Causes of Severe Low Blood Sugar

Causes of Severe Low Blood Sugar

Understanding the Risk of Severe Low Blood Sugar

00:07 – 00:08 Hello.

00:08 – 00:11 Thanks for joining me for Severe Low Blood Sugar Basics.

00:12 – 00:14 Life is a journey and so much of it happens

00:14 – 00:16 while we are busy making other plans.

00:16 – 00:19 And as much as we would like, we can’t plan for everything.

00:20 – 00:23 Sometimes, even when people with diabetes are taking steps

00:23 – 00:25 to prevent severe low blood sugar

00:26 – 00:29 life can still get in the way.

00:30 – 00:32 A1C is a blood test

00:32 – 00:34 that measures average blood sugar over the past 3 months.

00:35 – 00:39 Because A1C doesn’t look at how your blood sugar levels vary from hour to hour,

00:39 – 00:42 or from day to day, you may still be at risk

00:42 – 00:46 for severe low blood sugar, regardless of your A1C level.

00:47 – 00:49 Now, let’s talk about

00:49 – 00:51 some of the causes of severe low blood sugar.

00:52 – 00:56 In one study, people with diabetes who take insulin reported

00:56 – 00:58 a range of everyday circumstances that

00:58 – 01:00 can lead to low blood sugar emergencies.

01:00 – 01:03 These include not eating enough food,

01:03 – 01:05 unexpected or unusual physical activity,

01:06 – 01:08 taking the wrong amount of insulin,

01:08 – 01:10 situations that cause stress,

01:10 – 01:12 changing blood sugar levels,

01:12 – 01:16 and not noticing signs or symptoms of low blood sugar.

01:17 – 01:21 A severe low blood sugar emergency could happen anytime, and anywhere.

01:23 – 01:26 So, people with diabetes should be prepared with an emergency plan,

01:26 – 01:28 just in case.

01:29 – 01:31 Things to remember.

01:31 – 01:36 One, you may be at risk for severe low blood sugar, regardless of your A1C level.

01:36 – 01:41 Two, a range of everyday circumstances can lead to low blood sugar emergencies.

01:41 – 01:44 Three, be prepared with an emergency plan

01:44 – 01:46 just in case.

01:48 – 01:50 Thank you for joining us for Severe Low Blood Sugar Basics.

Why Might I Experience Low Blood Sugar?

00:00 – 00:21 Speaker 1: Most patients with diabetes will experience an episode of severe hypoglycemia, and there’s absolutely no shame in having hypoglycemia. It’s a really common event that your health care providers really want to know about, because the best way for us to help patients with hypoglycemia is to know about hypoglycemia.

00:22 – 00:52 Speaker 2: It’s not that unusual to have fairly mild hypoglycemia in everyday treatment and those symptoms are both mild and easily treated. But as I’ve said, if that isn’t dealt with, then your glucose levels can go very low. And that can make you unconscious. And we’ll talk a bit about those those effects as we go on. So what I want to do is to frame that risk.

00:53 – 01:24 Speaker 2: On average, you might expect during care where you’re achieving glucose levels close to target, but you might be feeling low maybe once or twice a week. That is to be expected. And for many, it’s easily treated, but more severe events, which we define as needing the help of another person for recovery because they are incapacitated and is much rarer.

01:24 – 01:50 Speaker 1: Some common causes of hypoglycemia are medications that we use to treat diabetes. Changes in the diet. Changes in activity or exercise regimen, even good changes that we as health care providers might encourage you to make sometimes can drop the blood sugar a little too low. So, for example, I sometimes will have patients say “Hey Doc, you told me to increase my exercise regimen.

01:50 – 01:55 Speaker 1: You told me to cut down on my carbohydrates and my sugars, and then I got a hypoglycemic episode!”

01:55 – 02:14 Speaker 3: It’s really important to just know how your medication are affecting you. I talk a lot about insulin, but other diabetes drugs can cause low blood sugars, too. So if you have Type 2 Diabetes, it’s definitely worth talking to a provider about, you know, certain medications that might cause hypoglycemia. Can I come off of them or limit them?

02:14 – 02:38 Speaker 3: But then if you’re on insulin, the chances are you probably need insulin And it’s just really important to know how to match your instance of what you’re eating, taking your insulin before you eat, not overcorrecting for high blood sugars. There’s a lot that goes into learning how to take insulin. It’s it’s a complicated medication that you have to be a master of knowing how it works, when to take it, how to match it with food.

02:38 – 02:52 Speaker 3: And that takes a lot of time and education. So if patients aren’t getting it right away and they really need to kind of commit with working with their provider, finding educational resources to know how this is affecting their body to avoid these low blood sugars.

02:53 – 03:16 Speaker 4: You don’t need to be afraid of low blood sugar too much. If you learn about low blood sugar and take right actions to prevent and prepare, you can cope with it so don’t need to worry so much. I hope you will learn how to appropriately manage and prepare for low blood sugar and have a full life.

Group 2

Did You Know?

Having one single low blood sugar event increases your risk of having a severe low blood sugar event in the future.

What Causes Severe Low Blood Sugar?

You may have a severe low blood sugar event for several reasons, and many of them are out of your control. But understanding why a severe low blood sugar event may happen in the first place can help you feel more in control—and potentially help you recognize low blood sugar before it becomes severe. Some common causes of severe low blood sugar include:

Taking too much medicine or taking the wrong medicine

Missing a meal or not being able to eat enough

Medicine that may increase the risk of low blood sugar (for example, insulin, glimepiride, or glipizide)

Exercising vigorously or for a long time

Eating foods that are high in fat and low in carbohydrates

Drinking alcohol

CGM* readings that are not accurate

Other medical conditions (for example, kidney disease)

*CGM=continuous glucose monitor

Group 2

Did You Know?

Most people with diabetes feel symptoms, such as sweating or anxiety, when they have low blood sugar. Others have difficulty noticing as they do not feel any symptoms, so they don’t know they need to treat it. This is known as “hypoglycemia unawareness” or “impaired hypoglycemia awareness.”

Hypoglycemia unawareness puts the person at higher risk for severe low blood sugar. People with hypoglycemia unawareness need to take extra care to check blood sugar frequently, especially before and during critical tasks such as driving.

To learn more, speak to your healthcare providers and they can help!

Learning About Your Own Low Blood Sugar Events

A nurse showing a lady results on a tablet

If you’re having low or severe low blood sugar events, but you don’t know the reasons, try the tips below. They may help you learn more about what’s causing your low blood sugar.

Keep a logbook (hand written or electronic) every day, or as often as you can. You can write down your:

  • Blood sugar levels
  • Medicines you take
  • How often and how much you exercise
  • Foods you eat and alcohol you drink

Think about your previous low or severe low blood sugar events. Write down any early warning signs or symptoms you noticed. Also, write down any changes in your daily activities around the time of low blood sugar events.

Discuss your logbook, and CGM data if available, with your healthcare provider. They may be able to
help you see trends related to your low blood sugar events.

Group 2

Did You Know?

A higher A1C level does not protect you from severe low blood sugar. A1C is a blood test that measures your average blood sugar over the past 3 months. Because A1C doesn’t look at how your blood sugar levels vary from hour to hour, or from day to day, you may still be at risk for severe low blood sugar, regardless of your A1C level.

Blood sugar traces of two people with the same A1C of 8.0%

Review Your Knowledge

Learn More About Severe Low Blood Sugar Below

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  2. EASD 2021 (European Association for the Study of Diabetes), September 27-October 1, 2021; Virtual; Day #2 Highlights.
  3. Kedia N. Diabetes Metab Syndr Obes. 2011;4:337-346.
  4. Lammert M, et al. J Med Econ. 2009;12(4):269-280.
  5. American Diabetes Association. Diabetes Care. 2021;44(1):S73-S84.
  6. Lipska KJ, et al. Diabetes Care. 2013;36(11):3535-3542.
  7. Frier BM. Nat Rev Endocrinol. 2014;10(12):711-722.
  8. Kovatchev B, et al. Diabetes Care. 2016;39:502-510.
  9. American Diabetes Association. Hypoglycemia (low blood sugar). Accessed November 1, 2021.
  10. Cox DJ, et al. Diabetes Spectr. 2006;19(1):43-49