7th September 2017 - The Dr Joe

What It Feels Like When Low Blood Sugar (Hypoglycemia) Strikes

By Dr Joe

Symptoms of low blood sugar or what we refer to as hypoglycemia symptoms are variable.

You could get hit with a myriad of low blood sugar symptoms, sometimes without warning. Take it from me. It’s never a bad idea to be prepared.

Here’s what you get on this page:

What The Symptoms of Low Blood Sugar Are
What Is Hypoglycemic Unawareness
Low Blood Sugar In Non-Diabetics
How Low Is Too Low
Why Does Low Blood Sugar Cause Shaking of The Body
Why Do Symptoms of Low Blood Sugar Occur In Diabetics
What Causes Low Blood Sugar Symptoms

Some of the symptoms of hypoglycemia are in actual fact warning signals though, alerting you to the real prospect of the more severe ones to come, if you do not act straightaway.

All of the hypoglycemia symptoms will affect individuals differently. No one individual will experience all of the symptoms of low blood sugar symptoms in one go.

You could liken the onset of symptoms of low blood sugar to driving your lovely car on the highway with the fuel gauge signalling ‘reserve’.

When you are on reserve, the drive is risky. It’s only a question of time before the car runs out of fuel. Running your car on fuel reserve is similar to running your body on low blood sugar.

> The point being, glucose is the energy substrate that our body cells prefer. That is unless you are one of those people on the ketogenic diet which of course means your body cells are now using fat as energy source by default.

Your body doesn’t use fat as energy source by choice. It does so when forced to do so.

When blood glucose levels drop to below a critical level, that is when the symptoms of low blood sugar will begin to manifest themselves.

All of these symptoms of low blood sugar occur because the preferred power agent i.e glucose, your body cells need is not readily available.

All sorts of symptoms then rear their ugly heads to herald what we call hypoglycemia.

What are the symptoms of low blood sugar?

How do you feel when your blood sugar is low? I can tell this much. It is not a pleasant feeling.

Like I said previously, the symptoms of low blood sugar do vary. The list below gives you a taste of what to expect.

You will probably tremble
You will feel weak and fatigued
You may become nervous
You will probably sweat (sometimes profusely)
You may feel agitated
You may have a headache
You may feel nauseated
You may feel dizzy or light-headed
You will have hunger pangs
You may feel your heart beat much more powerfully banging on your chest wall
Your heart rate quickens (beats much faster)

Other symptoms of low blood sugar include:

Your skin will go pale
You may become confused
Your memory may fail you at this point
You become short-tempered and ready to fly off the handle very quickly
Your vision is impaired (blurred vision or double vision)
Your speech may become slurred as seen in a drunken state
You will have difficulty concentrating
You might even act anti-socially or inappropriately (frightening thought, huh)
You may have difficulties with co-ordination even when performing simple tasks
You may experience tingling in your hands, your legs and around the mouth
You may become unconscious
You may have seizures

Protective mechanisms will kick in to keep vital organs working when your blood sugar levels drop really low.

For instance, fat stores are mobilised to generate ketones. These ketones will become a substitute for glucose to be used as fuel by your body cells.

That process however does take a while to kick in, and some damage may occur between before that ketogenic conversion takes place.

Usually before that, your body will mobilise your glucose stores called glycogen. This is discussed further below.

Hence, it makes sense to act and correct low blood sugar level as quickly as possible.

If you diabetic, you are probably clued up about how you feel when your blood sugar is low.

In fact, when I was in the medical school some decades ago, one of my university professors used to say, every adult diabetic should have an episode of hypoglycemia at least once.

His reason:

He felt that way the diabetic person will know how to recognise an attack early on in future. Cruel thought? Maybe.

An adult diabetic may recognise an episode of hypoglycemia but what about children diabetics? Well, kids will have to rely on their parents to be vigilant about the symptoms of low blood sugar.

A quick blood glucose test on a child will tell you if your child’s blood glucose is low or not.

What about hypoglycemic unawareness?

In the diabetic club, there is a group of individuals who unfortunately can go from zero to 60 or should I say 60 to zero in minutes. These diabetics have what we call hpoglycemic unawareness.

Hypoglycemic unawareness happens when the individual does not experience the early warning symptoms of low blood sugar like shaking, headache, sweating, fast heartbeat, nausea, feeling agitated etc.

Instead, the individual experiences the more significant symptoms like confusion and drift straight into unconsciousness within minutes.

Hypoglycemic unawareness happens usually to:

People with type 1 and type 2 diabetics who have had the diabetes for several years
Diabetics who tend to have frequent hypoglycemic attacks like many hypo attacks in a couple of days.

The theory is that hypoglycemic unawareness occurs because your body had developed tolerance to frequent hypo attacks.

Most of those early symptoms of low blood sugar are secondary to adrenaline release. These progress to the brain-related symptoms if the low blood glucose is not corrected early enough.

That is when symptoms like confusion, seizures and loss of consciousness kick in. These are central nervous system symptoms.

In hypoglycemic unawareness, the adrenaline phase is by-passed with a swift move to the central nervous system (brain-related) symptoms of low blood sugar. This is particularly risky for these individuals especially if they suffer an attack when they are alone.

I used to know a long-standing type 1 diabetic in secondary school who could drift into unconsciousness from being normal in minutes. It used to frighten the hell out of us as we were very young at the time.

Low Blood Sugar in non-diabetics

Low blood sugar is not an event that is exclusive to diabetics. Low blood sugar can also occur in non-diabetics but it is not as common as you will find in diabetics.

This is because the natural mechanisms that protect you tend to kick in as your blood sugar begins to drop.

For instance, low blood sugar will trigger the release of glucagon. Glucagon does the opposite of what insulin hormone does.

> Glucagon causes the breakdown of the storage form of glucose called glycogen to shore up blood glucose levels to normal levels.

If you are metabolically competent as a non-diabetic, these protective mechanisms are available to prevent significant damage resulting from low blood sugar levels.

If you consider yourself to be non-diabetic but you see yourself having symptoms of low blood sugar often I will encourage you to question whether you are in fact non-diabetic.

Non-diabetics having low blood sugar more than once should seek help from their doctor. It is possible that you may in fact be having prediabetes or frank type 2 diabetes. There is probably an element of undiagnosed insulin resistance which would require investigation to uncover.

It may sound counter-intuitive that someone who is having low blood sugar symptoms may in fact be having type 2 diabetes which is a high blood sugar disease. But you will be surprised. Reactive hypoglycemia and fasting hypoglycemia for instance are some of those surprises.

There are several causes of non-diabetic hypoglycemia. I have discussed the possible causes of low blood sugar including reactive and non-reactive hypoglycemia on that page. Go have a look.

How low is too low blood sugar?

As said earlier on, how people respond to low blood sugar will vary from individual to individual. So, the question of how low is too low blood sugar becomes somewhat fluid as responses differ.

However, when blood sugar drops to 2.0 mmol/l (36 mg/dl), then that low is too low blood sugar.

I do experience blood sugars of 3.5 mmol/l (63 mg/dl) and I will still be fine. You may not. If that’s the case, act on it i.e correct the blood sugar levels.

Low blood sugar by definition is actually blood sugar levels of below 4.0 mmol/l (72 mg/dl). A lot of people will not have symptoms of low blood sugar at this level but some will.

> The message here is; if you are experiencing symptoms of hypoglycemia and your blood sugar is below 4.0 mmol/l (72 mg/dl), then do something.

How low is too low blood sugar – certainly blood sugar of 2.0 mmol/l (36 mg/dl) and below, is glucose level that is too low. That is a level that has become critically and dangerously low. Swift action is required.

Why does low blood sugar cause shaking of the body?

One of the symptoms of low blood sugar is shaking or trembling. You begin to experience tremors and you find it difficult to maintain a steady hand.

Why is that:
As blood sugar begins on a downward slope, the body’s defensive mechanisms kick into gear. The idea is to restore blood glucose levels back to normal.

Your body calls upon the storage form of glucose called glycogen to be broken down to its simpler form – glucose. Remember, your body relies on glucose to provide energy as a primary source, unless you have re-programmed your body to use fat.

Glucagon is the hormone that does this job of glycogen breakdown so efficiently. Whilst all of these is going on, the flight or fight response is also triggered.

Where there is flight or fight, adrenaline takes charge. Adrenaline also helps with the breakdown of glycogen too although that is a secondary job for it.

Low blood sugar is a stressful situation. Your body quickly recognises that. The adrenal medulla is called upon to respond to this stressful situation. Your adrenal medulla releases the hormone called adrenaline.

Adrenaline or epinephrine (that’s the other name for adrenaline) prepares you for the fight or flight response. It will certainly help glucagon to break down glycogen stores to attempt to make free glucose available for use by your body cells.

One of the objectives of adrenaline is to change the metabolic process such that the muscles and in particular the brain are protected by making glucose readily available to those two organs.

It is this release and flooding of your body with adrenaline that causes the shaking that your body experiences when your blood sugar is low.

Why do symptoms of low blood sugar occur in diabetics?

Diabetes is a disease of high blood sugar. How come symptoms of low blood sugar occur more in diabetic than non-diabetics?

It sounds counterintuitive that the exact opposite of the disease they suffer from seems to affect diabetics more. In both type 1 and type diabetics the aim of diabetic management is to lower blood glucose levels.

In type 1 diabetics, this is always achieved by the use of the hormone preparation called insulin. There are various types of insulin – fast acting, medium acting and long acting. A great deal of education is involved teaching type 1 diabetics on how and when to administer their prescribed insulin.

How much insulin to administer is just as important as the ‘how’ and ‘when’. All of these variables can lead to problems, one of which is low blood sugar.

As for the type 2 diabetics, the vast majority will lower their blood sugar by changing their diet, altering their weight with or without oral prescription anti-diabetic medications. A small proportion will need insulin.

Those who need insulin will have the same issues as the type 1 diabetics.

What causes low blood sugar symptoms?

Causes of the symptoms of low blood sugar in diabetics are related to overzealous treatment and lifestyle issues inclusive of one or more of the following:

Administering too much insulin
Taking too many oral prescription anti-diabetic medications that make your pancreas produce more insulin. The class of medications called sulfonylureas like gliclazide, glibenclamide and the glinides like nateglinide and repaglinide can cause low blood sugar symptoms. Metformin does not fall into this category, you will be glad to know.
Prolonged intervals between meals
Eating too little food to match insulin or tablet intake
Consuming excessive alcohol especially in type 1 diabetics
Overly vigorous exercise not matched by appropriate food intake or reduction in insulin intake

Generally speaking, causes of hypoglycemia symptoms in diabetics will fall broadly into those categories above.

Usually a quick test blood sugar test will reveal to you if your blood sugar is low or not.

If you are non-diabetic and have experienced symptoms of low blood sugar on more than one occasion, you may benefit from learning the causes of non-diabetic hypoglycemia here and you can see how to treat symptoms of low blood sugar here.

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