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MoonDragon's Health & Wellness
Disorders
Hypoglycemia (Low Blood Sugar)




BASIC INFORMATION

DESCRIPTION

Hypoglycemia is a condition in which there is an abnormally low level of glucose (sugar) in the blood. Most often this results from the oversecretion of insulin by the pancreas. Insulin facilitates the transport of glucose from the bloodstream to the cells, especially those of muscle and fatty tissue, and causes glucose to be synthesized in the liver. If the pancreas is not functioning properly, normal carbohydrate metabolism is impossible.

Hypoglycemia is not a disease but a condition that results from a variety of causes. The main types of hypoglycemia are:


Fasting hypoglycemia may develop because of a serious underlying condition, while nonfasting hypoglycemia (if you haven't had previous intestinal surgery) does not involve serious illness.

CAUSES

More and more Americans today may have this condition due to poor dietary habits that include eating large quantities of simple carbohydrates, sugars, alcohol, caffeine, and soft drinks, and insufficient amounts of complex carbohydrates. High stress levels are believed to be a contributing factor in the increasing incidence of hypoglycemia.

Hypoglycemia can be inherited (as in inherited problems with metabolism), but most often it is precipitated by an inadequate diet. This is referred to as functional hypoglycemia (FH). Many other bodily disorders can cause hypoglycemic problems as well, among them adrenal insufficiency, thyroid disorders, pituitary disorders, kidney disease, and pancreatitis. Immune deficiency and candidiasis are strongly linked to hypoglycemia. Glucose intolerance and hyperinsulemia (high blood insulin levels), producing hypoglycemia, frequently occur in people with chronic liver failure. Other common causes are smoking and the consumption of large amounts of caffeine, found in colas, chocolate, and coffee.

Hypoglycemia is a common complication of diabetes treatment (diabetic hypoglycemia). You can develop hypoglycemia by taking too much insulin or other diabetic medication. Low blood sugar can also be an early sign of diabetes (high blood sugar). See Diabetes for more information.

Hypoglycemia also may result from medications, such as monoamine oxidase inhibitors (MAOIs), quinine sulfate, and salicylates (including aspirin).

SIGNS & SYMPTOMS

A person suffering from hypoglycemia may display any or all of the following symptoms:


Any or all of these symptoms may occur a few hours after eating sweets or fats. The onset and severity of symptoms are directly related to the length of time since the last meal was eaten and the type of foods that meal contained.

The symptoms of low blood sugar may be mild, moderate, or severe.
  • Mild hypoglycemia can cause nausea, a jittery or nervous feeling, cold, clammy, wet skin, excessive sweating not caused by exercise, extreme hunger, numbness or tingling of the fingertips or lips, trembling, and a rapid heartbeat (tachycardia). Symptoms of mild low blood sugar usually develop when blood glucose falls below 60-65 mg/dL.

  • Moderate hypoglycemia often makes you feel mood changes, such as irritability, restlessness, anxiety, or angry. Confusion, difficulty in thinking, or inability to concentrate may occur. You may have blurred vision, feel unsteady, have poor coordination, and have difficulty walking (such as staggering) and talking (slurred speech). Weakness, lack of energy, fatigue, lethargy, or drowsiness may occur. Symptoms of moderate hypoglycemia will affect the nervous system as the blood sugar continues to fall below 50 mg/dL.

  • Severe hypoglycemia symptoms occur when blood sugar falls below 30 mg/dL and can lead to loss of consciousness or coma, seizures or convulsions, and low body temperature (hypothermia). Coma may be fatal. Prolonged severe hypoglycemia can cause irreversible brain damage and heart problems, especially if you already have coronary artery disease. If emergency medical treatment is not provided, severe hypoglycemia can be fatal.

Some medications may mask symptoms of low blood sugar, including beta-blockers, which are often used to treat heart conditions and high blood pressure. Frequent and significant drops in blood sugar can keep you from noticing early symptoms of low blood sugar (hypoglycemia unawareness), such as tremor, fast heartbeat, and sweating. However, if you have hypoglycemia unawareness, you will notice later symptoms of the central nervous system—including irritability and confusion—if blood sugar drops low enough.

If you have hypoglycemia unawareness, it is important for you and your family to watch for changes in your mental state that signal hypoglycemia so the condition can be treated before loss of consciousness or seizures occur. You may want to check your blood sugar more frequently than usual.

Note: Different people may develop symptoms of mild, moderate, or severe hypoglycemia at varying blood sugar levels. While the blood sugar levels listed above are typical, they may not apply to everyone. If your blood sugar drops suddenly, you may develop symptoms even if your level is in the normal range.

A number of medical conditions can cause symptoms similar to those of hypoglycemia. Your health professional will use blood tests and other measures to make sure another condition isn't causing your symptoms.

RISK FACTORS

Risk factors for hypoglycemia include:

PREVENTION

Depending upon the underlying cause for hypoglycemic episodes, hypoglycemia can usually be controlled with a well planned and followed nutritional diet designed for hypoglycemia or diabetes.

TREATMENT

DIAGNOSIS & TESTS

Exams and Tests

Diagnosis of hypoglycemia can be difficult because the symptoms often mimic those of other disorders, including allergies, asthma, chronic fatigue syndrome, digestive or intestinal disorders, eating disorders, malabsorption syndrome, mental disorders, neurological problems, nutritional deficiencies, and weight problems.

Health professionals diagnose hypoglycemia using a medical history, physical examination, and tests to check blood sugar levels. Generally, you are diagnosed with the condition if a blood test shows you have low blood sugar and you have symptoms of hypoglycemia that go away after you eat sugar or other food.

During a medical history, your health professional will ask about your symptoms—when and how often they occur and how long they last. You also will be asked about any medications you are taking and whether you have recently lost or gained weight.

Medical history - Your health care provider will ask questions about:


Because an episode of hypoglycemia can impair mental functioning, your health professional may also want to talk to friends or relatives who have observed your symptoms.

You also will have a physical examination to rule out other causes of your symptoms.

Physical examination - Your health professional also will look for conditions that may cause hypoglycemia, including signs of:
  • Liver disease, such as an enlarged liver.
  • Kidney disease, such as swelling (edema) and too much urea in the blood.
  • Malnutrition, such as extreme weight loss.
  • Adrenal gland disease, such as too much pigment, or color, in the skin and low blood pressure.

However, between hypoglycemic episodes, you usually will have normal blood sugar levels and no symptoms. The blood glucose levels in healthy individuals fluctuate depending greatly on the duration of fasting. The normal range is 70 to 120 mg/dl after an overnight (12 hours) fast. In healthy men, the blood glucose can drop to 55 mg/dl after 24 hours of fasting and to 48 mg/dl after 72 hours of fasting. In healthy women, glucose levels can be as low as 35 mg/dl after only 24 hours of fasting.

Since blood glucose levels can fluctuate widely in healthy subjects, and symptoms of hypoglycemia can be vague and nonspecific, establishing the diagnosis of hypoglycemia as the cause of symptoms is often difficult. When symptoms of hypoglycemia occur together with a documented blood glucose under 45 mg/dl, and the symptoms promptly resolve with the administration of glucose, the diagnosis can be made with more certainty.

Health professionals rely on laboratory tests to confirm low blood sugar. Although it would be best to do these tests when you are having symptoms, it usually isn't possible. Instead, tests are done to try to reproduce your symptoms.

The main test for hypoglycemia is a prolonged (48- to 72-hour) supervised fast in the hospital. You will be asked to fast until the symptoms of moderate low blood sugar develop. If at the end of 72 hours you do not have low blood sugar, you may be asked to exercise for 30 minutes. The prolonged fast may be done to confirm that low blood sugar is causing your symptoms or to find out why confirmed hypoglycemia is occurring.
    Plasma glucose overnight fasting: Less than 60 mg/dL (3.33 mmol/L).

    Plasma glucose 72-hour fasting: Less than 45 mg/dL (2.5 mmol/L) for females; Less than 55 mg/dL (3.05 mmol/L for males.

A mixed meal test may be used if you have symptoms of nonfasting (postprandial) hypoglycemia within 3 to 4 hours of eating. You eat a meal similar to one that led to symptoms. Blood sugar levels are tested every 30 minutes while you are observed for signs of hypoglycemia. The test does not prove eating the meal led to hypoglycemia, but it can show that the symptoms developed in a consistent manner. If this test produces symptoms, you also may be asked to do the prolonged supervised fast.

During both tests, blood is drawn several times to monitor how well your body controls blood sugar. Various laboratory tests measure substances in the blood, including glucose and insulin.

A urine test also is done to look for ketones, substances the body produces when it breaks down fat for energy. These substances are produced in healthy people who fast for long periods or who have a diet very low in carbohydrates. Insulin prevents the production of ketones. If you have low blood sugar from too much insulin or by taking too much insulin (if you are diabetic), you will not produce ketones and will not have ketones in your urine. In people who have normal insulin levels, prolonged fasting causes ketone production.

Tests also may done to look for a tumor of the pancreas or an endocrine disorder.

If the suspected cause is rapid emptying of the stomach after a meal (alimentary hypoglycemia) or a tumor in the pancreas or other part of the body, you may have imaging tests, such as ultrasound or magnetic resonance imaging (MRI), to examine the stomach, pancreas, or other internal organs. In some cases pancreatic tumors are quite small, so an imaging test in which a dye is injected into the blood vessels (angiography) may be used to locate the tumor. Other imaging tests use radioactive proteins that bind to tumors to locate them. Imaging tests may be needed regularly for several years because such tumors can be hard to locate.

In some cases, home glucose monitors may be used to evaluate possible hypoglycemia. They can be used at home when symptoms occur. However, monitors may not be accurate in the lower range and occasionally may show a lower blood sugar level than would be found in a laboratory test. Hypoglycemia is defined according to the following serum glucose levels:
  • Less than 50 mg/dL in men.
  • Less than 45 mg/dL in women.
  • Less than 40 mg/dL in infants and children.

Some health care providers may perform a glucose tolerance test (GTT). This may be done by oral consumption of glucose. The oral glucose tolerance (OGT) test measures the body's ability to control blood glucose levels. After you drink a specific amount of concentrated glucose, blood sugar levels are measured over a period of several hours. Normally, blood glucose levels peak within an hour and then begin to drop.

The OGT test is frequently used to test for gestational diabetes. The OGT test was often used in the past to evaluate possible cases of nonfasting hypoglycemia.

However, when used to screen for hypoglycemia, the OGT test does not provide consistent and reliable results. The symptoms of hypoglycemia, if they occur at all, often do not correspond to the low point in blood sugar levels during the test. And, the OGT test can produce inconsistent results when repeated.

Studies also have shown that drinking concentrated glucose for the test may actually cause mild hypoglycemia in up to about 15% of otherwise normal individuals. Many people have symptoms of hypoglycemia even though the results of a 5 hour GTT are within normal limits. Oral glucose tolerance results less than 50 mg/dL (<2.78 mmol/L) is considered hypoglycemic.

A useful diagnostic test may be to follow the dietary and nutritional supplement regimen outlined below and see if symptoms improve.

Citations:

Service FJ (1999). Classification of hypoglycemic disorders. Endocrinology and Metabolism Clinics of North America, 28(3): 501–517.

Comi RJ, Gorden P (1995). Hypoglycemic disorders in the adult. In KL Becker et al., eds., Principles and Practice of Endocrinology and Metabolism, 2nd ed., pp. 1342–1350. Philadelphia: JB Lippincott.



CONVENTIONAL MEDICAL TREATMENT

Treatment for a sudden (acute) episode of hypoglycemia involves eating or drinking some form of sugar to restore your blood sugar to a normal level. Episodes of hypoglycemia caused by a long-term (chronic) health condition are treated the same way, but prevention of future episodes requires treatment or cure of the underlying condition.

Treatment of acute hypoglycemia:

If you are conscious and able to respond when symptoms develop, eat or drink some form of sugar. Drink fruit juice or sugared (non-diet) soda or eat sugar in the form of candy, cubes, or tablets, or other quick-sugar foods.

Quick-sugar foods: Because you have diabetes and are at risk for low blood sugar levels, you need to keep some type of food with you at all times that can quickly raise your blood sugar level. Eating quick-sugar foods puts glucose into your bloodstream in about 5 minutes. Any quick-sugar food on this list will raise your blood sugar about 30 milligrams per deciliter (mg/dL) in about 15 to 20 minutes.

Some foods that will help raise your blood sugar include:

FoodAmount
Table sugar1 tablespoon
Fruit juice or regular soda1/2 cup
Fat-free milk1 cup
Honey or corn syrup1 tablespoon
Jam2 tablespoons
Raisins2 tablespoons
Gum drops17 small
Life Savers candy8 pieces
Hard candy3 pieces
Glucose tablets3 tablets
Glucose gel1/2 tube


Although eating food or drinking beverages containing sugar is all you need to do to treat many cases of acute hypoglycemia, you will need help if the condition is severe. Family members, co-workers, and friends should be aware of your condition and should call 911 or other emergency services if you become sleepy or unconscious.

If you have diabetes and take insulin, you may be able to teach those close to you how to give you an injection of glucagon in an emergency.

They also should seek emergency help if you are not unconscious but they do not know how to give you an injection of glucagon. Always have a medical alert bracelet or tag with you. Medical alert jewelry can be bought in pharmacies or on the Internet.

Severe cases of hypoglycemia may require hospitalization. You may be given additional glucose in a vein (intravenously) until your blood sugar level is stable in the normal range. This could take several days. For prolonged severe hypoglycemia, additional treatment may be necessary if brain swelling (edema) or damage has occurred or if there are other complications.

Future episodes of low blood sugar may be avoided by changing the behavior or situation that led to the hypoglycemia. If medication causes hypoglycemia, you may be able to stop using it or change how it is used. Talk to your health professional about how to avoid future bouts of low blood sugar. See Hypoglycemic Diet for helpful dietary recommendations to prevent hypoglycemia.



TREATMENT CAUSED BY ANOTHER CONDITION

If you have low blood sugar caused by a chronic health condition, your symptoms will be treated the same as those of acute hypoglycemia. Once you have recovered from the immediate symptoms, you will need treatment for the underlying cause of hypoglycemia. In many situations, once the cause is identified, new episodes of hypoglycemia can be prevented.

Low blood sugar may have a long-term cause that can be cured, such as some endocrine disorders or diseases of the liver, adrenal glands, or pancreas. Some conditions that cause low blood sugar, such as alimentary hypoglycemia related to stomach problems, may require surgery. Effective long-term treatment of an insulin-producing tumor in the pancreas (insulinoma) usually requires surgery.

Even if the condition causing hypoglycemia is not curable, treatment often can prevent episodes of low blood sugar. Talk to your health care provider about whether you can modify your diet (what, when, or how much you eat), change the dosage or types of medications you take, or modify your physical activity (such as when and how hard you exercise).

This type of management is most common for people with diabetes, other chronic health conditions that may require long-term treatment (liver disease, kidney failure, or endocrine disorders), and inherited enzyme or hormone deficiencies. It may also be useful for alcohol-related illnesses.



HOME TREATMENT

If you are at risk for developing hypoglycemia, you need to know about health conditions or situations that may lead to low blood sugar and how to deal with them. Proper attention to your health and lifestyle can help you prevent hypoglycemia. See Hypoglycemic Diet for helpful dietary recommendations to prevent hypoglycemia.

You should learn to recognize the early symptoms of hypoglycemia and to take steps for dealing with low blood sugar immediately.

When blood sugar drops too low, drink fruit juice or sugared (non-diet) soda pop; eat sugar in the form of candy, cubes, or tablets; or eat other quick-sugar foods.

Members of your household, close friends, and co-workers also should know the symptoms of low blood sugar and learn about emergency care. Wear medical information on a badge or bracelet if you are at risk for developing moderate or severe hypoglycemia in case an episode occurs when you are away from family, friends, or care givers.

Be sure you and your family, friends and co-workers know emergency care for low blood sugar.

When hypoglycemia occurs because of an isolated, short-term cause such as prolonged fasting or strenuous exercise, further medical treatment is usually not needed. You may simply need to talk with your health professional about how to avoid such behaviors or situations.

When hypoglycemia has a chronic cause that is not curable, treatment of the condition often can prevent episodes of low blood sugar. Talk with your health professional about:
  • Modifying your diet with a long-term meal plan (what, when, and how much you eat).
  • Changing the dosage or types of medications you take.
  • Modifying the timing and level of physical activity (such as when and how hard you exercise).
  • Keeping a diary of low blood sugar episodes (when they occur and what and when you last ate).

Management of diet to prevent hypoglycemia is particularly important if you have diabetes, inherited enzyme or hormone deficiencies, or nonfasting (postprandial) hypoglycemia.

Your health professional will want to see you for annual physical examinations, more often if your symptoms become frequent. You and your health professional will discuss your home blood sugar monitoring records and your diary of episodes.



CONSIDERATIONS

  • The production of insulin is affected by the functioning of the adrenal glands. The adrenal glands produce epinephrine, which acts to "turn off" insulin production, among other things. If the adrenal glands are overstressed and exhausted, they cannot function properly and an over abundance of insulin may result. This causes the blood sugar level to sink below normal, creating a low energy syndrome in the body.

  • Injections of vitamin B complex plus extra vitamin B6 (pyridoxine) and liver extract have produced good results for those with hypoglycemia. Liver extract supplements contain a nutritional substance that aids liver regeneration. Only liver from organically raised beef should be used.

  • It is estimated that half the people with hypoglycemia who are over 50 have reduced thyroid function and hypothyroidism. See Hypothyroidism for more information.

  • Caffeine, alcohol, and tobacco cause profound swings in blood sugar levels. Insomnia can result if any type of sugar is consumed after dinner. Consuming sugar at any time tends to cause drowsiness and fatigue.

  • Some studies have shown that reducing the amount of meat protein in the diet and adding some starches, such as potatoes, may be beneficial.

  • Milk allergy is common as this disorder progresses. Allergy testing is recommended. See Allergies for more information.

    DIETARY RECOMMENDATIONS

  • Remove from the diet all alcohol, canned and packaged foods, refined and processed foods, salt, sugar, saturated fats, soft drinks, and white flour. Also avoid foods that contain artificial colors or preservatives.

  • Avoid sweet fruits and juices such as grape and prune. If you drink these, mix the juice with equal amount of water.

  • Eat a diet high in fiber and include large amounts of vegetables, especially broccoli, carrots, Jerusalem artichokes, raw spinach, squash, and string beans. Vegetables should be eaten raw or steamed. Also eat beans, brown rice, lentils, potatoes, soy products (tofu), and fruits, especially apples, apricots, avocados, bananas, cantaloupes, grapefruits, lemons, and persimmons.

  • For protein, eat low-fat cottage cheese, fish, grains, kefir, raw cheese, raw nuts, seeds, skinless white turkey or white chicken breast, and low-fat yogurt.

  • Eat starchy foods such as corn, hominy, noodles, pasta, white rice, and yams in moderation only.

  • Do not eat fatty foods such as bacon, cold cuts, fried foods, gravies, ham, sausage, or dairy products (except for low-fat soured products).

  • Do not go without food. Eat six to eight small meals throughout the day. Some people find that eating a small snack before bedtime helps.

  • Use a rotation diet; food allergies are often linked to hypoglycemia and can make the symptoms more pronounced. See Allergies for more information.

  • Try taking 200 mcg of chromium picolinate daily. This can alleviate many symptoms and raise blood glucose levels if symptoms occur after sugar or a heavy meal is consumed. Chromium, also known as glucose tolerance factor or GTF, has been known to alleviate sudden shock.

  • During a low blood sugar reaction, eat something that combines fiber with a protein food, such as bran or rice crackers with raw cheese or almond butter.

  • Instead of eating applesauce, have a whole apple, which has more fiber. The fiber in the apple will inhibit fluctuations in blood sugar. Fiber alone (found in popcorn, oat bran, rice bran, crackers, ground flaxseed, and psyllium husks) will slow down a hypoglycemic reaction. Take fiber half an hour before meals. Spirulina tablets taken between meals further help to stabilize blood sugar.

  • Fast once a month with live vegetable juices and a series of lemon juice enemas. See Fasting and Enemas for more information. To prevent a low blood sugar reaction while fasting, use spirulina or a protein powder supplement. Many people find this makes them start to feel better very quickly.

  • Kombucha tea may help to normalize blood sugar. See Kombucha Tea for more information.

  • See Hypoglycemic Diet for helpful dietary recommendations to prevent hypoglycemia.

  • Avocados contain a seven-carbon sugar that depresses insulin production, which makes them an excellent choice for people with hypoglycemia.



    HERBS

  • Bilberry and wild yam aid in controlling insulin levels.

  • Dandelion root is an excellent source of calcium and supports the pancreas and liver.

  • Licorice nourishes the adrenal glands. Caution: Do not use this herb on a daily basis for more than seven days in a row. Avoid if you have high blood pressure.

  • Milk thistle rejuvenates the liver.



    NUTRITIONAL SUPPLEMENTS

    Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between the ages of 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.

    NUTRIENTS
    SupplementSuggested DosageComments
    Very Important
    Brewer's Yeast As directed on label. Aids in stabilizing blood sugar levels.
    Chromium picolinate 300-600 mcg daily. Vital in glucose metabolism. Essential for optimal insulin activity.
    Pancreatin As directed on label. Take with meals. For proper protein digestion. Use a high-potency formula.
    Proteolytic enzyme. As directed on label. Take with meals. People with this disorder often fail to digest protein properly, resulting in "leaky gut syndrome: and allergies. Caution: Do not give this supplement to a child.
    Vitamin B complex 50-100 mg daily and up. Important in carbohydrate and protein metabolism, and proper digestion and absorption of foods; helps the body tolerate foods that produce low blood sugar reactions. Also helps counteract the effects of malabsorption disorders, common in people with hypoglycemia.
    Plus extra
    Vitamin B1 (thiamine)    		 100 mg daily. Aids in the production of hydrochloric acid, needed for proper digestion.
    And
    Vitamin B3 (niacin)    		 100 mg daily. Do not exceed this amount. Aids in the functioning of the nervous system and in proper digestion. Caution: Do not take niacin if you have a liver disorder, gout, or high blood pressure.
    And
    Vitamin B5 (pantothenic acid)    		 1,000 mg daily, in divided doses. Important in adrenal gland function and conversion of glucose to energy.
    And
    Vitamin B12    		 300 mcg twice daily, on an empty stomach. Crucial for prevention of anemia, common because malabsorption disorders result in deficiency.
    Zinc 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Needed for proper release of insulin. People with hypoglycemia are often zinc deficient. Use zinc gluconate lozenges or OptiZinc for best absorption.
    Important
    Vitamin E 400 IU daily and up. Improves energy and circulation.
    Magnesium 750 mg daily, in divided doses, after meals and at bedtime. Important in carbohydrate (sugar) metabolism.
    Plus
    Calcium    		 1,500 mg daily, in divided doses, after meals and at bedtime. Works with magnesium and aids in preventing colon cancer.
    L-Carnitine As directed on label. Converts stored body fat into energy.
    Plus
    L-Cysteine    		 As directed on label. Blocks the action of insulin, which lowers blood sugar.
    And
    L-Glutamine    		 1,000 mg daily, on an empty stomach. Take with water or juice. Do not take with milk. Take 50 mg Vitamin B6 and 100 mg Vitamin C for better absorption. Reduces cravings for sugar.
    Manganese As directed on label. Take separately from calcium. Important for the maintenance of blood glucose levels. Most people with hypoglycemia have low levels of this trace mineral in their blood.
    Vitamin C with bioflavonoids 3,000-8,000 mg daily, in divided doses. For adrenal insufficiency, common in people with hypoglycemia.
    Helpful
    Aerobic Bulk Cleanse (ABC) from Aerobic Life Industries
    Or
    Psyllium husks    		 As directed on label. Take with aloe vera juice on an empty stomach in the morning. Take separately from other supplements and medications. Aids in slowing down blood sugar reactions and keeping the colon clean.
    Liver extract injections
    Or
    Desiccated liver    		 Injections: 1 cc twice weekly for 3 months, then once weekly for 2 months or more, or as prescribed by health care provider.

    Desiccated liver: As directed on label.    		 Liver glandulars supply B vitamins and other valuable nutrients.
    Multivitamin and mineral complex As directed on label. All nutrients are required for healing.

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    NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...

    If you have reached this topic seeking information on emergency care for hypoglycemia, refer to the following:

    Emergency care for low blood sugar for people taking insulin:

    This information is for people who may help you if you are too weak or confused to treat your own low blood sugar from diabetes. Make a copy for your partner, co-workers, and friends. If your adolescent has diabetes, you need to provide a copy for teachers, coaches, and other school staff.


    Emergency care for low blood sugar for people who are not taking insulin. (Use this information if you do not know whether a person with hypoglycemia takes insulin.)

    This information is for people who may help you if you are too weak or confused to treat your own low blood sugar related to diabetes. Make a copy for your partner, co-workers, and friends.
    • Make sure the person can swallow.
        1. Lift the person's head so that it will be easier for him or her to swallow.
        2. Give the person 1/2 teaspoon of water to swallow.

      If the person can swallow the water without choking or coughing:
        1. Give him or her a liquid (juice or soda pop) from the list of quick-sugar foods.
        2. If a home blood sugar meter is available, check the person's blood sugar level.
        3. Wait 10 to 15 minutes.
        4. Offer more quick-sugar food if the person is feeling better but still has some symptoms of low blood sugar.
        5. If possible, check the blood sugar again.
        6. Offer the person a snack (such as cheese and crackers or half of a sandwich) if it is more than 30 minutes before a meal.
        7. If the person becomes more sleepy or lethargic, call 911 or other emergency services.
        8. Stay with the person until his or her blood sugar level is 65 milligrams per deciliter (mg/dL) or higher or emergency help comes.

    • If the person chokes or coughs on the water:
        1. Call 911 for emergency care immediately.
        2. Do not try to give the person foods or liquids because they could be inhaled.
        3. If a home blood sugar meter is available, check the person's blood sugar level.
        4. Stay with the person until emergency help comes.

    • If the person is unconscious but not having a seizure:
        1. Call 911 for emergency care immediately.
        2. Turn the person on his or her side.
        3. Rub or squeeze 1 to 2 tablespoons of cake icing, honey, syrup, or glucose gel under the tongue or in the space between the gum and cheek.
        4. If a home blood sugar meter is available, check the person's blood sugar level.
        5. If the person becomes more alert, give the person quick-sugar food or liquid.
        6. If possible, check the blood sugar level again.
        7. Stay with the person until emergency help comes.

    • If the person is unconscious and is having a seizure:
        1. Call 911 or other emergency services immediately.
        2. Get the person in a safe position, such as lying flat on the floor. Turn the head to the side.
        3. Do not try to give the person anything to eat or drink or put anything in the mouth.
        4. Stay with the person until emergency help comes.

    Because oral medications for diabetes may cause prolonged low blood sugar levels, have someone stay with the person for a few hours after the blood sugar level has returned to a safe range.

    If you are looking for general information on diabetes, see Diabetes.

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    • Helpful Links

    The Hypoglycemia Support Foundation
    The Hypoglycemic Diet - Low Sugar Diet Plan
    Med-sense: Hypoglycemia
    Reactive Hypoglycemia Treatment
    NIDDK: Hypoglycemia
    Hypoglycemia - Ask the Dietitian
    Hypoglycemia Forum
    eMedicine - Hypoglycemia
    Medicinenet.com: Hypoglycemia
    Herbs for Diabetes
    Holistic Online Alternative Hypoglycemia Help
    Hypoglycemic Symptoms & Alternative Hypoglycemic Treatments


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