“Spotting the Silent Danger: Hypoglycaemia Awareness”

Spotting the Silent Danger: Hypoglycemia Awareness

Hypoglycemic Info

Blood glucose deficiency is hypoglycemia. A blood glucose level below 4 mmol/L indicates hypoglycemia. Diabetic patients on insulin or oral diabetic medications are most likely to experience hypoglycemia.

As we all know, managing diabetes entails keeping your blood sugar within the healthy range prescribed by your healthcare provider. Diabetes can cause high blood sugar levels, but hypoglycemia—low blood sugar—is also harmful.

Hypoglycemia occurs when the blood glucose level drops below 70 mg/dL.

Hypoglycemia symptoms?

Hypoglycemia (low blood sugar) can lead to subtle warning signs that may escalate to serious neurological consequences. Early detection is essential since untreated hypoglycemia can kill.

Key Symptom Categories: 

1. Adrenergic (Autonomic) Symptoms

• The body releases adrenaline in reaction to falling glucose:
• Quaking or shaking
• Cold, clammy sweating
• Heart palpitations or a fast heartbeat
• Restlessness, anxiety, or irritation
• Hunger or sudden cravings

2. Neuroglycopenia

These come from brain glucose deficiency:

• Lack of focus, coordination, or confusion
• Haze or double vision
• Slurred speech (stroke-like)
• Drowsiness, weariness, or weakness
• Pain, dizziness, lightheadedness
• In severe cases, seizures or unconsciousness

3. Extra General Symptoms

• Pale skin
• Tingling or numbness (particularly lips or tongue)
• Irritability, unexpected grief, or hostility

Spectrum of severity

• Mild hypoglycemia: Hunger, perspiration, trembling, palpitations. One can easily treat mild hypoglycemia by quickly consuming sugar.
• Moderate hypoglycemia can cause confusion, impaired vision, and difficulty concentrating. Needs immediate repair.
• Severe hypoglycemia may cause seizures, unconsciousness, or coma. Needs immediate care.

Important Notes

• Diabetes patients who have numerous episodes may develop hypoglycemia unawareness.
• People without diabetes can develop hypoglycemia from prolonged fasting, alcohol, drugs, or unusual metabolic disorders.
• Preventing development requires prompt administration with glucose pills, juice, or other fast-acting carbs.
• If blood sugar levels continue to drop, neurological symptoms such as confusion, blurred vision, and seizures will develop. Early warning indications of hypoglycemia include sweating, tremors, palpitations, and hunger.

Hypoglycemia unawareness

Hypoglycemia unawareness makes episodes more dangerous because they might lead to confusion, seizures, or coma.

What are the reasons?

• Low blood glucose levels (<4 mmol/L) can cause autonomic symptoms like perspiration, tremors, palpitations, and hunger.
• Hypoglycemia unawareness blunts or eliminates the body's warning cues. The brain only shows symptoms when glucose levels are critically low.
• This condition is most common among individuals with type 1 diabetes and those with insulin-treated type 2 diabetes, particularly after many years of treatment.

Why It Happens

• Recurrent hypoglycemia occurs when low blood glucose levels desensitise the body's adrenaline response.
• In individuals with long-lasting diabetes, the glucagon-adrenaline response diminishes over time.
• Very stringent glucose targets may raise the risk of recurring lows and unawareness.
• Excessive rest and drinking can mask early warning symptoms.

Risks

• Severe hypoglycemia can cause patients to fall, suffer convulsions, or lose consciousness without warning.
• Driving, operating machinery, or walking alone can lead to accidents and injuries.
• The quality of life may be affected by fears of hypoxia, which can limit everyday activities.

Managing Strategies

• Avoiding recurring hypoglycemia: Relaxing glucose targets can restore awareness for weeks to months.
• Frequent monitoring includes fingerstick checks or continuous glucose monitors (CGM) with alarms.
• Structured education should focus on recognizing subtle or alternative signs of hypoglycemia, such as mood changes and weariness.
• Technology: Predictive low-glucose suspend insulin pumps reduce the risk.
• The support system, which includes family, friends, and coworkers, should recognise and treat extreme hypoglycemia.

Main Hypoglycemia Causes

1. Diabetic Patients: 

• Excess insulin or oral diabetic medicine (e.g., sulfonylureas, meglitinides).
• Skip or delay meals following medication.
• Overexercising without food or insulin adjustments.
• Alcohol, particularly on an empty stomach, inhibits hepatic glucose release.
• Recurrent lows due to tight glucose management and frequent adjustments.

2. Nondiabetics

• Hypoglycemia, albeit rare, can result from excessive alcohol consumption, particularly binge drinking without food.
• Sepsis, renal, liver, and serious infections are critical illnesses.
• Hypothyroidism, hypopituitarism, and adrenal insufficiency.
• Excessive insulin reaction after meals after bariatric surgery.
• Insulinoma: a rare pancreatic tumour that overproduces insulin.
• Genetic enzyme deficits alter glucose regulation.
• Extended fasting or hunger.

3. Special Cases

• Babies of diabetic mothers or premature or low-birth-weight infants often develop hypoglycemia.
• Quinolones, quinine, and beta-blockers may cause adverse effects.
• Reactive hypoglycemia: insulin release causes blood sugar to plummet hours after a high-carb meal.

Why is it important

• Quick sugar consumption fixes mild hypoglycemia.
• Untreated severe hypoglycemia can induce seizures, coma, or death.
• Recurrent hypoglycemia can cause hypoglycemia unawareness due to missed warning indicators.

Also, read https://www.lark.com/resources/what-is-hypoglycemia.

How is hypoglycemia diagnosed?

Diagnosing hypoglycemia involves testing for low blood glucose at the time of symptoms and proving that glucose correction improves symptoms. 

The Diagnostic Framework: 

1. Whipple's Triad

• The classic diagnosis standard:
• Hypoglycemia symptoms (sweating, tremors, disorientation, blurred vision).
• Low plasma glucose (usually <70 mg/dL, but important symptoms often occur <55 mg/dL).
• After eating or IV glucose, symptoms improve.
• With all three, hypoglycemia is verified.

2. Blood glucose test

• Quick bedside glucose fingerstick test if symptoms emerge.
• Laboratory plasma glucose: More accurate, especially for unexplained hypoglycemia.
• CGM can detect trends, nocturnal hypoglycemia, and asymptomatic episodes in diabetes.

3. Provocative screening for unexplained cases

• People without diabetes may need further assessment for hypoglycemia:
• Supervised 72-hour fast: Gold standard for fasting hypoglycemia and insulinoma diagnosis. Blood tests glucose, insulin, C-peptide, and ketones.
• Mixed-meal test: For reactive hypoglycemia from meals.

4. Additional Lab Workup

• Levels of insulin and C-peptide contrast insulinoma with exogenous insulin usage.
• Insulin-mediated hypoglycemia suppresses beta-hydroxybutyrate.
• For unintentional or covert drug intake, screen for sulfonylureas/meglitinides.
• Hormone tests: Endocrine deficiencies can impair cortisol, growth hormone, and thyroid function.

5. Clinical Setting

• Symptoms and low glucose on the meter usually diagnose diabetes.
• Non-diabetic hypoglycemia requires a meticulous history (fasting, alcohol, drugs, surgery, sickness) and specialised tests.

Hypoglycemia Treatment Steps

The video about the treatment of Hypoglycemia

1. Conscious, Swallowable Mild Hypoglycemia

• CDC/ADA recommendation 15–15:
• Consume 15 grams of fast-acting carbohydrate (e.g., 3-4 glucose tablets, ½ cup fruit juice, 1 tablespoon sugar/honey).
• Recheck blood glucose after 15 minutes.
• If still <70 mg/dL, repeat.

To prevent recurrence, consume a sandwich, yogurt, or almonds that contain protein and complex carbohydrates once your glucose levels normalize.

2. Unconscious, seizing, or unable to swallow hypoglycemia

• No oral feeding or drinking (choking risk).
• A trained caregiver should provide an intramuscular, subcutaneous, or nasal glucagon injection.
• If the person doesn't recover fast, contact emergency
• IV glucose solution is given in hospitals and ambulances.

3. Special Considerations

• Children may need lower carbohydrate doses (see pediatric team).
• Since alcohol limits hepatic glucose release, alcohol-related hypoglycemia requires glucose and monitoring.
• Recurrent hypoglycaemia: May require insulin/medication adjustments, meal planning, or CGM.
• Hypo unawareness: Higher glucose targets may help restore awareness.

Ways to prevent

• Regular meals/snacks: Avoid missing meals, especially on insulin or sulfonylureas.
• Check glucose periodically, especially before driving, exercising, or bedtime.
• Use activity, illness, or drinking to adjust insulin/medication.
• Educate friends/family: They should notice signs and use glucagon.
• Always have glucose tablets, gel, or tiny juice boxes.

Conclusion

Hypoglycemia is both preventable and treatable, but only if recognized early. Empowering patients, families, and healthcare providers with knowledge of symptoms, causes, and management strategies is the cornerstone of safety and quality of life.