Here’s a little story before we delve in;
Lucy was diagnosed with Type 2 Diabetes in 1998. One cold and rainy November night, she woke up feeling dizzy and sweaty at 2:00 am. This was strange, so she quickly thought to check her blood sugar. The result was 34 mg/dl/1.9mmol/L – a dangerous low level.
Lucy’s story is an example of hypoglycaemia in people living with diabetes.
To manage the situation, she took one tablet of glucose which helped to raise her blood sugar to 44mg/dl/2.4mmol/L after 15 minutes. Then she drank some apple juice that further raised her blood sugar to 90mg/dl/5.0mmol/L after another 15 minutes. She was able to go back to sleep without any more episodes.
What is Hypoglycaemia?
Hypoglycaemia, also known as low blood sugar, is a situation where the level of sugar in your blood drops below a certain range that is suitable for you. It is a complication that is often seen in people living with diabetes who are being treated with insulin, sulfonylurea, or glinide.
According to Bhagya Lakshmi, et al, in a global study of people living with diabetes who take insulin or oral hyperglycaemic agents, 4 out of 5 people living with type 1 diabetes reported an incidence of hypoglycaemia at least once in four weeks, and nearly half of people living with diabetes reported the same.
Generally, low blood sugar happens when the level of sugar in the blood falls below 70mg/dl (3.9mmol/L). For people without diabetes, low blood sugar level can be 55 mg/dL (3.1mmol/L).
The brain depends on a continuous supply of glucose to function properly. Unlike other organs, it has very limited ability to produce its own glucose. This is why hypoglycaemia can quickly progress from uncomfortable symptoms to a medical emergency if left untreated.
Symptoms and Causes of Hypoglycaemia
Hypoglycaemia symptoms can appear suddenly and vary depending on how low the blood sugar drops and how quickly it falls. They are generally grouped into early, moderate, and severe symptoms.
Early symptoms include shakiness or trembling, sweating (especially at night), a rapid or pounding heartbeat, hunger or nausea, anxiety or irritability, dizziness or light-headedness, and tingling or numbness in the lips, tongue, or cheeks.
Moderate symptoms occur as blood sugar continues to fall. These include difficulty concentrating, confusion or unusual behaviour, blurred vision, weakness and fatigue, slurred speech, and poor coordination.
Severe symptoms indicate a medical emergency and include seizures or convulsions, loss of consciousness, inability to eat or drink, and coma.
It is worth noting that hypoglycaemia can also occur during sleep. Signs of nocturnal hypoglycaemia include waking up with damp sheets or nightclothes from sweating, nightmares, and feeling tired, irritable, or confused upon waking.
One particularly dangerous condition is hypoglycaemia unawareness, which develops in people who experience frequent low blood sugar episodes. Over time, the body stops producing the usual warning symptoms, meaning blood sugar can drop to dangerous levels before the person even realises it.
Research shows that hypoglycaemia unawareness increases the risk of severe episodes by up to six times in people with Type 1 diabetes and up to seventeen times in people with Type 2 diabetes who take insulin.
Causes of Hypoglycaemia
Hypoglycaemia in diabetes typically occurs when there is an imbalance between medication, food intake, and physical activity. The most common causes include:
Medication-related causes: Taking too much insulin or a higher dose of sulfonylureas than needed, injecting insulin into muscle rather than fat tissue (which causes faster absorption), and timing insulin or oral medication incorrectly in relation to meals.
Diet-related causes: Skipping or delaying meals, eating significantly less carbohydrate than usual, and not eating enough before or after physical activity.
Activity-related causes: Exercising more intensely or for longer than usual without adjusting food intake or medication and engaging in physical activity without having eaten adequately beforehand.
Other contributing factors: Consuming alcohol, especially on an empty stomach (alcohol impairs the liver’s ability to release glucose), illness or infections that affect appetite and food intake, and changes in daily routine, travel, or stress levels.
Complications of Hypoglycaemia
Mild to moderate hypoglycaemia, when treated promptly, usually resolves without lasting harm. However, repeated or severe episodes can lead to serious complications.
Immediate complications of severe hypoglycaemia include seizures and convulsions, loss of consciousness, cardiac arrhythmias (irregular heartbeat), and in extreme cases, cardiac arrest or death.
Long-term complications of recurrent hypoglycaemia are equally concerning. These include cognitive impairment, as repeated severe episodes particularly those involving seizures have been associated with decline in memory, executive function, and overall cognitive performance. There is also an increased risk of cardiovascular events, as episodes of hypoglycaemia trigger stress hormones that can place strain on the heart. Perhaps most critically, recurrent episodes can lead to hypoglycaemia unawareness, a condition where the body stops producing warning symptoms, making future episodes more frequent and more dangerous.
There is also a significant psychological and quality-of-life impact. The fear of hypoglycaemia is one of the most common barriers to good blood glucose control. Many people living with diabetes intentionally keep their blood sugar higher than recommended to avoid the risk of going low, which paradoxically increases their risk of long-term diabetes complications such as nerve damage, kidney disease, and vision loss.
Hypoglycaemia also carries practical safety risks. Operating a vehicle or heavy machinery during an episode can result in accidents. An episode at work can impair performance and safety. Nocturnal episodes can disrupt sleep quality, leading to daytime fatigue and reduced quality of life.
Managing and Preventing Hypoglycaemia
The good news is that hypoglycaemia can be effectively managed when it occurs and, more importantly, many episodes can be prevented with the right strategies.
- Treating an episode (the 15-15 Rule): When blood sugar drops below 70 mg/dL (3.9 mmol/L), consume 15 to 20 grams of fast-acting carbohydrate immediately. Good options include glucose tablets, half a cup (120 ml) of fruit juice or regular soft drink, a tablespoon of honey or sugar. Wait 15 minutes, then recheck your blood sugar. If it is still below 70 mg/dL, repeat the process. Once blood sugar returns to a safe range, eat a small meal or snack to prevent it from dropping again. Lucy’s approach in our opening story, glucose tablets followed by apple juice is a textbook example of this method.
- For severe episodes: If the person is unconscious or unable to eat or drink, do not attempt to force food or liquid into their mouth. Administer glucagon if available (and if you have been trained to use it) and reach for emergency medical help immediately. It is important that family members and close contacts of people living with diabetes know how to recognise severe hypoglycaemia and how to respond.
Prevention strategies include monitoring blood sugar regularly using a reliable glucometer, eating meals and snacks at consistent times each day, adjusting food intake and medication when increasing physical activity, avoiding alcohol on an empty stomach, and carrying fast-acting carbohydrate at all times. It is also important to communicate with your healthcare team regularly, especially if you are experiencing frequent episodes, as your medication regimen may need to be adjusted.
Wearing a medical alert bracelet or card can also be lifesaving in situations where you are unable to communicate your condition to others.
Reliable Blood Glucose Monitoring with Accu-Chek Glucometers
Lucy’s story began with one critical action: she checked her blood sugar. That single step, reaching for her glucometer gave her the information she needed to act fast and prevent a medical emergency.
Regular blood glucose monitoring is one of the most important tools for preventing and managing hypoglycaemia. It allows you to detect falling blood sugar before symptoms become severe, make informed decisions about food, medication, and activity, identify patterns in your blood sugar readings over time, and share accurate data with your healthcare provider for better treatment decisions.
ISN Medical is the authorised distributor of Accu-Chek glucometers and test strips in Nigeria. Manufactured by Roche, Accu-Chek is one of the most trusted names in blood glucose monitoring worldwide, with over 220 test strips used every second globally.
The Accu-Chek Active is a reliable and easy-to-use meter that delivers accurate results in just 5 seconds. It features a large display, simple two-button navigation, stores up to 500 test results, and allows you to view your blood sugar averages over 7, 14, 30, or 90 days. It also offers pre- and post-meal flagging, a particularly useful feature for tracking how meals affect your blood sugar.
The Accu-Chek Instant takes convenience further with a colour-coded Target Range Indicator that shows at a glance whether your blood sugar is high, low, or within range. It also connects wirelessly via Bluetooth to the mySugr diabetes management app, which automatically logs your results on your smartphone and allows you to track trends, set reminders, and share reports with your healthcare team, all from the palm of your hand.
Both meters meet the ISO 15197:2013/EN ISO 15197:2015 standards of accuracy, ensuring that the readings you rely on to make daily health decisions are ones you can trust.
Living with diabetes requires daily vigilance, and a dependable glucometer is not just a device — it is peace of mind in your pocket.
Buy your Accu-Chek Meters here →
0913 938 5053 | 0800 225 5476 contact@isnmedical.com