Hypoglycemia or Low Blood Sugar: The Symptoms

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by Nora Saul, M.S, R.D., L.D.N., C.D.E.

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.

  • Dizzy
  • Shaky
  • Sweaty
  • Irritable
  • Wea
  • Headache
  • Difficulty concentrating
  • Confusion
  • Blurred vision
  • Increased hunger
  • No symptom
To others you may appear to:

– Have an unsteady walk
– Have trouble focusing
– Be irritable before meals
– Be acting differently

Next week:  Hypoglycemia or Low Blood Sugar:  The Causes

40 Responses to Hypoglycemia or Low Blood Sugar: The Symptoms

  1. Pingback: Tweets that mention Hypoglycemia or Low Blood Sugar: The Symptoms | Joslin Diabetes Center Blog -- Topsy.com

  2. Dorcas says:

    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?

  3. angela Paratore says:

    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:)

    • Kathy says:

      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.

      • Linda Alipuria says:

        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?

    • joslin reply says:

      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.

    • Payne Eli says:

      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.

    • phyllis says:


      • 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.

    • Brook cooper says:

      I agree. Nor much info out there. I am in the same boat. Is it maybe not as big of deal than diabetes?

  4. Stephanie says:

    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

    • Sherry Svec says:

      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.

    • Kathy says:

      Not if you drink skim milk! 🙂

  5. Bernard Campbell says:

    I would add noticeably slower speech to the list of symptoms.

  6. Jeanne Altman says:

    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.

  7. Ibrahim H Caglayan says:

    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.

    • Linda Alipuria says:

      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.

  8. Atheria says:

    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.

    • Bob Ambal says:

      Atheria, you are not alone. Read about False Hypo. Your symptoms appeared to me as well, when I had sudden drops in blood sugars.

  9. Denise Fortin says:

    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.

  10. Diane A says:

    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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  24. Vishal Sabharwal says:


    My mother is highly diabetic, her sugar level drops to about 40, which is very scary.

    For this very purpose , i got her admitted in the hospital all her reports were fine, she was there in the hospital for around 5 days.

    But now again her sugar levels have started dripping very frequently and sometimes even when shes sleeping, when i talk to my concerned doctor..i am told she needs to exercise..but she does that and even eats a proper meal with around 3-4 glasses of fruit juice everday.

    Its happening very frequently now, and seeing her in that condition is very scary, can you please suggest us what can be the root cause of this problem, and is there actually any way we can curb this for good.

    • Nora Saul, Manager Nutrition Services says:

      Dear Ms. Sabhawal:
      Hypoglycemia (low blood sugar) is caused by a mismatch between the available amount of insulin and the glucose concentration in the blood. When the active insulin exceeds the amount of glucose, the blood glucose (sugar) plumments.
      Exercise, not eating sufficient carbohydrates, or taking too much insulin are usually the culprits. There are also other less common causes (certain medications, insulinomas, hepatic dysfunction) that can also lead to low blood glucose. If your mother did well in the hospital but is having problems at home, it may be something in her routine that is causing the lows. Your mother might want to keep extensive food/exercise and blood glucose records and bring them to her next appointment with her physician. The two of you could also discuss the possibility of wearing a continuous glucose monitor with her physician.

  25. Ellen says:

    I had one or two ‘blank stare and falling’ episodes when I was a toddler, and my parents were told I had “childhood epilepsy’ but also that it might be from low blood sugar. It never happened in my memory but now at 62 I am wondering if I have a blood sugar problem (probably secondary to a digestive issue, which I am now having some tests for). I have 3 cousins (on my mother’s side) who became diabetic as adults, one very suddenly, with no other risk factors, while the other two (sisters, cousins of the first) might have more to do with alcohol. I’ve pretty much survived the last several years on caffeine keeping me going at work, and have finally been able to retire. I am still incredibly tired, but have had to pretty much give up caffeine because it wasn’t working anymore (I’m wondering about insulin production or if my body is just ‘burned out’ somehow). I’m sleeping much better (I do during the spring to fall seasons anyway) but still tired by after breakfast. In fast, I feel better (up to a point) fasting but that quickly disappears once I eat. I eat healthy food for the most part for meals but still have those salty snacks (my blood pressure is normal, but it used to always be low and that was my ‘justification/explanation’). I’ve been tested for sleep apnea and it was so mild they didn’t recommend any treatment or device. I also developed asthma a couple of years ago (new stressful job after downsizing may have contributed to that!). I also have rheumatoid arthritis (since 2004) but the symptoms have pretty much gone to sleep for over a year (weird but I’m not complaining about pain most of the time now!) I will be getting a HemoA1C along with the other yearly tests from my gastro doc…. it’s only been toward the pre-diabetic range once, when i didn’t fast for the full 12 hours. (So I will be extra careful about that!)
    I have to be amused that I’m being ‘forced’ to fast during Lent – and feel better briefly but then of course am starved…and eat after. But maybe some of these tests will be helpful. and if not, I may ask for a 5-hr glucose test. I just want to get to the bottom of this! I do have other vague symptoms that come and go – nausea, dizziness, sweating (new recently), that are hard to track down. I’ve tended to try and have some protein but have learned more here – carbs vs. protein (without fat). I have yogurt (Activity low-fat: I will not longer get the non-fat because the Nutrasweet gave me a constant headache for two months before I figured out what was causing it. Gosh there are so many variables to keep track of, to figure things out! Thanks for reading this…

  26. ANDREW HORNBY says:

    For the past 8 months I have been having severe dizzy spells as soon as I really exert myself during sport, mainly football. I’ve recently had a blood test and everything has come back as normal and I went to see a heart specialist who did all sorts of tests on my heart including a scan and everything was healthy.
    My doctor cannot tell me what the problem is but after visiting your website I feel it may connected to low blood sugar??? I really need answers as I have not stopped playing sport

    • Nora Saul Nutrition Manager says:

      Dear Mr. Hornby:
      Your symptoms could be related to many things. You may want to discuss with your physician if there is a possibility it is connected to low blood glucose. If your physician feels that this has any merit, you may want to check your glucose level during the times you are experiencing an episode you describe.

  27. Dee33 says:

    my fasting blood sugar is 62 , and this have never happened!! What does it mean????

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