Low blood sugar · Reactive hypoglycemia · Hypoglycemia unawareness
Low blood sugar, taken seriously.
Shakiness, sweating, a racing heart and sudden hunger that vanish with food can be hypoglycemia. In people on insulin or sulfonylureas it is a known risk that can be engineered away. In people without diabetes it is uncommon and always deserves a proper explanation. Dr. Hasan is experienced in both.
Recognizing hypoglycemia
Hypoglycemia is confirmed by Whipple's triad: symptoms, a measured low glucose (generally under 55 mg/dL in people without diabetes, under 70 mg/dL in people with diabetes) and relief when glucose rises. A low reading on a fingerstick or CGM without symptoms, or symptoms without a documented low, is not enough on its own.
How low glucose feels
- 1Confusion, trouble concentrating, slurred speech, drowsiness (below ~50 mg/dL)
- 2Blurred vision; headache
- 3Pounding or racing heart; anxiety
- 4Sweating, pallor, clamminess
- 5Sudden intense hunger, nausea
- 6Trembling, tingling lips and fingers
With repeated lows the warning symptoms fade (hypoglycemia unawareness). Restoring them requires several weeks of strict avoidance of lows.
Causes and treatment
The cause determines the fix, and the causes differ sharply between people with and without diabetes.
In people without diabetes, a documented low with inappropriately high insulin and C-peptide points to the pancreas or to a hidden sulfonylurea.
- Diabetes: adjust insulin ratios and timing, switch sulfonylureas to agents that do not cause lows, use CGM alerts and predictive low-glucose suspend on pumps, and prescribe glucagon for everyone on insulin.
- Treat a low correctly: 15 grams of fast carbohydrate (glucose tablets, 4 oz juice), recheck in 15 minutes, repeat if still under 70, then a snack if the next meal is more than an hour away.
- Post-bariatric hypoglycemia: smaller, protein-forward meals, less refined carbohydrate, and medications such as acarbose when diet is not enough.
- Reactive hypoglycemia in people with insulin resistance responds to the same dietary approach and weight management.
- Insulinoma is rare but curable with surgery once located.
Dr. Hasan is experienced in eliminating hypoglycemia in insulin-treated diabetes with CGM and pump technology, evaluating low blood sugar in people without diabetes, and managing post-bariatric hypoglycemia.
Common questions
I feel shaky when I skip meals but my glucose is normal. Is that hypoglycemia?
Usually not. Adrenaline-type symptoms with a normal glucose are common and not dangerous, though they are worth understanding. True hypoglycemia requires a documented low with symptoms.
Can a CGM diagnose hypoglycemia in someone without diabetes?
CGMs are less accurate at low values and often read falsely low overnight from pressure on the sensor. They are useful for patterns, but the diagnosis rests on a laboratory glucose during symptoms.
Is hypoglycemia dangerous?
Severe lows can cause falls, accidents, seizures and heart rhythm problems, and repeated lows blunt the body's warning system. Preventing them is a priority in every diabetes plan.
Related conditions
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