low sugar flare ups

Overview

A low sugar flare-up, also called hypoglycemia (say: HY-po-gly-SEE-mee-uh), is when the level of glucose (sugar) in your blood drops lower than normal. Glucose is the main fuel for your body and brain, so when it gets too low, you may feel shaky, sweaty, confused, or faint. It often happens in people who take certain diabetes medicines, but it can also happen to people without diabetes.

Yes. Low sugar episodes are common, especially among people with diabetes who use insulin or certain other glucose-lowering medicines. They can also affect people without diabetes, although this is less common.

Most often, it affects people with diabetes (type 1 or type 2) who take medication to lower blood sugar. It can also happen to people without diabetes, sometimes after a meal (reactive hypoglycemia) or after long periods without eating.

Symptoms

Common symptoms

• Shakiness or trembling
• Sweating
• Feeling anxious or irritable
• Dizziness or light-headedness
• Hunger
• Fast heartbeat
• Headache
• Difficulty concentrating
• Paleness

Symptoms in children

• Tiredness or unusual weakness
• Irritability or tantrums
• Crying or low mood
• Blurred vision
• Difficulty speaking or concentrating
• Clumsiness or unsteady walking

Symptoms in older adults

• Confusion or disorientation
• Dizziness and falls
• Changes in behaviour
• Sleepiness during the day
• Nightmares or restless sleep
• Slurred speech

Causes

Main causes

• Taking too much diabetes medication or insulin
• Skipping or delaying a meal
• Eating less than usual
• Exercising more than usual
• Drinking alcohol (especially on an empty stomach)
• Long periods without food

Risk factors

• Have diabetes (especially taking insulin)
• Take certain diabetes medicines
• Are older
• Have kidney or liver problems
• Have had low sugar before
• Drink alcohol heavily
• Exercise without adjusting food or medication

When to see a doctor

See a doctor urgently if:

• If you have repeated low sugar episodes, even after treatment
• If you have symptoms that do not get better after eating or drinking sugary food
• If you are unable to keep foods or drinks down

Book a routine appointment if:

• If you have new or unusual symptoms that could be low sugar
• If you are adjusting diabetes medications and want guidance
• If you experience low sugar without a clear cause

Diagnosis

A doctor will ask about your symptoms and may test your blood sugar during a symptom episode. You may also be asked to keep a diary of your symptoms and blood sugar readings.

Tests that may be done

• Blood glucose test (finger-prick or lab blood test) to check sugar levels
• A test called a 'mixed-meal tolerance test' or a prolonged fasting test if the cause is unclear
• Review of your medicines and eating patterns

What to expect at your appointment

Your doctor will probably refer you to an endocrinologist (a specialist in hormones and metabolism) if the diagnosis is unclear or you have difficult-to-control episodes.

Treatment

The main goal is to bring your blood sugar back to a safe level quickly and prevent future episodes. For most people, eating or drinking a fast-acting carbohydrate works. Long-term treatment focuses on adjusting your diabetes medicines, meals, and daily routine to reduce the risk of low sugar.

Self-care at home

• Keep a supply of fast-acting carbohydrates (like glucose tablets, fruit juice, or regular soda) nearby
• Check your blood sugar as recommended by your healthcare team
• Wear a medical ID bracelet that says you have diabetes or are prone to low sugar
• Teach friends and family what to do if you have a severe episode

Medical treatments

Your doctor may adjust the medicines that lower blood sugar, such as changing the dose or type of insulin or tablets. They may also advise on using a continuous glucose monitor to spot drops early. Never change your medicines without talking to your doctor.

When is surgery considered?

Surgery is not used to treat low sugar flare-ups.

Living with this condition

Living with low sugar means learning to spot the early signs and always having a quick snack available. It can also mean planning meals and snacks to avoid long gaps without food. Many people find it helpful to tell close friends and colleagues what to look out for.

Lifestyle tips

• Eat regular meals and snacks as advised
• Limit alcohol, especially on an empty stomach
• Keep a routine around exercise and rest
• Wear a medical ID and tell people how to help you

Diet and exercise

Think of food as your fuel. Eating a balance of carbohydrates, protein, and healthy fats can help keep your blood sugar steadier. Exercise is good, but you may need to adjust your food or medication around it. Ask your doctor or dietitian for a plan that works for you.

Mental health and emotional wellbeing

Dealing with low sugar episodes can make you feel anxious or stressed. It is normal to worry about having a bad episode. If these feelings are affecting your daily life, please talk to your doctor or a mental health professional. If you ever feel overwhelmed or have thoughts of self-harm, please contact a crisis support service in your area or go to your nearest emergency department.

Prevention

You can greatly reduce the risk of low sugar flare-ups. The key is to match your food, activity, and medication. Regular blood sugar checks and working closely with your healthcare team are the best ways to prevent them.

Vaccines

There is no vaccine for low sugar.

Screening programmes

If you have diabetes, your doctor should check your blood sugar regularly. If you do not have diabetes but suspect low sugar, your doctor can arrange a blood test to measure your sugar during symptoms.

Complications

If left untreated

• Severe confusion or unconsciousness
• Seizures
• Injuries from falls or accidents during a low sugar episode
• Damage to the brain in very rare cases, if low sugar is prolonged and severe

Long-term outlook

For most people, low sugar flare-ups can be managed well with the right plan. You can continue to lead a full and active life. The key is to work with your healthcare team to find a routine that works for you and to always be prepared.

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