Low blood sugar, or hypoglycemia, can happen with both Type 1 and Type 2 diabetes. It is not exclusive to one type. The key factor isn’t the type of diabetes itself but whether you take medications that actively lower blood sugar, especially insulin or a class of pills called sulfonylureas. That said, low blood sugar is far more frequent and often more dangerous in Type 1 diabetes, where insulin use is constant and unavoidable.
Why Type 1 Diabetes Carries the Highest Risk
Everyone with Type 1 diabetes depends on injected or pumped insulin to survive because their body produces little to none on its own. That external insulin doesn’t respond to real-time blood sugar levels the way a healthy pancreas would. If you take too much insulin, eat fewer carbohydrates than expected, exercise more than usual, or mistime a dose, your blood sugar can drop below 70 mg/dL. According to the CDC, people with diabetes can experience low blood sugar once or twice a week, even when managing it carefully.
Over time, repeated lows create a particularly dangerous pattern. The body and brain stop producing the early warning signs, like shakiness, sweating, and a racing heart, that normally alert you to a drop. This is called hypoglycemia unawareness, and it raises the risk of severe episodes where blood sugar falls so low that you need someone else’s help to recover. Hypoglycemia unawareness is most common in people who have lived with Type 1 diabetes for many years.
How Type 2 Diabetes Medications Cause Lows
Not all Type 2 diabetes medications carry a risk of low blood sugar. Metformin, the most commonly prescribed first-line drug, rarely causes it on its own. The medications that do cause lows are those that increase the amount of insulin circulating in your body, whether by injecting it directly or by stimulating your pancreas to release more.
Sulfonylureas are the most common culprits among oral medications. They work by pushing the beta cells in your pancreas to release insulin into the bloodstream regardless of what your blood sugar is doing at that moment. If you take more than prescribed, skip a meal, or combine them with certain other drugs (including some antibiotics, antifungals, and anti-inflammatory painkillers), the extra insulin can send your blood sugar too low. Doubling up on a missed dose is especially risky.
People with Type 2 diabetes who use insulin injections face the same timing and dosing challenges as those with Type 1, though typically with somewhat lower frequency because many still produce some of their own insulin, which provides a small buffer.
What Low Blood Sugar Feels Like
The symptoms arrive in a predictable sequence. Early on, your body releases adrenaline in an attempt to push blood sugar back up. This produces sweating, trembling, a pounding heartbeat, anxiety, and sudden hunger. These warning signs are your body’s alarm system, and they typically appear first.
If blood sugar keeps dropping, the brain starts running short on fuel. At this stage, symptoms shift to confusion, difficulty concentrating, irritability, and trouble speaking or walking normally. In severe cases, this can progress to hallucinations, seizures, loss of consciousness, and, rarely, death. A severe episode is defined as one where you need another person’s help to treat it, regardless of the exact number on your meter.
The 15-15 Rule for Treating a Low
The standard approach is simple. Eat or drink 15 grams of fast-acting carbohydrates: four glucose tablets, half a cup of juice, or a tablespoon of honey. Wait 15 minutes and recheck your blood sugar. If it’s still below 70 mg/dL, repeat with another 15 grams. Keep cycling through these steps until your reading is back in your target range. Once it is, follow up with a balanced snack or small meal that includes both protein and carbohydrates to keep it stable.
If someone is confused or unconscious, they cannot safely swallow food or liquid. This is when an emergency glucagon kit becomes critical. These are prescription products that people on insulin or sulfonylureas should keep on hand, and the people around them should know how to use.
Low Blood Sugar Without Diabetes
It’s worth noting that low blood sugar can also occur in people who don’t have diabetes at all. This is sometimes called reactive hypoglycemia, where blood sugar dips a few hours after eating. The exact cause is often unclear, though it can be linked to alcohol use, prior gastric bypass surgery, inherited metabolic conditions, or rare insulin-producing tumors. If you’re experiencing symptoms of low blood sugar and don’t have a diabetes diagnosis, that pattern is worth investigating on its own rather than assuming it points to diabetes.
Which Medications Don’t Cause Lows
If you have Type 2 diabetes and are concerned about hypoglycemia, it helps to know that several common medication classes carry little to no risk of lows when used alone. Metformin, SGLT2 inhibitors (which help your kidneys remove excess sugar), and DPP-4 inhibitors all work in ways that don’t force insulin release independent of your blood sugar level. GLP-1 receptor agonists, a popular injectable class, also have a low risk on their own, though combining them with sulfonylureas or insulin increases the chance of a drop.
The practical takeaway: low blood sugar is a side effect of specific treatments, not an inevitable part of living with any type of diabetes. Understanding which medications you take and how they work gives you a much clearer picture of your personal risk.