Common Health Issues

Causes and Effects of Hypoglycemia

• By Rich Health Editorial Team
• November 01, 2021

Common Causes of Hypoglycemia and Effect

 

NUTRITION

If you skip meals or eat less food than you normally do after an insulin injection, hypoglycemia is more likely to occur. Also, if you delay your meals and snacks for too long after an insulin injection, hypoglycemia is more likely. Even if you don’t take insulin, you may invite an occasional episode of hypoglycemia if you don’t eat regularly. Talk to your dietitian about how to better coordinate your meals with your medication, insulin and daily activities

 

EXERCISE

Any time you exercise when you did not intend to, or exercise longer or more strenuously than you usually do, you may develop hypoglycemia.

Always have a pocket carbohydrate available when exercising. If you experience any early warning signs during exercise, don’t continue. Stop and test your blood glucose if you are able to. If you can’t test or if your blood glucose level is low, eat a 15-gram portion of a fast-acting carbohydrate. 

 

If you have become hypoglycemic during a similar exercise or activity in the past, plan ahead and eat an extra snack either before, during, or after the activity, depending on when the episode occurred. Or, you could make adjustments in your insulin schedule to accommodate your exercise. Talk to your doctor first.

 

SEXUAL ACTIVITY

If you tend to develop hypoglycemia when you sleep or when you exercise, then you may also have a low blood glucose reaction following sexual activity, especially if you are intimate at night. Talk to your doctor about how to adjust for this. 

 

Because some of the symptoms of hypoglycemia—sweating, rapid heartbeat, chills and clamminess, and shakiness—occur naturally during orgasm, it may be difficult in the middle of sexual ecstasy to tell whether you are having a low blood glucose reaction. And it may be less desirable to stop in the middle of a sexual encounter and test your blood glucose.

Therefore, it is especially important to take preventive steps in advance. You may want to change the timing of your insulin or you may need a snack before or after any sexual activity. If you try testing yourself after an act of intimacy to see whether hypoglycemia is a problem for you, then you can develop a plan for preventing it in the future. Be especially careful if you are combining sexual activity with alcohol.

 

NIGHT-TIME HYPOGLYCEMIA

You can become hypoglycemic during the night without even knowing it. This is especially true if you have been adjusting your insulin and meals to avoid morning hypoglycemia. The problem is that sometimes you end up with low blood glucose in the middle of the night. Sometimes when this happens, the body compensates by releasing more glucose and you become hyperglycemic.

 

To prevent nighttime hypoglycemia, try monitoring your blood glucose at bed time and again at 2 or 3 am. If you are indeed having hypoglycemic episodes during the night, talk to your doctor about what to do. You may want to add extra food at bedtime. 

 

Consider a snack that contains protein, which stimulates glucagon production, which in turn releases glucose from the liver. A snack is especially important when you think you might develop hypoglycemia, such as when you have exercised intensely during the day or when your bedtime glucose is less than 100mg/dl.

 

Also, consider using an insulin that does not peak between 1 and 3 am. If you are taking insulin twice a day, taking your intermediate-acting insulin at bedtime or substituting a long-acting insulin for it may do the trick. If you are using an insulin pump, you may consider programming it to give less insulin during the predawn hours. Talk to your doctor about the strategy that works best for you.

 

SLEEPING LATE

You can probably sleep an extra 30 to 45 minutes without having to change your eating or insulin schedule. If you sleep more than 45 minutes past when you normally get up, then you may need to make some adjustments. Talk to your health care team about what to do if you oversleep. If you oversleep accidentally, test your blood glucose immediately when you wake up and take a dose of fast-acting carbohydrate if you are hypoglycemic. If you know you are going to sleep in the next morning, you may need to make some changes in your nighttime schedule. 

For example, you may try reducing your nighttime dose of intermediate- or long-acting insulin by 10 to 15 percent. This increases the risk of high blood glucose in the morning, however. Or you could eat a little more before you go to bed at night. 

 

But again, you have to be careful you don’t end up hyperglycemic. It is probably safest to wake up at your normal time, test your blood glucose level, take insulin or oral medication, eat breakfast, and then go to sleep. Don’t wake up and take insulin without eating under any circumstances. Talk to your health care team about how to best plan for those days when you need to sleep in.

 

ALCOHOL

Alcohol indirectly lowers blood glucose levels, so it is especially important to prevent hypoglycemia if you are drinking alcohol. Normally, when blood glucose levels start to drop, your body signal the liver to release more glucose. This gives you some time to recognize and treat hypoglycemia before it becomes severe. But alcohol interferes with that process and you can have a severe episode of hypoglycemia with little warning. Alcohol also affects your judgements and so it might become even more difficult to recognize the warning signs and to act appropriately.

 

But that doesn’t mean that you can never have an alcoholic drink. If you do drink, do so in moderation. For women, this means no more than one drink a day, and for men, two drinks a day. One drink is defined as 0.3 liters of beer, 0.1 liters of wine or 0.04 liters of 80 proof distilled spirits. 

Make sure you never drink alcohol on an empty stomach, especially if you take insulin or sulfonylurea drugs. Make sure those around you know how to recognize a hypoglycemic episode, since the signs of hypoglycemia are similar to those of intoxication. Also, keep in mind that you need to be able to think clearly enough to recognize the signs of low blood glucose and to know how to treat it.

 

Talk to your doctor or dietitian about the best way to incorporate alcohol into your meal plan and how best to accommodate an alcoholic beverage you may want to have even if you haven’t planned ahead. You may want to test your blood glucose before you have a drink to make sure it isn’t on the low side. If your blood glucose is below 100mg/dl, make sure to have a snack. You may want to have a small snack anytime you drink alcohol to counteract any glucose-lowering effect.

 

Check with your doctor about the advisability of drinking alcohol. Some medications limit alcohol use. You may also be advised not to drink alcohol if you have pancreatitis, high triglyceride levels, stomach problems, neuropathy, kidney disease, certain kinds of heart disease, or medical conditions

 

HYPOGLYCEMIA IN THE ELDERLY

If you are elderly, you are at high risk for developing hypoglycemia, especially if you have any complicating conditions, take insulin or oral agents, or receive any other medications. If you have physical limitations that interfere with your ability to monitor blood glucose, give yourself insulin, or even manage day-to-day living, then keeping your blood glucose within the optimal range may be even more challenging. It is important that you and those around you be aware of the signs of hypoglycemia and know what to do should it occur.

 

WHAT YOU SHOULD DO

If you are older, but in good general health, you and your health care team may want to aim for a plan that gives you good blood glucose control but does not put you at risk for hypoglycemia. For example, you may want to keep your fasting glucose level at 115m/dl and your after meal glucose level at around 180mg/dl. 

 

However, if you have any complicating factors or medical conditions or are prone to hypoglycemia, you may want to take a more conservative approach. Some older patients find it more appropriate to aim for fasting glucose levels of less than 140mg/dl and after-meal glucose levels under 200-220mg/dl. Talk to the members of your health care team about what works for you.

 

If you have mobility problems, make sure to keep a source of fast-acting glucose near you at all times—in your pocket or on a bedside table, for example. If you have problems testing your blood glucose or administering insulin, try to get someone to help you carry out these tasks at specific times. Also, make sure you don’t skip meals, medications or insulin injections. 

 

If you tend to forget, set an alarm to go off at designated times to remind you to eat or take insulin. Try to enlist the help of your health care team and those around you to help you control your blood glucose so that hypoglycemia does not occur. Also, make sure your friends, family or caregivers know what to do during a hypoglycemic episode

 

HYPOGLYCEMIA AND INTENSIVE THERAPY

If you are managing your diabetes with intensive therapy, then you are at high risk of hypoglycemia. This is especially true if you are male, an adolescent, have had diabetes for a long time, had a high glycated hemoglobin level before beginning intensive therapy and have a low glycated hemoglobin reading during therapy or if you have a history of hypoglycemia

 

WHAT YOU SHOULD DO

Make sure you know the warning signs and symptoms of a hypoglycemic episode and know what blood glucose level triggers these symptoms for you. Be especially careful during exercise and physical activity. Even a routine activity such as household chores or climbing stairs may cause blood glucose levels to drop. Any vigorous exercise could provoke hypoglycemia for as long as 12-24 hours after exercising. Talk to your doctor about how you might modify your current program to incorporate both routine and vigorous activities.

 

If you are under intensive therapy, make sure you test your blood glucose more frequently. In addition to testing four times a day, as recommended, also test 2 hours after eating. 

If your blood glucose level is under 100mg/dl, you have a higher than usual chance of developing hypoglycemia before your next meal and may need an additional snack. If you are under intensive therapy and have experienced repeated episodes of hypoglycemia, test your blood glucose before driving an automobile

 

 

PREVENTION OF HYPOGLYCEMIA

Whenever you develop hypoglycemia, try to figure out what happened. Did you just engage in sexual activity? Did you skip part of your meal because it was too salty? Did you swim a few extra laps in the pool or end up vacumming the whole house because your teenager neglected his chores? 

 

Thinks about what events could have precipitated the attack and make not of it. If you exercised a little more, you may need to eat a little more or alter the timing of your insulin. If your schedule changes, you may need to test more often and make adjustments in insulin doses or timing or in what you eat. By becoming aware of what activities and actions trigger hypoglycemia, you can prevent it from happening in the future. Make sure to go over your plan with your health care team

 

Sources and References

• The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

 

• Hypoglycemia in Diabetes Mellitus by Barbara Freeland

 

• Hypoglycemia by Javier Morales and Doron Schneider