Low Blood Sugar (Hypoglycemia)

• What exactly does hypoglycaemia mean? Hypoglycaemia is a condition called low blood sugar. The blood sugar level drops below 50 mg/dl.
• Symptoms: mainly heart palpitations, ravenous hunger, trembling or pale skin, sometimes also concentration problems, nausea or headaches
• Causes: When the body uses more glucose than it has available, hypoglycaemia occurs. Pre-existing conditions such as diabetes, hormonal or metabolic disorders or also various intolerances and medications are often the triggers of this process.
• Measures: The blood sugar level can often be normalised again by consuming glucose or sweetened drinks. However, in the case of more severe hypoglycaemia, an infusion may also be necessary in some cases.
• Risks: In the case of a particularly severe hypoglycaemia, seizures, unconsciousness, breathing and circulatory problems as well as paralysis may be the result. Rarely, hypoglycaemia can also mean death.

Diabetics are among the most likely to experience hypoglycaemia. However, they often notice the symptoms very late or not at all. For this reason, it is especially important for diabetics to know at what time hypoglycaemia is most likely to occur.

Diabetics can learn how to prevent hypoglycaemia and how to react to it in special seminars or training courses. Usually, these seminars are conducted by doctors or diabetes counsellors.

For the human body, hypoglycaemia is associated with a great deal of stress. The brain must be permanently supplied with sufficient glucose. To do this, the body must perform glycogenolysis (conversion of glycogen into glucose) and produce new sugar (gluconeogenesis). This in turn requires the stress hormones adrenaline and cortisol, which are secreted by the adrenal glands.

Diabetics often worry about suffering hypoglycaemia while sleeping. It is true that hormonal gene regulation does not work as well during sleep as it does during the day. The symptoms of hypoglycaemia at night are identical to those during the day. However, they often go undetected during sleep. So, it can happen that you feel weak the next morning. In this case, it is advisable to talk to your doctor about it. Adjusting your diabetes medication and avoiding food intake just before sleep, late evening exercise and alcohol can be helpful.

Hypoglycaemia is usually counteracted by the conversion of glycogen into glucose. This release of glucose from the body’s stores is done with the help of hormones. However, this mechanism for regulating blood glucose levels is only functional to a limited extent or not at all in some people. This may be due to a hormone deficiency or because the body’s glycogen stores are completely depleted.

The blood sugar is used up quickly, especially during physical exertion. This can result in hypoglycaemia. Despite these circumstances, diabetics are perfectly capable of doing sports, as long as they eat enough food.

Diabetes is the most common cause of hypoglycaemia. However, it is not uncommon for people with hormonal or metabolic disorders and liver disease to be affected.

Normally, diabetics inject themselves with insulin. The dosage of insulin is adjusted to the amount of carbohydrates in a meal and the amount of physical activity. Simple calculation errors or misjudgements can therefore easily lead to an overdose of insulin and thus to hypoglycaemia.

When injecting insulin, however, it is not only the dosage that is decisive. The time interval between administration and meal is also of particular relevance. For example, the blood glucose level could drop too early if the insulin is injected too soon or if gastric emptying is greatly delayed. Hypoglycaemia can also occur if a diabetic administers an injection before a planned meal and yet does not eat.

The site at which the injection is administered is also particularly important. For example, if the insulin is injected into the muscle instead of the subcutaneous fat tissue, the hormone reaches the body’s bloodstream much more quickly.

At the beginning of a diabetes disease, there is often an excessive production of insulin. This is the body’s attempt to compensate for the weak effect of the hormone. Due to the high amount of insulin released after food intake, far too much glucose enters the cells of the organism. In medicine, this process is called “postprandial hypoglycaemia”.

Although hypoglycaemia mainly occurs in diabetics, it is also common in people without diabetes.

Hypoglycaemia can also be caused by different hormone disorders. In this context, however, it usually occurs together with other symptoms. One example is the underactivity of the so-called adrenal cortex. The latter is responsible for the production and release of hormones that should normally prevent hypoglycaemia. However, if this hormone production is impaired, the risk of hypoglycaemia is significantly higher.

The adrenal cortex is not independent. It is controlled and regulated by the so-called pituitary gland. So, if the function of the pituitary gland is also limited, the production of hormones cannot take place correctly. In addition, the pituitary gland itself produces two hormones (somatotropin and TSH) that also influence blood sugar levels. For this reason, hypofunction of the pituitary gland is often associated with hypoglycaemia.

These include:

• Prolonged abuse of alcohol: often associated with malnutrition, alcohol itself causes a drop in glucose concentration in the blood.
• Diabetes during pregnancy: Permanently elevated glucose levels in the mother lead to increased insulin production in the foetus. After birth, the new born often suffers from hypoglycaemia.
• Dumping syndrome: This condition is common in people who have had part of their stomach removed. Ingested food suddenly enters the intestine in large quantities. The blood sugar level rises sharply and insulin production increases. This often results in hypoglycaemia.
• Various medications, for example antibiotics or beta-blockers, can also trigger hypoglycaemia in combination with other risk factors.
• Serious liver diseases that impair the conversion of glycogen into glucose prevent compensation for low blood sugar levels.
• Reactive hypoglycaemia: If too much sugar is consumed at once, the body reacts with a marked increase in insulin secretion. As a result, the blood sugar level drops so much that hypoglycaemia can occur.
• Metabolic disorders: Impaired glycogen build-up or storage of glucose, for example, due to diseases of the carbohydrate metabolism, are potential triggers of hypoglycaemia.
• Impaired food intake, e.g., coeliac disease: The body cannot absorb enough glucose from the intestine.

Diabetics are most often affected by hypoglycaemia. For this reason, most of them are well prepared for such an incident. A blood glucose meter is usually at hand at all times. If hypoglycaemia is suspected, it is advisable to measure the blood glucose level first. This makes it easy to determine the extent of the hypoglycaemia. The necessary measures depend on the result of the measurement:

Normally, diabetics can act on their own in the case of mild hypoglycaemia:

• Consume glucose (20 grams is usually sufficient).
• Drink a glass (about 200 ml) of sweetened drink such as cola or juice
• After about 15 minutes, the blood sugar should be measured again. If the value is still not above 50 to 60 mg/dl, it is advisable to consume more glucose or drinks.
• If the blood sugar level improves, it can be helpful to stabilise it with a small meal containing carbohydrates. For example, some bread, sweetened yoghurt or fruit is suitable for this.

A particularly pronounced hypoglycaemia is a potentially life-threatening condition. It should always be treated by a doctor. In the worst case, an ever-increasing hypoglycaemia can lead to a so-called glycaemic shock. This may even result in a coma after previous unconsciousness. For this reason, you should always call an emergency doctor in case of severe hypoglycaemia with unconsciousness.

The symptoms of hypoglycaemia can often be related to other diseases and health conditions. To make sure that it is really hypoglycaemia, doctors usually take a so-called medical history. The medical history is important information about a patient’s health history. Often the doctor wants to find out which previous or underlying diseases (e.g., diabetes) exist, whether and which medications the person concerned is taking or whether alcohol consumption has preceded the condition.

It is especially important to measure blood glucose levels as regularly as possible. The devices used for this purpose are usually easy to use and provide a reliable result in just a few minutes.

If the suspicion of hypoglycaemia is confirmed, the doctor usually administers glucose to the patient. If the person is still conscious, the required glucose is usually ingested as dextrose. Sweets or sugary drinks are also sufficient in most cases. However, depending on the composition of this food, the blood glucose level can rise differently, sometimes very slowly.

In the case of a particularly severe hypoglycaemia accompanied by disturbances of consciousness, vomiting and nausea, the doctor must administer the glucose as an infusion. To prevent an overdose of glucose, the blood glucose level is checked regularly during the infusion.

Another measure to help the blood sugar level rise again quickly is the administration of glucagon. However, the latter only works if the glycogen stores are still full. As long as the patient has not exercised excessively or fasted, this is usually the case. In people with a glycogen metabolism disorder or after increased alcohol consumption, however, glycogen does not work.

The following, particularly important examinations are helpful for the doctor to find out possible causes of the respective complaints:

Every cell in our body needs to be supplied with energy. The body obtains energy from various nutrients that it uses. The sugar molecule glucose is the most important of these energy sources. Humans absorb carbohydrates, as sugar compounds, with their food. In the digestive tract, these are processed into glucose and then absorbed by the bloodstream. Insulin is primarily involved in this process.

The body also has ways of producing energy through the breakdown of fat and protein. However, to ensure a quick supply of energy, a direct supply of carbohydrates is crucial.

Nerve cells in the brain and spinal cord are particularly threatened by low blood sugar (hypoglycaemia), as they only obtain their energy by breaking down glucose (glycolysis).