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	'''Hypoglycaemia''', also called a '''hypo''' or '''low blood sugar''', is an abnormally low level of glucose in the blood. NHS inform describes hypoglycaemia as a blood glucose level below 4 mmol/L.

Hypoglycemia, also known as low blood sugar, is a condition characterized by an abnormally low level of glucose in the blood. It most commonly occurs as a complication of diabetes treatment, but can also affect individuals without diabetes. Hypoglycemia requires prompt recognition and treatment to prevent complications.
	It is most often discussed in relation to diabetes treatment, especially insulin and some tablets that increase insulin release. It can also occur in people without diabetes, but this is much less common and usually needs investigation for an underlying cause.

== Symptoms ==	== Symptoms ==
The symptoms of hypoglycemia can vary among individuals and may include:
	Symptoms vary, but common warning signs include:

* Shakiness: Tremors or shakiness, particularly in the hands.
* Sweating: Excessive sweating, even when the surrounding temperature is not warm.
* Hunger: Increased appetite or a feeling of intense hunger.
* Dizziness and lightheadedness: Feeling dizzy or lightheaded, potentially leading to loss of balance.
* Confusion: Difficulty concentrating, confusion, or difficulty speaking.
* Irritability: Sudden mood changes, irritability, or aggressiveness.
* Weakness and Fatigue: Weakness, fatigue, or lack of energy.
* Headache: Headache or migraine-like symptoms.
* Blurred Vision: Blurred or impaired vision.
* Palpitations: Rapid heartbeat or palpitations.
	* Hunger.
	* Sweating.
	* Trembling or shakiness.
	* Dizziness.
	* Tiredness.
	* Blurred vision.
	* Fast pulse or palpitations.
	* Tingling lips.
	* Irritability or anxiety.
	* Difficulty concentrating.
	* Confusion.

== Causes ==
Hypoglycemia can occur due to various reasons, including:
	Severe hypoglycaemia can cause drowsiness, seizures, collapse, or loss of consciousness. Some people, especially those who have had diabetes for a long time, may lose their early warning symptoms. This is known as impaired awareness of hypoglycaemia.

* Diabetes Treatment: Most commonly, hypoglycemia is a side effect of diabetes medications, such as insulin or certain oral antidiabetic drugs, that lower blood sugar levels.
* Excessive Insulin Production: Rare tumors, called insulinomas, in the pancreas can produce excessive amounts of insulin, leading to hypoglycemia.
* Hormonal Imbalances: Certain hormonal deficiencies or excesses, such as adrenal insufficiency or growth hormone deficiency, can disrupt glucose regulation and cause hypoglycemia.
* Liver Disorders: Liver diseases impair the organ's ability to store and release glucose, potentially resulting in low blood sugar.
* Alcohol Consumption: Drinking alcohol, particularly on an empty stomach or in excess, can interfere with liver function and cause hypoglycemia.
	== Causes in Diabetes ==
	In people with diabetes, hypoglycaemia is usually linked to the balance between medicine, food, exercise, and alcohol. Causes include:

== Diagnosis ==
Diagnosing hypoglycemia involves evaluating symptoms, measuring blood glucose levels, and identifying potential underlying causes. Diagnostic methods may include:
	* Taking too much insulin for the amount of carbohydrate eaten.
	* Taking sulphonylurea or similar medication that increases insulin release.
	* Missing or delaying a meal.
	* Eating less carbohydrate than planned.
	* Exercising more than expected.
	* Drinking alcohol, especially without food.
	* Changes in injection site absorption.
	* Illness, weight change, or changes to routine.

* Symptom Assessment: Evaluating the presence and severity of symptoms suggestive of hypoglycemia.
* Blood Glucose Measurement: Checking blood glucose levels using a glucose meter. A reading below the normal range (typically below 70 mg/dL or 3.9 mmol/L) indicates hypoglycemia.
* Fasting Test: Conducting a supervised fast to assess blood glucose levels and evaluate for reactive hypoglycemia.
* Glycated Hemoglobin (HbA1c) Test: Measuring average blood glucose levels over the past two to three months to assess long-term glucose control in individuals with diabetes.
	The same glucose number may affect people differently, so diabetes teams often give individual advice on targets and prevention.

== Treatment ==
The primary goal of treating hypoglycemia is to promptly raise blood sugar levels to alleviate symptoms and prevent complications. Treatment methods may include:
	== Causes Without Diabetes ==
	Hypoglycaemia without diabetes is uncommon. Possible causes include prolonged fasting, malnutrition, heavy alcohol intake, severe liver or kidney disease, adrenal insufficiency, some medicines, previous gastric surgery, and rare insulin-producing tumours.

* Carbohydrate Consumption: Consuming a rapidly absorbed source of carbohydrates, such as glucose tablets, fruit juice, or candy, to raise blood sugar levels quickly.
* Glucagon Administration: In severe cases or if the individual is unconscious, an emergency glucagon injection may be necessary to raise blood sugar levels.
* Adjusting Medications: In individuals with diabetes, modifying diabetes treatment plans, such as adjusting insulin doses or switching medications, to minimize the risk of hypoglycemia.
* Identifying and Managing Underlying Causes: Addressing any underlying conditions or medications that contribute to hypoglycemia.
* Regular Blood Glucose Monitoring: Monitoring blood sugar levels regularly, particularly in individuals with diabetes, to prevent recurrent hypoglycemic episodes.
	Because the cause may be unclear, repeated episodes in someone without diabetes should be assessed clinically.

== Complications ==
If left untreated, hypoglycemia can lead to serious complications, including:
	== Immediate Treatment ==
	Mild hypoglycaemia is usually treated with fast-acting carbohydrate. NHS inform gives examples such as dextrose tablets, fruit juice, or a non-diet soft drink. A common adult treatment amount is about 15 to 20 g of rapidly acting carbohydrate, followed by rechecking glucose after about 15 minutes where testing is available.

* Seizures: Prolonged or severe hypoglycemia can cause seizures or convulsions.
* Loss of Consciousness: Hypoglycemia can result in loss of consciousness, requiring immediate medical attention.
* Impaired Cognitive Function: Recurrent episodes of hypoglycemia may impair cognitive function and impact daily activities.
* Accidents: Hypoglycemia can lead to accidents or falls, especially while driving or operating machinery.
* Worsening of Underlying Conditions: Hypoglycemia can exacerbate underlying health conditions, particularly cardiovascular diseases.
	After glucose has recovered, a longer-acting carbohydrate may be needed, especially if the next meal is not due. Examples include a sandwich, biscuits, fruit, or a cereal bar.

	Chocolate is not usually the best first treatment because fat can slow sugar absorption.

	== Severe Hypoglycaemia ==
	If a person is drowsy, fitting, or unconscious, food or drink should not be put in their mouth because of choking risk. A trained person may give glucagon if it is available and prescribed. Emergency help is needed if glucagon is not available, no trained person is present, or the person does not recover promptly.

== Prevention ==	== Prevention ==
Preventing hypoglycemia involves:
	Prevention usually involves identifying patterns. Measures may include:

* Balanced Diabetes Management: Careful management of diabetes, including regular blood glucose monitoring, medication adjustments, and meal planning.
* Consistent Carbohydrate Intake: Maintaining consistent carbohydrate consumption throughout the day, particularly when using insulin or oral antidiabetic medications.
* Regular Meals and Snacks: Eating balanced meals and snacks at regular intervals to prevent prolonged periods without food.
* Alcohol Moderation: Limiting alcohol consumption and avoiding excessive drinking, particularly on an empty stomach.
* Education and Awareness: Learning to recognize early signs of hypoglycemia and understanding how to manage blood sugar levels effectively.
	* Regular blood glucose monitoring where advised.
	* Carrying rapid-acting carbohydrate.
	* Eating regular meals or snacks when needed.
	* Adjusting insulin or food around exercise.
	* Taking care with alcohol.
	* Reviewing medication after repeated hypos.
	* Teaching family, friends, or carers what to do in an emergency.

== See Also ==
	People who have frequent hypos, severe hypos, night-time hypos, or loss of warning symptoms should discuss this with their diabetes team.

* [[Type 1 Diabetes]] - Learn about a chronic autoimmune condition characterized by a lack of insulin production.
* [[Type 2 Diabetes]] - Explore a metabolic disorder characterized by insulin resistance and high blood sugar levels.
	== Driving ==
	Hypoglycaemia can impair concentration, reaction time, and consciousness. In the UK, drivers with diabetes treated with insulin or some glucose-lowering medicines may have legal duties to monitor glucose and inform the DVLA in defined circumstances. NHS inform advises people at risk to test before driving, test during longer journeys, avoid driving when glucose is low, and avoid driving for a period after treating a hypo.

	== References ==
	* [https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hypoglycaemia-low-blood-sugar/ NHS inform: Hypoglycaemia]
	* [https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Clinical%20Support%20Services/Dietetics/Diabetes%20-%20Low%20blood%20sugar%20%28hypoglycaemia%29.pdf University Hospitals Coventry and Warwickshire NHS Trust: Low blood sugar patient information]

	[[Category:Endocrinology]]
	[[Category:Diabetes]]
	[[Category:Medicine]]