Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 31, 2016

Hypoglycemia is a serious medical condition that occurs when there is a deficiency of glucose in the blood and tissues necessary for basic bodily functions. If left untreated, this condition can severely damage the central nervous system or even become fatal. Low blood sugar symptoms are more common among those who have diabetes but can present themselves in people without diabetes. Medical treatment for hypoglycemia, which is also called low blood glucose is extremely critical and those suffering from its symptoms should seek medical treatment immediately.


Definition & Facts

Hypoglycemia is a medical condition in which the level of glucose (sugar) in the blood is too low for the body to function properly. Glucose is the body’s main source of energy for performing even its most basic functions. Hypoglycemia is an indicator of other medical issues that are typically related to the endocrine system, most often, the pancreas. The warning signs of the onset of low blood sugar usually include but are not limited to: hunger, trembling and shakiness, nausea, pallor, and sweating.

Symptoms & Complaints

The majority of people know when their blood sugar level has dropped and usually have enough time to correct the problem before it becomes critical. In some cases, however, a severe onset can occur with little or no warning. A person experiencing hypoglycemia will complain of or present the following symptoms:


During digestion, the body breaks down carbohydrates from food we consume into various sugar molecules. One of these sugar molecules is glucose. Glucose is absorbed into the bloodstream after digestion, but it cannot enter the cells of most of the body’s tissues without the help of insulin.

After eating, glucose levels rise, signaling the pancreas to produce the hormone, insulin, in order to regulate glucose distribution. Once glucose levels begin to drop, insulin levels also drop, maintaining a proper balance. When a person hasn’t eaten for a while, then the liver takes over the process by supplying glucose from stores of glycogen into the bloodstream, thus maintaining glucose levels in the body until a person eats again. Hypoglycemia is present whenever this system of glucose regulation breaks down. Diabetic hypoglycemia is the most common form of hypoglycemia and it can occur as a side effect of diabetes medication that increases the production of insulin.

Hypoglycemia may also be caused by the following:

Diagnosis & Tests

The most definitive indicator of hypoglycemia is a blood test that shows glucose levels have fallen below 70 mg/dL or 70 milligrams per deciliter of blood. People with diabetes usually carry a glucose testing meter in order to more closely monitor their glucose levels.

Three criteria, sometimes referred to as Whipple’s triad, are used to diagnose hypoglycemia. The first of these is a presentation of the signs and symptoms of hypoglycemia. When preparing for an initial visit for suspected hypoglycemia, the patient is typically asked to fast overnight (or sometimes longer) in order to see if symptoms occur.

The second test used to diagnose hypoglycemia is a lab analysis of your blood. The lab analysis will be concerned with several factors; however the most telling will be the ratios of both glucose and insulin present in the blood. The third test used to diagnose hypoglycemia is to determine if the signs and symptom presented go away after glucose levels have been raised.

Additional tests, after hypoglycemia has been detected may be required in order to diagnose the underlying cause of a person’s hypoglycemia. Certain medications in the patient’s medical history might be considered, certain lifestyle factors like anorexia nervosa, drug abuse or alcohol abuse, hepatitis, kidney disorders, pituitary disorders or the presence of insulinoma (tumor on the pancreas) might also be examined in greater detail to determine the cause of hypoglycemia.

Treatment & Therapy

There are two instances to consider in the treatment of hypoglycemia: immediate, initial treatment to raise blood sugar and ongoing treatment of the underlying condition. Depending upon the severity of the symptoms, immediate treatment to stabilize glucose levels can vary. With less severe symptoms or early warning symptoms, initial treatment can be as simple as consuming between 15 to 20 grams of fast acting carbohydrates such as: candy, fruit juice, regular (not diet) soft drinks, or glucose tablets.

Once the levels are raised enough to counteract the initial symptoms, then a meal or snack to maintain proper levels should be consumed. In severe cases, such as hypoglycemic shock (blood sugar level of 40 mg/dL or lower), the person will likely be unconscious or unable to function and will need an injection of glucose in order to help stabilize blood sugar levels. Ongoing treatment of the underlying condition can include medications, lifestyle changes or the surgical removal of portions of the malfunctioning organ or tumors. 

Prevention & Prophylaxis

Prevention can depend upon a person’s medical history and lifestyle. Diabetics can prevent hypoglycemia by carefully following the instructions and management plan provided by a healthcare provider. They can make certain that fast acting carbohydrates are always, readily available to treat hypoglycemia before glucose levels reach a critical state.

Those with non-diabetic hypoglycemia need to be aware of eating properly, the effects of alcohol and drug abuse, and the possibility that other medical conditions can present as hypoglycemia. Frequent episodes of hypoglycemia or a single episode of hypoglycemic shock should be a certain sign of the need to consult a physician about the condition.