Blood glucose goes up and down in a small range throughout the day. In people with diabetes, the range can be much wider. It is important to understand the fine balance between treating the high sugars and avoiding the low sugars.

If you have diabetes and take certain diabetes drugs like insulin, you may experience low blood sugar (hypoglycemia) sometimes. Hypoglycemia is blood sugar less than 70 mg/dL. However, some people have symptoms of low blood sugar even at higher blood sugar levels. This can happen when blood sugar is dropping too quickly or if the person has had very high blood sugar for a long time.

Even mild hypoglycemia symptoms are difficult on your body and emotions. By learning more about the signs and causes of low blood sugar, you can take steps to keep it from happening again. Frequent low blood sugars are serious, because the body becomes less able to show the warning signals of low blood sugar.

Causes and symptoms of low blood sugar

Low blood sugar is usually caused by eating less or later than usual, changing your physical activity or taking a diabetes medicine that is not right for your needs. Even mistakes in dosing can lead to hypoglycemia. For example, you could mistake one insulin for another or forget that you had already taken your diabetes pills. Common symptoms of low blood sugar are:

•             Feeling dizzy or lightheaded

•             Feeling nervous, anxious or irritated

•             Having a fast heart beat

•             Sweating or having clammy skin

•             Feeling tired or confused

•             Having a headache

What to do to prevent low blood sugar

If you think you have any low blood sugar symptoms, check your blood sugar right away. If your blood sugar is less than 3.0 mmol/L (or below the level set by your doctor) take one of the following right away (15 grams of carbohydrates).

•             3-4 glucose tablets (4-5 grams of glucose each)

•             Half cup of fruit juice

•             One tablespoon of sugar, jam or honey

•             7-8 candies

If you feel your blood sugar is low and you cannot test it, take one of the above anyway. It is better to be safe than sorry. After treating your low blood sugar, wait for 15 minutes then test your blood sugar again. If it is still low, eat or drink another 15 grams of carbohydrates. Waiting to treat low blood sugar is not safe. Not treating symptoms quickly can cause you to faint and lose consciousness, which would then require emergency treatment.

How to avoid low blood sugar

•             Stay close to your schedule of eating, activity and medication

•             Don't skip meals

•             Carry snacks and carbohydrates that have sugar so you can treat low blood sugar levels any time

•             Test your blood sugar on schedule and anytime you feel different

•             Carry identification: a bracelet, necklace, or ankle bracelet that has a medical alert message stating that you are taking diabetes medication

Why worry about hypoglycemia?

Clearly the symptoms of hypo-glycemia are unpleasant and can continue for hours even after the low blood sugar returns to normal levels. If severely low blood sugar is untreated, seizures, coma or even death can occur.

New evidence shows that hypoglycemia can include changes in heart rhythm and electrical problems in the heart. Heart attacks can occur later in life in people with diabetes-associated nerve function loss. Should you then give up on controlling your blood sugar? No, but discuss your blood sugar goals with your doctor to decide what blood sugar targets are the best and safest for you.

The writer is an Assistant Professor of Endocrinology Department at Bangabandhu Sheikh Mujib Medical University.

Email: selimshahjada@gmail.com