Diabetes occurs when there is too much sugar (glucose) in the blood because the body doesn’t produce enough insulin or can’t use insulin properly. Insulin converts carbohydrates into energy. Good blood glucose control is achieved by having a fine balance between insulin and carbohydrate intake. Excess insulin relative to the carbohydrate intake can lead to low blood sugar. This is a condition called hypoglycaemia, and a potential medical emergency.

“Hypoglycaemia is when blood sugar falls below 70 mg/dL or 4 mmol/L,” says Dr Teh Ming Ming​, Senior Consultant, Department of Endocrinology​, Singapore General Hospital​ (SGH), a member of the SingHealth group.

What can cause hypoglycaemia (low blood sugar) in a person with diabetes?

Blood sugar levels can fall suddenly because of factors related to diet, exercise and diabetic medication. Examples include:

1. Doing more physical exercise than usual
2. Skipping meals or not eating enough at a meal
3. Change in meal timings or eating habits
4. Altering the timings or doses of insulin and other diabetic medication
5. Consuming alcohol on an empty stomach

Hypoglycaemia symptoms

Low blood sugar symptoms can be mild to severe. Common examples are as follows:

1. Nervousness
2. Shaking or trembling
3. Fatigue
4. Muscle weakness
5. Drowsiness
6. Perspiration
7. Hunger
8. Headache
9. Confusion
10. Blurred vision
11. Irritability
12. Dizziness

How to treat hypoglycaemia

“Exercise is excellent for people with diabetes but some care must be taken. Hypoglycaemia can occur during or after a workout,” says Dr Teh.

If you experience low blood sugar symptoms, immediately stop any physical activity and check your blood sugar level with a blood sugar monitor to confirm that it is low. It is recommended to consume a sugary food or beverage, or over-the-counter glucose tablets immediately to raise your blood sugar level. Do not take your diabetes medication until your blood sugar level is normal.

“If you are unable to check your blood sugar level immediately, it would be reasonable to assume that you have hypoglycaemia and eat or drink something sugary right away,” says Dr Teh. “A person with diabetes should carry at least one sugary item at all times as a precaution against hypoglycaemia.”

Check your blood sugar level 15-20 minutes after eating to make sure it is back to normal. You can resume your regular activities if you no longer have low blood sugar.

The following are foods and beverages, with the recommended serving size, that can quickly raise your blood sugar level:

• Hard candy (5-6 pieces)
• Fruit juice (100 ml or about half a glass)
• Sugar, jelly or honey (1 tablespoon)
• Glucose tablets (3)

It would be reasonable to eat or drink something sugary again if the first snack or drink does not bring up your blood sugar sufficiently.

Tips to prevent hypoglycaemia

• Take your diabetes medication regularly as recommended by your doctor.
• Eat nutritious meals and time them to balance your diabetes medication.
• Monitor your blood sugar level regularly based on your doctor’s recommendation.
• Adjust your food intake and medication according to your exercise routine.

“Untreated hypoglycaemia can lead to seizures, loss of consciousness and even death. It is therefore essential to treat it immediately. Seizures and loss of consciousness are examples of severe hypoglycaemia which is a medical emergency. It is essential to seek medical help if severe hypoglycaemia happens,” says Dr Teh.

If you experience repeated hypoglycaemia, promptly consult your doctor for a review of your diet, lifestyle and medication.

People with diabetes should always carry some form of diabetes’ identification in case of an emergency.

Ref: R14