Insulin is a hormone naturally produced by the pancreas that acts like a key, allowing glucose, or blood sugar, to move from the bloodstream into the body’s cells for energy. When individuals with diabetes use synthetic insulin or medications that stimulate insulin production, there is a risk of a dose being too potent for the amount of glucose available. This imbalance leads to a condition called hypoglycemia, defined as a dangerously low blood sugar level, typically falling below 70 milligrams per deciliter (mg/dL) for most people with diabetes.
Recognizing the Immediate Signs of Low Blood Sugar
The body responds quickly to this dip in its primary fuel source by releasing stress hormones like epinephrine, which trigger a set of noticeable physical reactions. These immediate signs serve as the body’s warning system, signaling the need for glucose to prevent further decline. Common physical symptoms include a sudden onset of shakiness or trembling, profuse sweating, and a noticeably rapid or irregular heart rate.
The brain, which relies almost exclusively on glucose for energy, begins to show signs of distress. Early cognitive symptoms include anxiety, unexplained irritability, or difficulty concentrating. Other common signs are a strong feeling of hunger, tingling or numbness in the lips and cheeks, and fatigue or lightheadedness. Recognizing these symptoms early allows for prompt self-treatment.
Why Insulin Levels Drop Too Quickly
The most frequent cause of an insulin-induced blood sugar drop is a mismatch between the administered dose and carbohydrate intake. This often happens when an individual takes their usual dose but then skips or significantly delays a scheduled meal or snack. Miscalculating the carbohydrate content of a meal can also result in injecting too much insulin for the amount of glucose entering the bloodstream.
Physical activity introduces another variable, as muscles draw on glucose more efficiently during and after exercise, amplifying the effect of circulating insulin. Unusually strenuous or prolonged activity, especially if unplanned, may cause blood sugar to plummet hours later. Consuming alcohol, particularly on an empty stomach, further inhibits the liver’s ability to release its stored glucose reserves (glycogen), accelerating the drop into hypoglycemia.
Immediate Steps for Correction
For conscious individuals experiencing mild to moderate hypoglycemia, the immediate action is to consume a source of fast-acting carbohydrate to raise blood sugar rapidly. This protocol is often referred to as the “Rule of 15,” which involves consuming 15 grams of simple, quick-absorbing carbohydrates. Ideal sources include:
- Four ounces of fruit juice or regular soda.
- Three to four glucose tablets.
- One tablespoon of honey.
- One tablespoon of sugar.
After consuming the fast-acting sugar, wait 15 minutes before re-testing the blood glucose level. This waiting period ensures the simple sugar has been fully absorbed, preventing an over-correction that could lead to high blood sugar. If the blood sugar level remains below 70 mg/dL after the initial treatment, repeat the “Rule of 15” until the glucose level is safely above this threshold. Once stable, consuming a small snack with protein and complex carbohydrates helps maintain the blood sugar within a safe range.
Severe Complications and Emergency Care
If untreated, a mild blood sugar drop can rapidly progress to severe hypoglycemia, a state where the brain is starved of glucose. This lack of energy to the central nervous system can lead to profound mental status changes, including confusion, slurred speech, and an inability to perform routine tasks. As the condition worsens, the individual may experience seizures, lose consciousness, and slip into a coma.
In severe instances, where the person is unconscious or unable to swallow, no food or drink should be given due to the risk of choking. This situation requires immediate emergency medical attention, and an emergency glucagon rescue treatment should be administered. Glucagon is a hormone that opposes insulin, signaling the liver to release stored glucose, which raises blood sugar levels quickly. Caregivers must be trained to administer this injection or nasal spray, which can be life-saving while waiting for professional medical help.