Hypoglycaemia, or hypo, is the medical term or low blood sugar level – that is a blood glucose (sugar) level less than 70 mg/dl. This is too low to provide sufficient energy for your body’s activities. Hypoglycaemia is one of the most feared complications of diabetes treatment. This is because it leads to a very uncomfortable feeling and a risk of losing consciousness. This can be frightening and may also be a cause for embarrassment in the social or work setting. Also, severe hypoglycaemia can cause acute harm to the person with diabetes or others, if it causes falls, motor vehicle accidents, or other injury. Hypos can happen when patients are treated with insulin or certain diabetes medication. No matter how much patient know about diabetes or how careful patient is, if diabetes is treated with certain medication, person is at risk of experiencing hypoglycaemia and hypoglycaemia education should always be part of all diabetics’ education in the first visit only.

What can cause a hypoglycaemia?

Hypoglycaemia occurs due to a relative excess of insulin in the blood, which in turn lowers blood glucose to below normal level. This can be due to-

Relative hypoglycaemia

Symptoms of hypoglycaemia may also occur when the blood glucose level falls rapidly, from a high level to lower, but the patient is still at an elevated or normal blood glucose level, as body perceive these glucose levels low. The response is related to the rate of fall of blood glucose as opposed to actual blood glucose level.

What are the signs and symptoms of hypoglycaemia?

Hypoglycaemia can be mild to moderate, or severe. If your blood glucose drops below normal, you may experience a variety of symptoms.

Signs and Symptoms of Hypoglycaemia

Mild to moderate

  • Feeling hungry

  • Nervousness and shakiness

  • Sweating

  • Dizziness

  • Sleepiness

  • Confusion

  • Difficulty speaking

  • Feeling anxious or weak

  • Fast pulse or palpitations

  • Tingling of the lips

  • Blurred vision

Severe hypos: blood glucose below 35-40 mg/dL

  • Seizure or convulsion

  • Loss of consciousness or

  • Coma


Hypoglycaemia unawareness

Some people, particularly those who have had diabetes for a long time, or who have had frequent low blood glucose episodes may not feel any of the early symptoms and may not recognise that their blood glucose is dangerously low. This is called hypoglycaemia unawareness.


Immediate treatment of hypoglycemia

The rule of 15 is a helpful way to remember the treatment regimen.

If your blood glucose is 70 mg/dL or below, use the rule of 15 to treat hypoglycaemia.

If your blood glucose is still less than 70 mg/dL, eat another 15 grams of carbohydrate and re-check blood glucose in 15 minutes. Repeat as needed until blood glucose is in goal range.

These items contain 15 grams of carbohydrate:

Once you notice your hypo warnings, take action quickly or it will become more severe, and you may become unconscious or have a fit.

Note: If you are unable to swallow or unconscious you should not be given anything by mouth (including Glucose, jam or honey). Make sure your family and friends are aware of this.

Follow on treatment

Once your hypoglycemia is settled, to prevent the blood glucose dropping again, you should follow your sugary foods with a starchy carbohydrate snack such as: