Hypoglycemia means low level of blood sugar (glucose). It is a relatively common symptom in diabetics, but it can also occur in other conditions.


Treatment of diabetes

Treatment of patients suffering from diabetes is probably the most common cause of moderate and severe hypoglycemia cases. Insulin and majority of oral antidiabetic agents have ability to reduce blood sugar too powerfully causing hypoglycemic state.

Exhaustion and lack of energy

Hypoglycemia can occur even in otherwise healthy people taking too much physical activity accompanied with insufficient intake of sugar. Hypoglycemia is not so strong. Usually it manifests with unpleasant symptoms (see below), but it does not lead to unconsciousness.


A milder form of hypoglycemia is often present when sobering. The liver tissue breaks down alcohol and its metabolites and does not release sugar into the blood.


This tumor is most often found in pancreas or anatomically neighboring tissues and organs. It consists of cells with ability to create insulin. Insulinoma has many forms, some are benign but others are able to create metastases. Affected person suffers from recurrent hypoglycemic states when tumor cells release larger amount of insulin hormone into bloodstream.


The severity of symptoms is individual. Low blood glucose endurance is individual and therefore we can not determine a fixed level of sugar when a particular person starts to experience symptom. Usually, if one is accustomed to common hypoglycemia states, his or her resistance increases and symptoms weaken.


Weak hypoglycemia may not be reflected in any way, or by fatigue and inefficiency. Stronger hypoglycemia begins with initially apparent activation of defense mechanisms. Affected person becomes restless, palpitations appear and breath is accelerated. Patient suffers from sweating and his or her hands shake. Consciousness disorders may occur such as euphoria, dizziness, confusion, and sometimes even aggression. The most serious symptom is unconsciousness known as hypoglycemic coma. Most of the symptoms are, as you surely noticed, connected to lack of glucose in brain. Brain cells are in permanent need of glucose and are very sensitive to its deficiency.


Note to medical students: During hypoglycemia person's skin is typically sweaty, during hyperglycemia skin is dry. That is because hyperglycemia usually causes dehydration (sugar is filtered into urine takes fluid and minerals with).

Diagnostic approach

When there is a disorder of consciousness or unconsciousness, especially in patients with known diabetes, blood glucose level should be measured. Special devices known as glucometers (glucose meters) can quickly measure glucose from a drop of blood.


Best prevention is proper and careful treatment of diabetes. Diabetics should follow certain rules. For example, they should modify insulin dosage when they have higher physical activity, or when they plan to eat less food than usual. Concentration of blood sugar is also influenced by drug abuse and alcohol excess.


If person is conscious and feels incoming hypoglycemic state, he or she must have some extra sugar intake as quickly as possible. Sweetened drink or a piece of a bakery product is ideal solution. Seemingly favorable chocolate is not so effective; its rich fat content prevents uick absorption of sugar in digestive tract. Medical first aid for hypoglycemia is an intravenous glucose administration. First, it is advisable to give a bolus dose by injection and then slow infusion with lower glucose concentration. The effect is very fast and patient usually quickly returns to full consciousness. He or she should be, however, further monitored, because, especially by usage of some anti-diabetic drugs, recurrent hypoglycemia may emerge.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources