Hypoglycemia
What is hypoglycemia?
Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. Glucose, an important source of energy for the body, comes from food. Carbohydrates are the main dietary source of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.
After a meal, glucose is absorbed into the bloodstream and carried to the body’s cells. Insulin, a hormone made by the pancreas, helps the cells use glucose for energy. If a person takes in more glucose than the body needs at the time, the body stores the extra glucose in the liver and muscles in a form called glycogen. The body can use glycogen for energy between meals. Extra glucose can also be changed to fat and stored in fat cells. Fat can also be used for energy.
When blood glucose begins to fall, glucagon—another hormone made by the pancreas—signals the liver to break down glycogen and release glucose into the bloodstream. Blood glucose will then rise toward a normal level. In some people with diabetes, this glucagon response to hypoglycemia is impaired and other hormones such as epinephrine, also called adrenaline, may raise the blood glucose level. But with diabetes treated with insulin or pills that increase insulin production, glucose levels can’t easily return to the normal range.
Hypoglycemia can happen suddenly. It is usually mild and can be treated quickly and easily by eating or drinking a small amount of glucose-rich food. If left untreated, hypoglycemia can get worse and cause confusion, clumsiness, or fainting. Severe hypoglycemia can lead to seizures, coma, and even death.
In adults and children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment. Hypoglycemia can also result, however, from other medications or diseases, hormone or enzyme deficiencies, or tumors.
What are the symptoms of hypoglycemia?
Hypoglycemia causes symptoms such as
- hunger
- shakiness
- nervousness
- sweating
- dizziness or light-headedness
- sleepiness
- confusion
- difficulty speaking
- anxiety
- weakness
Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include
- crying out or having nightmares
- finding pajamas or sheets damp from perspiration
- feeling tired, irritable, or confused after waking up
What causes hypoglycemia in people with diabetes?
Diabetes Medications
Hypoglycemia can occur as a side effect of some diabetes medications, including insulin and oral diabetes medications—pills—that increase insulin production, such as
- chlorpropamide (Diabinese)
- glimepiride (Amaryl)
- glipizide (Glucotrol, Glucotrol XL)
- glyburide (DiaBeta, Glynase, Micronase)
- nateglinide (Starlix)
- repaglinide (Prandin)
- sitagliptin (Januvia)
- tolazamide
- tolbutamide
Certain combination pills can also cause hypoglycemia, including
- glipizide + metformin (Metaglip)
- glyburide + metformin (Glucovance)
- pioglitazone + glimepiride (Duetact)
- rosiglitazone + glimepiride (Avandaryl)
- sitagliptin + metformin (Janumet)
Other types of diabetes pills, when taken alone, do not cause hypoglycemia. Examples of these medications are
- acarbose (Precose)
- metformin (Glucophage)
- miglitol (Glyset)
- pioglitazone (Actos)
- rosiglitazone (Avandia)
However, taking these pills along with other diabetes medications—insulin, pills that increase insulin production, or both—increases the risk of hypoglycemia.
In addition, use of the following injectable medications can cause hypoglycemia:
- Pramlintide (Symlin), which is used along with insulin
- Exenatide (Byetta), which can cause hypoglycemia when used in combination with chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, and tolbutamide
Source: National Diabetes Information Clearinghouse (NDIC)
