Low blood sugar: Warning signs, ways to treat and when to call the doctor

According to the Centers for Disease Control and Prevention's 2020 National Diabetes Statistics Report, 34 million people living in the United States had diabetes in 2018 -- and amazingly, 21% of adults with diabetes did not even know they had it. The scariest part is that, if left untreated, diabetes can be deadly. In fact, it was the seventh leading cause of death in the year 2017. 

And while normally associated with high blood sugar (aka hyperglycemia), diabetic folks can also experience hypoglycemia, or low blood sugar, alongside its own bevy of problems -- including more severe and/or long-term effects like seizures, loss of consciousness, dementia and even death. Further, according to the Mayo Clinic, hypoglycemia can also cause low blood sugar in folks without diabetes due to a variety of conditions and medications.

So, needless to say, it's important to maintain healthy blood sugar levels. But how is this done, especially if you don't know the first thing about blood sugar?

What is normal blood sugar?

When we eat, glucose (aka blood sugar) -- which is our body's main source of energy -- enters our bloodstream from our food. Then our pancreas secretes a hormone called insulin in just the right amount to help the glucose go from the bloodstream to our body's various cells to be used as energy. This process usually keeps the glucose in our bloodstream in a healthy range, being neither too high, nor too low. 

This range is measured in milligrams of blood glucose per deciliter, or mg/dL. Dr. Saleh Aldasouqi, Chief of Endocrinology at Michigan State University, explains to CNET: "Normal blood sugar is defined as anywhere from 70 to 110 mg/dL within a healthy physiology, as a person without diabetes or other related diagnosed condition. Sugar below 70 is generally considered low, and above 110 is considered high (depending on the time since the person's last meal)."

Signs of low blood sugar 

With hypoglycemia, the blood sugar falls below the normal, healthy levels mentioned earlier, which can occur for a variety of reasons.

"Although some people with blood sugar problems may not experience symptoms," Dr. Aldasouqi continued, "there are some key things to look out for. For those with low blood sugar, someone might have symptoms like anxiety, sweating, increased heart rate, confusion, and may go into what is called 'a hypoglycemic coma'... The term 'diabetic coma' is also used by some."

Other symptoms of low blood sugar may include:

• Fatigue
• Shakiness
• Hunger
• Irritability
• Pale skin
• Tingling or numb lips, tongue or cheek
• Blurry vision

What causes low blood sugar?

Hypoglycemia often occurs in people who've been diagnosed with diabetes. Problems with low blood sugar can be experienced with either Type 1 or Type 2 diabetes.

Type 1 

Type 1 diabetes happens when the body's immune system starts fighting the pancreatic cells that make insulin. As a result, the pancreas stops making insulin, and the glucose in your bloodstream can't get into the necessary cells -- so your blood sugar level rises to new heights. This usually occurs in children and young adults, and they usually need to take insulin every day for the remainder of their lives. 

Type 2

This type of diabetes occurs when your blood glucose is too high and your body either doesn't make sufficient insulin, or doesn't work well with the insulin it does make. Your blood sugar levels remain too high in your bloodstream, and there isn't enough getting moved into your cells. Type 2 diabetes is more prevalent in middle and old age, but you can get it anytime, including during childhood. 

Other causes of low blood sugar

While low blood sugar is often associated with diabetes, it can also be affected by other factors. According to Dr. Danine Fruge, Medical Director of the Pritikin Longevity Center in Miami, Florida, the causes of blood sugar problems can include not only "diabetes, prediabetes (a condition where the blood sugar is high, but not yet high enough to be diagnosed as diabetes), reactive hypoglycemia (when your body produces excessive insulin after a meal) or other health issues, but also by not eating enough, taking too much insulin or even taking certain diabetes medications."

Other medications can also cause hypoglycemia, like quinine, or Qualaquin, which is used to treat malaria, or various medications for kidney failure. Exercising more than usual can also cause it, especially while taking such medications. 

Some other potential causes for low blood sugar include:

• Heavy drinking without eating
• Eating without ingesting enough carbohydrates
• Eating fewer carbs than usual without reducing insulin amounts, or improper balancing of liquid/solid carbs and timing of insulin
• Hormone deficiencies due to adrenal or pituitary tumor disorders, or in children without sufficient growth hormone
• Long-term starvation, such as that which can occur with anorexia nervosa
• Serious illness like hepatitis, kidney disorders and liver disease
• Pancreatic tumors (and some other types of tumors) that make the body secrete too much insulin

Hypoglycemia unawareness

You may "feel bad and not know why," according to Dr. Fruge, whether you're experiencing low or high blood sugar. She suggests that a glucose finger stick test can "give you an indication" as to what the problem is, but she stresses that "it's important to confirm with a glucose test. An HbA1c blood test will tell you if you have prediabetes or diabetes."

When the body gives no warning signs in the form of symptoms, hypoglycemia can become very dangerous. For those with diabetes or others who consistently experience hypoglycemia unawareness, treatment modification may be in order, as well as blood glucose awareness training. 

What to do if you think you have low blood sugar

Act quickly to treat the situation

If you suspect you have low blood sugar, Dr. Fruge recommends quickly treating the situation, which she says should include "eating healthy foods such as complex carbohydrates, beans or fruit." 

"At the Pritikin Longevity Center we serve a cup of fruit with a cup of veggies to prevent a spike in insulin, which can sometimes lead to a later drop in blood sugar again," she explains. "Adjusting your diabetes medication as prescribed by your physician may also be necessary. It's important to retest your blood sugar 20 minutes after eating to confirm it has improved."

Keep a fast-acting carb or two on hand

The American Diabetes Association suggests that those prone to low blood sugar make sure to always have a small juice box, glucose tablets or something similar with them at all times just in case their blood sugar levels drop below normal. A good rule of thumb to follow is the 15:15 Rule, which instructs the person with falling blood sugar levels to eat 15 grams of carbohydrates every 15 minutes, then test to see if their blood sugar is still below 70 mg/dL -- then have another 15 gram serving and repeat until normal.

The American Diabetes Association also recommends for those prone to hypoglycemia that eating small meals throughout the day can help blood sugar levels remain consistent and prevent dips. 

Stay in good communication with your doctor

Be sure to keep your doctor informed as to any changes you plan to make to your eating, exercise, or medication schedules. This can help you work together to make sure your blood sugar levels remain as consistently normal as possible.

When it's time to call a doctor

If any of the symptoms mentioned have begun to impact your life, such as fatigue so severe you can't stay awake through the day, it's a good idea to consult your physician. Dr. Fruge warns that "unstable blood sugar levels could put you at higher risk of heart disease and stroke and it is a red flag for serious health issues" -- so blood sugar issues should be taken seriously.

You should also see a doctor if you're experiencing symptoms of hypoglycemia and haven't been diagnosed with diabetes or any other underlying condition. 

If you do have diabetes and your hypoglycemia isn't responding to the treatments described above, that's another good cue to call your health care provider. 

If testing reveals you have Type 1 diabetes, you'll need to continue to test your blood sugar levels as often as instructed by your physician, take insulin regularly and participate in regular exercise. This may mean you will need a new glucose monitoring system, so ask your doctor what they recommend. If you're diagnosed with Type 2 diabetes, you'll most likely need to do the same as for Type 1, as well as working with health care professionals to make lifestyle changes such as improving nutrition and planning workouts. Medication may be necessary as well.

Maintaining a healthy eating and exercise regimen, monitoring blood sugar levels as/if instructed, taking medications as prescribed, and above all, keeping your doctor regularly informed on any changes to your routines, is essential to staying healthy overall and keeping low blood sugar at bay.