by Nora Saul, M.S, R.D., L.D.N., C.D.E.
Nora Saul is Manager of Nutritional Education at Joslin Diabetes Center
Do you remember the scene in the film Steel Magnolias where Julia Roberts’ character is in Dolly Parton’s beauty parlor and all of a sudden she is sweating and gets agitated for no apparent reason and, as her friends and family try to get her to drink some orange juice, she tries to push them away?
One of the scariest moments for friends and families of people with diabetes is when an individual is having an episode of low blood sugar, known in scientific jargon as hypoglycemia.
Most episodes of hypoglycemia aren’t as severe as what was portrayed in the movie, thankfully. But hypoglycemia is a real concern for people with diabetes and as a diabetes educator I find myself talking about hypoglycemia with patients and their families a lot.
Hypoglycemia can manifest itself in many different ways and with different degrees of severity. Severe hypoglycemic reactions, defined as the person needing assistance to treat a low blood sugar, are medical emergencies. If you have diabetes or are close to someone with diabetes, it is important to understand what hypoglycemia is, why it occurs and what can be done to both treat it and prevent it.
Usually we think of diabetes as a disease where there is too much glucose (or sugar) in the blood. But, it may be clearer to think about it as an imbalance between the amount of insulin in the blood and the amount of glucose. When there is not enough insulin for the amount of glucose, hyperglycemia or high blood sugar occurs. On the other hand, when there is more insulin available than glucose, hypoglycemia ensues. Medically, hypoglycemia is defined for people with diabetes as a blood glucose level less than 70gm/dl.
In general people with diabetes who take medications that cause their pancreas to secret insulin (insulin secretagogues (Micronase®, Glucotrol® Prandin®, Starlix®) or who take insulin are at risk for hypoglycemia. Those whose blood glucose levels are controlled with lifestyle (diet and exercise) or with drugs from the following classes biguanides (Glucophage®), thiazolidinediones (Avandia® and Actos®), alpha-glucosidase inhibitors (Precose®, Glyset®) and DPP-4 inhibitors (Januvia® and Onglyza®) do not usually experience symptoms of hypoglycemia.
But getting back to the Julie Roberts’ character, could she or her family and friends have noticed her declining blood glucose before things became so critical? Many times it is possible. Sometimes you can’t. Some symptoms can be very subtle. But often if you know someone well you may pick up on certain cues. The individual may seem fine and be able to carry on a conversation but something may be a little off. For example, he or she may take too long to respond to a question, or be unable to add a simple sum or snap at you when you ask a simple question.
Below are some of the common symptoms people may feel when their blood sugar is too low.
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To others you may appear to:
- Have an unsteady walk |
- Click here to learn about the Joslin Clinic’s special class: Low Blood Glucose Awareness Training.
- Click here for more information on Patient Education at the Joslin Diabetes Center.
- Click here to view our videos on diabetes.
- Click here to learn more about Joslin Diabetes Center.
Next week: Hypoglycemia or Low Blood Sugar: The Causes
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My son is 18 yearsold and has had a seizure from low blood sugar a couple of years ago and now has had (2) siezures they say is epilepsy. Is there a connection?
Hi,
I am a bit confused! I had a 5 hour glucose test and was recently diagnosed with hypoglycemia. I do not have diabetes nor am I obese. Im having a hard time finding information on hypoglycemia. It is all related to diabetes which I do not have. Im confused as to what to eat. Have you heard of the zone diet? Would this be a good option for me? It seems like its so hard to get my sugar to level out. What do I do? Help:)
I’m type 1 diabetic, but what I’ve heard is that you need to eat a protien because if you eat a carb your body produces more insulin to take care of the carb- which would drop your blood sugars more.
I have heard from two dieticians giving lectures that the protein with meals does not change the glucose curve but fast will. What does the latest research show on this subject?
Dear Reader:
Hypoglycemia can be either a separate disorder or it can sometimes present as a prelude to diabetes. There are a number of causes of hypoglycemia not related to diabetes, for example one very rare cause is an insulin producing tumor. Most hypoglycemia is reactive hypoglycemia which is a mismatch between the timing of digestion and the secretion of insulin. The dietary treatment for reactive hypoglyemia is a diet lower in carbohydrate, higher in protein, moderate in fat with smaller meals spread throughout the day. You may want to discuss this with your health care provider and seeing a registered dietitian for dietary guidance can be beneficial.
I am seventeen and have Hypoglycemi and they tell me to eat oatmeal and toast with a little bit of sugar for breakfast to balance everything out. Just watch so you don’t take in too much sugar but just enough to keep you going. Do some kind of exercise to make sure you stay in good condition and live life.
I don’t think you should be reccomending milk to treat low blood sugars……it has fat in it so it is not fast acting.
Stephanie McGrath, RD, LDN
Vanderbilt Eskind Diabetes
Low-fat or skim milk plus a couple of graham crackers is wonderful for hypoglycemia. Both the milk and graham crackers contain complex carbs that raise your glucose levels quickly and for an extended time. Before I got my insulin pump and CGM system, my diabetes educator advised the skim milk and grahams before bed every night in order to keep my levels stable.
Not if you drink skim milk!
I would add noticeably slower speech to the list of symptoms.
I would add that there is an increased desire for food rather than actual hunger. Our bodies likely recognize the need for carbohydrates to offset the low bg. But this may result in wildly unchecked eating.
After Thanksgiving dinner this past year, my life became h*ll with constant low blood sugar attacks. Up until then, I had been a happy vegan for 16 years, but I’ve been forced to go back to meat. Just this past weekend I ate veganly to see if I could get it to work, but I dropped down to 62 before lunch yesterday and got very sick last night. It’s like my body suddenly demands an insane amount of protein or I get sick. I hate it and it breaks my heart that I’ve had to quit being a strict vegetarian. I’ve gone through tons of tests and the doctors can’t find anything wrong. They treat me like I’m some kind of hallucinating irrational idiot. People have witnessed my episodes of racing heart, shaking, being close to passing out, dry mouth, diarrhea, nausea, etc. and it is definitely affected by food. I hate having to eat all the time, but that is what I sometimes need to do….although I have found if I eat at least 30-40 grams of protein at a time, it keeps me stable longer. I don’t know why so many doctors poo-poo the concept of hypoglycemia without diabetes, but they still do. My mom started off like me decades ago and didn’t take care of herself and is now an insulin dependent diabetic. I pray to NOT go that route…but I’m also not living on sugar like she continued to do and I have no plans to put on a bunch of weight like she did. Right now I’m too thin. The attacks got me down to 85 lbs. I’m up to 91 today, but I keep tending to drop weight and it’s a struggle. I seem to burn through food like crazy.
Reply for Dorcas:
I am an insulin dependent diabetic and my son 15 yrs old is epileptic since birth. I am not a medical doctor but from my own experience: I would say epileptic seizures may be related to hypoglycemia. Please check with your doctor for sure but what I have seen the last 15 yrs, epileptic seizures may be evoked by the most unlikely of reasons. My son suffers seizures from power drill noise. High body temperature, even an approaching low pressure weather front has set on seizures in my son. As soon as rain or snow starts, my son’s tensions go away. So I would not discount potential seizure triggering effect of hypoglycemia.
I had a temporal lobe bleed due to a fall, hitting my head
The symptoms involved expressive aphasia. This would come and go, but occurred when my blood glucose was low.
I have hypeerinsulinemichypoglycemia after Ruen-Y gastric bypass. Before I was approved for a contiuous glucose monitor I was hospitalized 13 times in less than a year. Each time I was in the ICU unit of the hospital and very close to death. It took the hospital awhile to realize that my hypoglycemia could not be treated the same as regular hypoglycemia. It seems tha every time they gave me amps of D-50 I would have a rapid rise in blood sugar which would then drop to critical levels in less than one half hour. The monitor has brought some semblance of order to my life. I have been hospital free since I received it. It is not a cure and it is so rare that they really don’t have a cure for it. I have to watch what I heat Iespecially carbs and processed foods). White bread and certain types of wheat bread as well as pasta and rice are “no no’s”. Exertion, emotions and diet are the major stumbling points to my disease. My monitor goes off many times throughout the day and night…what I take makes a difference in how long my sugar stays up…a fast acting carb followed by some fat and protein serves me the best. I know there must be other people out there like me…I hope this helps…I know Joselin heads up the team that helps me manage this condition.
Denise, after months for trouble, I;ve finally gotten into an endocrinologist who knows my insulin flood is real. Now for a month I;ve got an almost entirely protein diet to follow, then I don’t know what he will decide he wants for labs or other things. I’m on a leave from work beause it is messing with my life so much.
I’d love to email with others who have this probem of too much insulin output after bariatric surgery. I’ve seen sites that also call it NIPHS (that googles), it is not a well know condition and I don’t know how things will turn out. I’m not interested in having part of my pancreas taken out—sounds far too risky in the long term.
Your blog is the only one I’ve found in months for looking that talks about a pump. I’;d love to know what ever you’d like to share with me.
I’m glad I’ve found this site to explore. Maybe I won’t feel Iike I’m a guinea pig, lost on a raft on the sea…
diane a
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This site is very informative and helpful to people who are suffering from diabetes. Thanks for sharing this info to us and I will tell my diabetic friends about this site. Please keep on posting and more power.
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