Low Blood Sugar in Adults: Common Symptoms and Effective Management

March 20, 2024

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Blood sugar levels are tightly regulated in the body, but when glucose concentrations fall too low, it causes the condition known as hypoglycemia or “low blood sugar.” For adults, hypoglycemia occurs when blood sugar drops under 70 mg/dL, triggering an array of symptoms that can progress from uncomfortable to severe if left untreated.

Although low blood glucose most frequently affects adults with diabetes, it can occasionally impact those without the disease as well. Understanding the common warning signs of dropping sugar levels empowers patients to take swift action to resolve hypoglycemic episodes before they escalate or cause impairment. Catching and addressing mild lows promptly is also key to avoiding medication adjustments that increase health risks.

How Hypoglycemia Develops

Glucose acts as the prime energy source for cells. A number of hormones work continuously behind the scenes to keep blood sugar levels stable. If concentrations slide too low, sensors trigger key responses designed to normalize glucose:

  • Pancreatic alpha cells release glucagon, which directs the liver to pump out stored glycogen to raise blood sugar
  • Pituitary gland secretes growth hormone to free up energy from fat and muscle tissue
  • The sympathetic nerves activate adrenaline secretion, making glucose more available to cells through mechanisms like breakdown of liver glycogen

In a normal individual, this regulated feedback loop swiftly brings low blood glucose back up again. But for some adults, dysregulation in these control mechanisms can lead to recurring hypoglycemic episodes:

Diabetes Medication Effects

The most common cause of low blood sugar is overmedication for diabetes, particularly among insulin users. Injecting too much rapid-acting insulin relative to food intake and activity levels frequently results in lows 2-4 hours later as cells absorb glucose faster than the liver can replenish it.

Long-acting basal insulin peaks can also lead to falling overnight glucose levels. Secretagogues like sulfonylureas that spur insulin output likewise raise hypoglycemia risk.

Impaired Glucose Counterregulation

Repeated severe low blood sugar blunts the glucagon and epinephrine response essential to reverse hypoglycemia. This impaired awareness and risk for recurrent lows is most prevalent in type 1 diabetes patients, but a fraction of type 2 diabetics face progressively worsening glucose counterregulation as well.

Medication Side Effects

Beyond diabetes pharmaceuticals, numerous prescription drugs lists hypoglycemia as a potential adverse effect including antibiotic fluoroquinolones, pentamidine used to treat infections, antimalarials like quinine, and some anticancer agents. Over-the-counter medicines like salicylates found in some pain relievers and anti-inflammatories can also provoke low blood sugar in sensitive individuals.

Critical Illness

Sepsis, trauma, malnutrition, alcoholism, liver or kidney dysfunction, and enzymes deficiencies that disrupt carbohydrate metabolism rarely trigger transient low blood glucose unrelated to diabetes medication use.

Reactive Hypoglycemia

A small subset of adults suffers postprandial reactive hypoglycemia, characterized by abrupt glucose crashes following meals rich in refined carbs. This stems from excessive insulin secreted in response to rapidly absorbed simple sugars that drives levels down within a few hours after eating.

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Red Flag Warning Signs of Hypoglycemia

Catching declining blood sugar early makes treatment easier. Left unaddressed, progressively lower glucose sparks neurological and cardiovascular effects. Being attuned to common symptoms empowers patients and caregivers to intervene at the initial manifestation of potential hypoglycemia rather than when more disruptive indicators appear.

Mild to moderate low blood sugar patterns typically emerge between 60-70 mg/dL readings:

  • Nervousness, anxiety, irritability
  • Shakiness, tremors
  • Sweating, clammy skin
  • Hunger, nausea
  • Fast heartbeat
  • Headache
  • Difficulty concentrating, confusion
  • Weakness, fatigue, dizziness

More severe manifestations below 50 mg/dL include:

  • Blurry vision, double vision
  • Slurred speech
  • Loss of coordination, unsteady gait
  • Personality changes, combative behavior
  • Seizures
  • Unconsciousness

The adrenergic fight-or-flight response accounts for many early symptoms wired to mobilize glucose to reverse the low. Cognitive impacts reflect the brain’s exceptional sensitivity to declining fuel supply. Prompt intake of fast-acting carbohydrates curtails progression to more extreme manifestations.

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Risk Factors Influencing Susceptibility

While many factors outside patients’ control raise odds of low blood sugar, understanding individual risk profiles allows customizing prevention approaches. Key considerations include:

Diabetes and Medications

  • Longstanding insulin-dependent diabetes
  • High/increasing diabetes medication doses
  • Tight glycemic control regimens
  • Impaired awareness of hypoglycemia
  • Recent medication changes

Lifestyle and Health Status

  • Inconsistent meal timing
  • Delaying/missing meals
  • Increased exercise without adjustment
  • Excess alcohol intake
  • Advanced age
  • Impaired kidney or liver function
  • Adrenal insufficiency

Ongoing Medical Issues

  • Recurrent hypoglycemia episodes
  • Gastroparesis complicating diabetes
  • Malnutrition, vitamin deficiencies
  • SARS-CoV-2 infection
  • Anorexia, bulimia, bariatric surgery

Adjusting modifiable contributors to low blood sugar through steps like setting reminder alarms for meals, carrying glucose tabs when exercising, limiting alcohol, and coordinating care for health conditions reduces avoidable risk.

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Testing Blood Glucose to Confirm Hypoglycemia

Manifesting any of the hypoglycemic warning signs described necessitates promptly checking blood sugar levels to determine if glucose concentrations truly warrant intervention. While symptoms provide clues to likelihood of low blood glucose, confirmation via glucose monitoring reduces guessing and inappropriate intake of rapid carbohydrates when alternative explanations exist for someone’s distress.

Available options to measure current blood sugar levels include:

  • Glucometers: Provide immediate numerical blood glucose readings with a finger stick.
  • Continuous glucose monitors: Interstitial fluid sensors worn on the arm or abdomen detect dropping/low glucose levels.
  • Flash glucose monitors: On-demand non-fingerstick blood sugar scans.

Urgent low blood sugar treatment decisions hinge on verifying a glucose level under 70 mg/dL on one of these devices. Anything in the normal range above this threshold suggests symptoms stem from another cause requiring different management.

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Appropriate Treatment Procedures

Upon documentation of a low blood sugar reading, established medical protocols advise immediately consuming fast-acting carbohydrates to resolve the hypoglycemia. Key steps include:

  1. Ingest 15 grams of rapid sugars: Fruit juice, regular soda, glucose tabs/gel or hard candies all work quickly. Honey, sugar packets or icing also suffice in a pinch.
  2. Recheck glucose after 15 minutes: If still under 70 mg/dL, consume another 15 grams of fast carbohydrates and retest again until levels normalize.
  3. Eat a balanced snack with protein/complex carbs: Once glucose returns to normal, eating or drinking 15-30 grams of balanced nutrition helps sustain appropriate glucose concentrations and prevent rebound low blood sugar.

During a severe hypoglycemic emergency with profound neuroglycopenic symptoms like seizures or unconsciousness, glucagon injection represents the appropriate crisis treatment approach to rapidly reverse low blood glucose when the individual can’t quickly swallow sugary solutions.

Preventative Tactics to Avoid Hypoglycemia

While timely hypoglycemia treatment saves health and lives during acute episodes, the ultimate goal focuses on avoiding low blood sugar in the first place through preventative and supportive self-care:

Medication Adjustments

  • More frequent blood glucose testing around activity and meals identifies patterns requiring medication changes.
  • Basal insulin modifications prevent overnight hypoglycemia.
  • New generation insulins reduce risk.

Lifestyle Modifications

  • Eating regularly spaced smaller meals every 3-4 hours
  • Not delaying or skipping meals
  • Carrying emergency glucose sources
  • Adding protein, fiber and fat to meals
  • Drinking alcohol cautiously
  • Coordinating medication/food with exercise

Wellness Support

  • Getting adequate restful sleep
  • Employing healthy coping methods that reduce anxiety
  • Seeking treatment for disordered eating patterns or eating disorders
  • Optimizing vitamin and mineral status

While the possibility of occasional low blood sugar episodes persists for many adults even with reasonable precautions, feeling empowered to catch and treat hypoglycemia promptly combined with diligent day-to-day risk reduction behaviors offers the best protection against both transient and enduring health consequences.

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Potential Complications of Recurrent Hypoglycemia

Research confirms repeated low blood glucose incidences threaten physical health and quality of life for adults via mechanisms including:

Cardiovascular Impacts

  • Heart rhythm abnormalities
  • Reduced blood flow to the heart
  • Increased clotting risk raising chances of heart attack and stroke
  • Poor blood pressure regulation
  • Accelerated atherosclerosis

Neurological Effects

  • Cognitive dysfunction
  • Motor impairment similar to functional neurologic disorders
  • Increased dementia risk
  • Seizures
  • Anxiety, depression and reduced well-being

Metabolic Disruption

  • Insulin resistance promoting higher blood sugars
  • Postprandial hyperglycemia
  • Dyslipidemia
  • Liver injury

Behavioural Changes

  • Defensive eating of excess calories trying to avoid lows
  • Activity avoidance due to hypoglycemia fear
  • Diabetes burnout

While most consequences resolve with blood glucose stabilization, some effects appear lasting. Minimizing low blood sugar events protects health as much as rapid corrective treatment during inevitable occasional episodes.

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Special Considerations for Older Adults

Progressive loss of physiological and cognitive reserves with aging raises risks related to managing low blood sugar. Older adults face amplified threats of emergency scenarios, long-term organ damage and physical injury stemming from falling during disorientation. Adding to risks:

  • Natural decline in kidney filtration enabling longer-lasting medication effects
  • Increased medication use for multiple conditions
  • Cognitive troubles noticing or reporting symptoms
  • Mobility issues delaying self-treatment
  • Loss of thirst reflex and hunger cues
  • Social isolation or living alone limiting external support

Proactive prevention measures take on expanded importance in this population given poorer prognoses should dangerous hypoglycemia occur unattended. Adapting the treatment environment, encouraging hypoglycemia education among family/friends providing caregiving support, setting clear emergency protocols and ensuring access to rapid sugar sources offer safeguards that supplement clinical guidance on diet, physical activity and medication adjustments tailored to this group.

Frequently Asked Questions

How do I recognize low blood sugar coming on?

Classic initial cues include shakiness, headache, sudden hunger, anxiety/irritability, fatigue, fast heartbeat, and trouble concentrating. Paying attention to subtle bodily sensations or mood changes provides early warning to intervene when glucose starts trending down before more disruptive symptoms like blurry vision or loss of coordination appear.

If I feel hypoglycemic should I check or just treat?

Always confirm suspected low blood sugars with a glucose meter or continuous monitor before treating to ensure symptoms indeed stem from hypoglycemia requiring rapid intervention. Common mimics like caffeine withdrawal or stress may better explain someone’s experience. Accurately identifying and addressing the true underlying cause means better health outcomes.

What food can I grab quickly to correct low blood sugar?

Fast-acting carbohydrates that reliably and quickly raise blood glucose include 4-6 ounces fruit juice, non-diet soda, 2 tablespoons honey, 5-6 hard candies, 3-4 glucose tablets or a tube of cake decorating gel. Candy bars work but aren’t preferred due to their fat content slowing absorption.

How often can you have low blood sugar without long term issues?

Evidence links impaired awareness of hypoglycemia and reduced hormonal counterregulation to recent antecedent episodes. Any single moderate event likely causes negligible lasting harm, but recurrent drops potentially recalibrate glucose thresholds or neuro-signalling pathways regulating hormones that stabilize levels. Minimizing frequent lows protects future health.

Why is low blood sugar worse at night?

Circadian mismatches with insulin activity peaks put many at increased overnight hypoglycemia risk. Liver contribution to glucose maintenance declines during sleep and nocturnal pituitary growth hormone secretion preferentially taps fat rather than glycogen for fuel. Delayed awakening or impaired sleep blunts restorative glucagon and epinephrine secretion. Overall, the body works against itself resulting in more extreme and prolonged lows.

In Conclusion: Key Takeaways

While effectively treating low blood sugar comprises an essential self-care skill for many adults with diabetes, preventing hypoglycemia should be the ultimate goal. This requires expanding knowledge to recognize personal risk factors, subtle symptom cues and appropriate acute treatment procedures. Making informed medication, nutrition and lifestyle adjustments further empowers patients to maintain safe blood glucose ranges day and night while supporting overall wellness. Combining vigilance, self-advocacy and self-care offers the best protection against both transient hypoglycemia episodes and enduring harms from this dangerous condition.

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