated before your hypoglycemia becomes life-threatening. If you're still having symptoms after treating your low blood sugar with the above measures, go to the emergency room immediately.

If you're diabetic, you will most likely deal with hypoglycemia on occasion. If your blood sugar is below 70 mg/dl, try one of the remedies detailed above or take glucose tablets as directed by the package. As long as your blood sugar goes back to normal, you can resume your regular activities. However, if you've treated your hypoglycemia and your blood sugar remains low and/or you still have symptoms, it's time to contact your doctor as soon as possible.

You should also visit with your doctor right away if you have symptoms of nocturnal hypoglycemia and/or recurring episodes of hypoglycemia since these can turn into serious, potentially life-threatening, problems if they're not treated.

If you or a loved one have severe symptoms such as behavioral changes, confusion, visual changes, slurred speech, seizures, or unconsciousness, get emergency help.

Sources:

American Diabetes Association. Hypoglycemia (Low Blood Glucose). Updated July 1, 2015.

Healthwise Staff. Nocturnal Hypoglycemia. Healthwise. Government of Alberta. Updated March 13, 2017.

Martín-Timón I, del Cañizo-Gómez FJ. Mechanisms of Hypoglycemia Unawareness and Implications in Diabetic Patients. World Journal of Diabetes. 2015;6(7):912-926. doi:10.4239/wjd.v6.i7.912.

Mayo Clinic Staff. Hypoglycemia. Mayo Clinic. Updated February 16, 2018.

Service FJ, Cryer PE, Vella A. Hypoglycemia in Adults: Clinical Manifestations, Definition, and Causes. UpToDate. Updated March 14, 2017.