Hypoglycemia (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is hypoglycemia?
- Who is at risk for hypoglycemia?
- I thought high blood sugar was bad. Why is low blood sugar also bad?
- Can the body protect itself from hypoglycemia?
- What are symptoms of hypoglycemia and how low is too low?
- How is hypoglycemia treated?
- Is there anything else that should be done to manage hypoglycemia?
- Find a local Endocrinologist in your town
What are symptoms of hypoglycemia, and how low is too low?
The normal range of glucose in the bloodstream is from 70 to 100 mg/dL when the individual is fasting (that is not immediately after a meal). The body's biochemical response to hypoglycemia usually starts when sugars are in the high/mid 70's. At this point, the liver releases its stores and the hormones mentioned above start to activate. In many people, this process occurs without any clinical symptoms. The amount of insulin produced also declines in an attempt to prevent a further drop in glucose.
While there is some degree of variability among people, most will usually develop symptoms suggestive of hypoglycemia when blood glucose levels are lowered to the mid 60's. The first set of symptoms are called adrenergic (or sympathetic) because they relate to the nervous system's response to hypoglycemia. Patients may experience any of the following;
- nervousness,
- sweating,
- intense hunger,
- trembling,
- weakness,
- palpitations, and
- often have trouble speaking.
In most people, these symptoms are easily recognizable. The vast majority of individuals with diabetes only experience this degree of hypoglycemia if they are on medications or insulin. People (with diabetes or who have insulin resistance) with high circulating levels of insulin who fast, diet, or lower their carbohydrate intake drastically should also be cautioned. These individuals may also experience modest hypoglycemia.
People being treated for diabetes who experience hypoglycemia may not experience symptoms as easily as people without diabetes. This phenomenon has been referred to as hypoglycemic unawareness. This can be dangerous as blood sugars may approach extremely low levels before any symptoms are perceived.
Anyone who has experienced an episode of hypoglycemia describes a sense of urgency to eat and resolve the symptoms. And, that's exactly the point of these symptoms. They act as warning signs to tell the body to consume more fuel. At this level, the brain still can access circulating blood glucose for fuel. The symptoms provide a person the opportunity to raise blood glucose levels before the brain is affected.
If a person does not or cannot respond by eating something to raise blood glucose, the levels of glucose continue to drop. Somewhere in the 50 mg/dl range, most patients progress to neuro-glyco-penic ranges (meaning that the brain is not getting enough glucose). At this point, symptoms progress to confusion, drowsiness, changes in behavior, coma, and seizure.
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