Hypoglycemia (Low Blood Sugar) in People Without Diabetes

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Hypoglycemia (Low Blood Sugar) in People Without Diabetes

What is hypoglycemia?
Hypoglycemia is low blood sugar. It occurs when the level of sugar, or glucose, in the blood drops too low to give the body energy. The medical condition of low blood sugar occurs when all 3 of the following are present:

Blood sugar is low.
Low blood sugar is causing symptoms.
The symptoms go away when blood sugar returns to normal.
Fasting blood sugar levels are measured in mg/dL. A fasting blood sugar level of:

70 to 99 mg/dL is normal.
50 to 69 mg/dL is mildly low.
Less than 50 mg/dL is very low.
The bloodstream carries glucose—a type of sugar produced from the digestion of carbohydrates and other foods—to provide energy to cells throughout the body. Unused glucose is stored mainly in the liver as glycogen. Insulin, glucagon, and other hormone levels rise and fall to keep blood sugar in a normal range. Too little or too much of these hormones can cause blood sugar levels to fall too low (hypoglycemia)

Normally, blood glucose levels increase slightly after you eat a meal. When blood sugar rises, cells in the pancreas release insulin, causing the body to absorb glucose from the blood, which lowers the blood sugar level to normal. When blood sugar drops too low, the level of insulin declines and other cells in the pancreas release glucagon, which causes the liver to turn stored glycogen back into glucose and release it into the blood. Low blood sugar also triggers the release of hormones by the pituitary and adrenal glands. These hormones also help bring sugar back to normal.

Hypoglycemia is not a disease but a condition that results from a variety of causes.

What causes hypoglycemia?
Hypoglycemia is most commonly a complication of diabetes treatment, but it is otherwise rare.

Hypoglycemia may also result from:

Medicines, such as monoamine oxidase inhibitors (MAOIs), quinine sulfate, and salicylates (including aspirin).
Drinking too much alcohol.
Diseases that affect the pancreas, liver, kidneys, adrenal glands, or other organs.
Inherited problems with metabolism.
Rapid stomach emptying after a meal. This may happen after stomach surgery.
What are the symptoms?
The symptoms can vary depending on how low the blood sugar level drops.

Mild hypoglycemia can cause nausea, a jittery or nervous feeling, cold and clammy skin, sweating, hunger, and a rapid heartbeat.
Moderate hypoglycemia often makes you feel irritable, anxious, or confused. You may have blurred vision, feel unsteady, and have difficulty walking.
Severe hypoglycemia can lead to loss of consciousness, seizures, and coma—and it may be fatal.
Some medicines may mask symptoms of low blood sugar, including beta-blockers, which are often used to treat heart conditions and high blood pressure.

How is hypoglycemia diagnosed?
Doctors 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 carbohydrate such as sugar.

During a medical history, your doctor will ask about your symptoms—when and how often they occur, what brings them on, and how long they last. You also will be asked about any medicines you are taking and whether you have recently lost or gained weight.

A physical examination will also help your doctor look for the cause of your symptoms.

Doctors 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.

How is hypoglycemia treated?
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 long-term condition that is causing the hypoglycemia.

Although eating food or drinking beverages that contain 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, coworkers, and friends should be aware of your condition and should call 911 or other emergency services if you become sleepy or unconscious.

What should you do in an emergency?
It is important to know what to do in an emergency when you have low blood sugar.

Emergency care for low blood sugar for people who are not taking insulin includes consuming some kind of quick-sugar food, such as fruit juice, as long as you are able to swallow. (Use this information if you do not know whether a person with hypoglycemia takes insulin.)

Symptoms
The symptoms of hypoglycemia may vary from episode to episode because low blood sugar can be mild, moderate, or severe. Increasingly severe symptoms appear as the blood sugar level falls.

In healthy people, fasting blood sugar levels are usually between 70 and 99 mg/dL.

Mild hypoglycemia

Symptoms of mild low blood sugar usually develop when blood sugar falls below 70 mg/dL and may include:

Nausea.
Extreme hunger.
Feeling nervous or jittery.
Cold, clammy, wet skin and/or excessive sweating not caused by exercise.
A rapid heartbeat (tachycardia).
Numbness or tingling of the fingertips or lips.
Trembling.
Moderate hypoglycemia

If blood sugar continues to fall, the nervous system will be affected. Symptoms usually develop when the blood sugar falls below 55 mg/dL and may include:

Mood changes, such as irritability, anxiety, restlessness, or anger.
Confusion, difficulty in thinking, or inability to concentrate.
Blurred vision, dizziness, or headache.
Weakness, lack of energy.
Poor coordination.
Difficulty walking or talking, such as staggering or slurred speech.
Fatigue, lethargy, or drowsiness.
Severe hypoglycemia

The symptoms of severe low blood sugar develop when blood sugar falls below 35-40 mg/dL and may include:

Seizures or convulsions.
Loss of consciousness, coma.
Low body temperature (hypothermia).
Prolonged severe hypoglycemia can cause irreversible brain damage and heart problems, especially in people who already have coronary artery disease. If emergency medical treatment is not provided, severe hypoglycemia can be fatal.

Some medicines may mask symptoms of low blood sugar, including beta-blockers, which are often used to treat heart conditions and high blood pressure.

What to think about
Different people may develop symptoms of mild, moderate, or severe hypoglycemia at varying blood sugar levels. Although 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 doctor will use blood tests and other measures to make sure another condition isn't causing your symptoms.

Exams and Tests
Doctors diagnose hypoglycemia using a medical history, physical examination, and tests to check the blood sugar level.

Generally, you are diagnosed with hypoglycemia if you have a low blood sugar level and symptoms that go away after you have taken glucose to restore your blood sugar level.1

Medical history
Your doctor will ask questions about:

What symptoms you experience—how long they last, when they occur, how often they occur, and what happens to your symptoms when you eat something.
Past medical treatments, any current medical conditions, and whether you are taking medicines (bring all medicines—both prescription and nonprescription—to your appointment for review) or receiving other treatment.
Diet and nutrition, such as what and when you eat, and whether you have had recent changes in your eating or bowel habits.
Whether you have gained or lost weight recently.
Because an episode of hypoglycemia can impair mental functioning, your doctor may also want to talk to friends or relatives who have seen your symptoms.

Physical examination
Your doctor 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 (color) in the skin and/or low blood pressure.
Primary laboratory tests
Often hypoglycemia is a complication of diabetes treatment. If you are not being treated for diabetes or another obvious cause of low blood sugar, you will have laboratory tests to confirm hypoglycemia. Ideally, your doctor would like to do these tests when you are experiencing symptoms. But because this is usually not possible, you probably will have tests that attempt to reproduce symptoms. These tests are usually done in a clinic or a hospital.

In some cases, home glucose monitors, which are often used by people who have diabetes, may be used to evaluate possible hypoglycemia. But a low blood sugar reading needs to be confirmed by these formal laboratory tests:

Overnight fast. You will be asked not to eat overnight, and you will have your blood sugar and insulin levels checked the following morning. In many cases, this test will tell your doctor if you have fasting hypoglycemia.
Prolonged supervised fast. The primary test for hypoglycemia is a prolonged (48- to 72-hour) supervised fast. You will be asked to fast until the symptoms of moderate low blood sugar develop, or until blood glucose levels drop below 45 mg/dL. If at the end of 72 hours you do not have low blood sugar, you may be asked to exercise for 30 minutes. This test also can help determine why confirmed hypoglycemia is occurring.
During the prolonged supervised fast test, your blood is drawn at regular intervals to monitor how well your body controls blood sugar levels. Various laboratory tests measure substances in the blood, such as glucose, insulin, and C-peptide.

Other tests
A urine or blood test may be done to look for substances called ketones that the body produces when it breaks down fat for energy. Insulin prevents the production of ketones. If you have low blood sugar from too much insulin, your body will not produce ketones. In people who have normal insulin release, prolonged fasting causes a drop in insulin and an increase in ketone production.

Tests also may be 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 (reactive or alimentary hypoglycemia) or a tumor in the pancreas or other part of the body, you may have imaging tests, such as ultrasound CT scan or MRI, to examine your 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.

What to think about
The oral glucose tolerance test should not be used to evaluate possible nonfasting (postprandial) hypoglycemia. This test does not provide consistent and reliable results when it is used to screen for hypoglycemia.

Treatment Overview
You can treat a sudden (acute) episode of hypoglycemia by eating or drinking some form of sugar to return your blood sugar to a normal range. This treatment is usually all that is necessary for an isolated episode of hypoglycemia, such as from prolonged fasting or strenuous exercise without adequate food.

Hypoglycemia caused by a long-term (chronic) health condition requires treatment of the long-term health 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 pop or eat sugar in the form of candy, cubes, or tablets, or other quick-sugar foods
Make sure your family members, coworkers, and others close to you are aware that you may have episodes of hypoglycemia, so they can help you. Emergency treatment for people who do not use insulin usually does not require glucagon, but it may be needed in rare cases.
Tell the people close to you that they should call 911 or other emergency services if you become sleepy or unconscious. 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, depending on the cause.
Future episodes of low blood sugar may be avoided by changing the behavior or situation that led to the hypoglycemia. If medicine causes hypoglycemia, you may be able to stop using it or change how it is used. Talk to your doctor about how to avoid future episodes of low blood sugar.
It is important to remember that low blood sugar may be only temporarily corrected with acute treatment, and you may need additional treatment. If you have a glucose meter, you should recheck your blood sugar level in 10 to 15 minutes. If you do not have a blood glucose meter, you should be alert for the return of low blood sugar symptoms and be prepared to seek emergency care.
Treatment of hypoglycemia 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. After you have recovered from the immediate symptoms, you will need treatment for the condition that is causing hypoglycemia. In many situations, after 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. Effective long-term treatment of an insulin-producing tumor in the pancreas (insulinoma) usually requires surgery.

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

This type of management is most common for people who have 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 people who have 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.

It is important to learn to recognize the early symptoms of hypoglycemia and to take steps to deal with low blood sugar immediately.

When your 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 coworkers 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 caregivers.

Emergency care
Emergency care for low blood sugar for people who are not taking insulin includes consuming some kind of quick-sugar food, such as fruit juice, as long as you are able to swallow. (Use this information if you do not know whether a person with hypoglycemia takes insulin.)

Health and lifestyle management to avoid hypoglycemia
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 doctor 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 doctor about:

Modifying your diet with a long-term meal plan (what, when, and how much you eat).
Changing the dosage or types of medicines 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 symptoms (when they occur and what and when you last ate).
Managing your diet to prevent hypoglycemia is particularly important if you have diabetes, inherited enzyme or hormone deficiencies, or nonfasting (postprandial) hypoglycemia.

Your doctor will want to see you for a physical examination every year (annual), and more often if your symptoms become frequent. You and your doctor will discuss your home blood sugar monitoring records and your diary of your symptoms.