Diabetic Hypoglycemia - Diagnosis and Treatment

Diagnosis

Doctors use a blood glucose meter to measure blood sugar when checking for hypoglycemia. If the value is under 70 mg/dL (3.9 mmol/L), they often diagnose hypoglycemia.

Common signs that may prompt testing include:

Shaking or trembling
Sweating
Dizziness
Fast heartbeat
Anxiety or nervousness
Irritability
Blurred vision
Palpitations

In some cases, especially if symptoms are unclear or recurrent, healthcare providers may perform additional testing. These may include:

Plasma glucose tests during symptoms
Serum insulin levels
C-peptide levels
Anti-insulin antibody tests (in rare cases)

To confirm true hypoglycemia, clinicians may apply Whipple’s triad, which includes:

Symptoms consistent with low blood sugar
A documented low blood glucose level
Relief of symptoms once blood sugar returns to normal

This approach helps ensure that symptoms are truly due to hypoglycemia and not another condition with similar signs.

Treatment

Steps for Handling a Drop in Blood Sugar

When someone suspects low blood sugar, they should check their glucose level using a blood glucose meter if possible.

If this cannot be done right away and symptoms are present, treat the situation as a low blood sugar event. Taking quick action can prevent more serious problems.

Quick-acting carbohydrates are the first choice for raising blood sugar. Foods and drinks that work well include:

Four glucose tablets
One serving of glucose gel (follow the product label for details)
Five or six pieces of hard candy or jelly beans (check the package for serving size)
Four ounces of fruit juice or non-diet soda
One tablespoon of sugar, honey, or corn syrup

These foods provide about 15 to 20 grams of carbohydrate, which is usually enough to raise blood sugar to a safer level. Foods high in fat, like chocolate, do not work quickly enough. Diet sodas do not contain sugar and should be avoided.

After eating or drinking a fast-acting carbohydrate, recheck blood sugar after 15 minutes.

If the level remains below 70 mg/dL (3.9 mmol/L), repeat the process with another 15 to 20 grams of carbohydrate. Continue this cycle until blood sugar is above 70 mg/dL.

Once blood sugar is stable, eat a snack or meal to avoid another drop. If someone uses insulin around mealtimes and has just treated hypoglycemia with a snack, they usually do not need extra insulin.

If about to eat a meal, the insulin dose may need to be slightly lower than usual.

Tips to Remember:

Avoid overtreatment, as it can cause blood sugar to go too high.
Watch for symptoms such as shakiness, hunger, sweating, or irritability.

Life-Saving Care for Severe Low Blood Sugar

If a person passes out or cannot safely eat or drink, someone should give glucagon. Glucagon is a hormone that quickly raises blood glucose, and it is available by prescription.

You can give it in several ways:

Method	Details
Emergency injection	Syringe kit or pre-filled injectable pen
Nasal spray	Powdered form administered in one nostril

Always store glucagon as directed by the manufacturer and check the expiration date.

How to use glucagon:

If giving by injection or spray, turn the person on their side to prevent choking in case of vomiting.
Wait about 15 minutes. If the person does not wake up, call emergency services immediately.
After regaining alertness, the person should eat as soon as possible.
Medical follow-up is important to review diabetes medicine or insulin dosages after a severe episode.

Teach family, friends, and coworkers how to use glucagon to save lives.

Handling Difficult or Frequent Low Blood Sugar Events

Some people experience frequent or hard-to-control low blood sugar, even after changing their diabetes medicines or doses.

In such cases, a provider may recommend keeping glucose levels slightly higher than usual to avoid further episodes.

Additional steps include:

Using a Continuous Glucose Monitor (CGM): This device checks blood sugar every few minutes through a sensor under the skin.
Always Carry Glucagon: Be prepared for emergencies.
Teach a support team (family, friends, coworkers) how to respond in case of a severe drop.

Work closely with a healthcare provider to prevent repeated episodes and to adjust medications. This may include insulin or blood sugar-lowering agents from the sulfonylurea class, depending on the individual’s condition and risk factors.

Blood Sugar Monitors and Insulin Devices

People can wear continuous glucose monitors to track blood sugar every few minutes. The sensor sits under the skin and can show blood sugar changes before symptoms appear.

Some CGMs send alerts for rising or falling glucose levels. You can use insulin pumps with or without a CGM.

The pump connects to a thin tube placed under the skin and provides insulin throughout the day, as well as extra insulin when eating.

This helps keep blood sugar steady and can make it easier to prevent both low and high readings.

Table: CGM and Insulin Pump Comparison

Device	Main Use	How it Works
CGM	Tracks glucose	Sensor under skin gives real-time glucose readings.
Insulin pump	Delivers insulin	Small pump outside the body sends insulin through a tube.

These tools help people who want more control over their blood sugar, especially those who take insulin or worry about severe low blood sugar episodes.

When Symptoms of Low Blood Sugar Are Not Obvious

Some individuals do not feel or notice the early signs of low blood sugar. This is known as reduced awareness of hypoglycemia.

In these cases, doctors may suggest aiming for a higher blood sugar target to lower the risk of unnoticed episodes.

Important safety steps include:

Always check blood sugar before going to sleep.
Have a carbohydrate-containing snack at bedtime if blood sugar is close to the low end of the bedtime target.
Use a blood sugar monitor with an alarm that sounds if blood sugar gets too low.
Follow up regularly with a healthcare provider to review treatment options and technologies.

Stay alert to possible problems, use the right equipment, and adjust medicine to reduce risk and keep blood sugar levels safer. Continuous glucose monitoring and support from others play a big role for people with this condition.

Looking After Yourself

Help Others Support You

Let trusted people like friends, family, or coworkers know about low blood sugar. They should learn how to spot warning signs, such as sweating or confusion.

Teach them where to find your glucagon and how to use it if your blood glucose level drops too low.

Prepare for Emergencies

Always keep quick sources of carbohydrates, such as glucose tablets, hard candy, or gel, in your bag or pocket.

If your doctor prescribes glucagon, carry it as well. Use a blood glucose meter to watch your blood sugar levels, especially during physical activity or after drinking alcohol.

Medical Identification

Wear a medical ID bracelet or necklace that says you have diabetes. You can also carry a wallet card.

This helps people and emergency workers know about your condition and the need for fast treatment if you cannot speak.

Getting Ready for Your Visit

Steps You Can Take Before Your Appointment

Preparing for a health care appointment can help make the visit more effective. Here are some ways to get ready:

Check for instructions before your appointment. Some tests might require you to fast for 8 to 12 hours. Ask if you need to avoid food or drink, except water. If fasting is needed, ask how to adjust your diabetes plan, including any medicines or insulin.
Write down your symptoms and how often they occur. Track when you have low blood sugar, what you feel, and your blood sugar readings. Having these details helps your healthcare provider see patterns and find possible causes.
Keep a record of important personal information. Note any big changes in your life, unusual stress, or changes in your daily routine. If you check your blood sugar at home, bring a log of your results with dates and times.
Make a list of all medicines, vitamins, and supplements. Record their names and doses. Include any insulin you use and the amount.
Bring your blood sugar meter. Some meters let the healthcare team upload your readings directly to their computers for review.
Prepare questions for your healthcare provider. Ask anything that is unclear or causes concern.

Examples of helpful questions:

Topic	Example Question
Blood Sugar Checks	How often do I need to test my blood sugar each day?
Target Ranges	What numbers should my blood sugar readings be?
Lifestyle Effects	How do eating, being active, or losing weight change my blood sugar?
Preventing Lows	What steps can help prevent hypoglycemia?
Emergency Care	Should I have a prescription for emergency glucagon?
Getting Support	When should I contact you if low blood sugars keep happening?

It can also be helpful to ask about specific conditions. For example, ask if you have type 1 diabetes, liver disease, an insulinoma, or low cortisol, since these may lead to more frequent low blood sugar.

Tip: Don’t forget to mention any recent changes in your diabetes management, such as new medicines or a change in diet.

What Your Health Professional May Discuss With You

During your visit, the healthcare provider will likely ask you several questions to learn more about your situation. Being ready to answer these will make the consultation run smoothly.

Questions you may be asked:

What symptoms do you notice during low blood sugar episodes?
How many times each week do you experience symptoms?
What do you usually do to raise your blood sugar levels?
What is a normal day of eating and activity like for you?
How often do you exercise, and what kind of activities do you do?
Do your friends, family, or people at work know what to do if your sugar drops too low?
Are you aware of any possible causes like type 1 diabetes, liver disease, known tumors like insulinoma, or problems with cortisol?

Sometimes, your healthcare provider might ask detailed questions about your medicines and supplements, how your blood sugar has changed over time, and any recent illnesses or hospital visits.

They may use your blood glucose meter data or your records to see blood sugar control over time.

It’s normal for them to ask about your feelings, mood changes, and if you’ve noticed new stress. They may also talk about your targets for blood sugar and what to do in case of emergencies, like severe hypoglycemia.

Tip: Be open about any missed doses, skipped meals, or unusual routines to help your provider make the best recommendations.

Here is a simple chart to help you organize your information:

What to Bring	Why It Helps
List of symptoms	Spots patterns and possible triggers.
Log of blood sugar readings	Shows trends for better treatment.
Record of medicines & doses	Checks for interactions or errors.
Questions for provider	Makes sure all concerns are addressed.
Glucose meter	Allows download and review of results.

Diabetic Hypoglycemia – Diagnosis and Treatment