Introduction:

Hypoglycemia (low blood sugar) is a condition in which there is an abnormally low level of glucose (sugar) in your blood. Normally your body keeps blood sugar levels within a narrow range through the coordinated work of several organs and glands and their hormones, primarily insulin and glucagon. But factors such as disease or a poor diet can disrupt the mechanisms that regulate your sugar levels. Too much glucose results in hyperglycemia, one of the major symptoms of diabetes. However, hypoglycemia is most common among people with diabetes, as too much insulin can cause blood sugar levels to fall (an insulin reaction). Left untreated, hypoglycemia can cause permanent neurological damage and death.

Signs and Symptoms:

Since glucose (sugar) is the brain's primary fuel, your brain feels the following effects of hypoglycemia:

• Headache
• Excessive sweating
• Blurred vision, dizziness
• Trembling, lack of coordination
• Depression, anxiety
• Mental confusion, irritability
• Heart palpitations
• Slurred speech
• Seizures
• Fatigue
• Coma

What Causes It?:

The following conditions can cause hypoglycemia:

• (In diabetics) taking too much insulin, skipping a meal, exercising too strenuously, drinking too much alcohol
• Critical organ failure (kidney, heart, or liver)
• Hormone deficiencies
• Tumors
• Fasting
• Inherited abnormalities
• Lack of an appropriate diet, especially with a critical illness
• With strenuous exercise
• After gastrointestinal surgery
• Certain medications, including quinolones, pentamidine, quinine, beta blockers, angiotensin-converting enzyme agents and IGF
• Autoimmune disorders

What to Expect at Your Provider's Office:

If your symptoms are not severe, your health care provider will order a blood test called a glucose tolerance test, the same test used to diagnose diabetes. If your levels are only slightly below normal, your health care provider may recommend diet and lifestyle changes. If your symptoms are severe, your health care provider will immediately give you glucose in either an oral or injectable form to bring your blood sugar level back to normal as quickly as possible. Additional tests may determine the cause of your low blood sugar.

Treatment Options:

It is important to treat low blood sugar immediately to avoid long term serious effects. Hypoglycemia resulting from exercise several hours after a meal rarely produces serious symptoms. A glass of orange juice and a piece of bread can correct your blood sugar levels within minutes. However, in people with underlying diseases, fluctuating blood sugar levels are more serious and must be treated with oral or injectable forms of glucose. You can take oral glucose if you are able to swallow. If not, your health care provider can give you an injection.

Drug Therapies

• Oral glucose for people who are able to swallow (10 - 20 g carbohydrate)
• Intravenous glucose for people who are unable to swallow
• Subcutaneous or intramuscular injection of glucagon is an alternative to the above treatments, but the individual must also eat because the effect of glucagon is short
• Intravenous mannitol and glucocorticoids may be used to treat an individual who remains in a coma after glucose levels return to normal

Complementary and Alternative Therapies

Long-term treatment is aimed at the cause of the hypoglycemia, but alternative therapies may also be useful in regulating blood sugar in the short term. Nutritional support should be part of treatment. Keep all of your physicians informed regarding all complementary and alternative treatments. Some of these treatments can interfere with conventional medical therapies. Work with a provider who is knowledgeable in complementary medicine to find the right mix of treatments for you.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), fresh vegetables, and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Soluble fiber, such as flaxseed and pure oat bran, can slow the rate at which dietary sugars enter the blood and help regulate blood sugars throughout the day. Consume 1 - 3 tsp. of either of these fiber sources before meals. Talk to your doctor first if you have a history of digestive disorders.
• Some doctors may suggest a high protein diet, although evidence is mixed on the benefits. A "Zone"-style diet, combines proteins, fats, and carbohydrates in a 30/30/40 ratio and can be very helpful in maintaining stable blood sugar throughout the day. Eat lean meats, preferably that do not contain hormones or antibiotics. Cold water fish or beans can also be used for protein. Limit the intake of processed meats, such as fast foods and lunch meats.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid alcohol and tobacco. Lower caffeine intake, as caffeine impacts several conditions and medications.
• Exercise, if possible, 30 minutes daily, 5 days a week. Light exercise may be advisable at first until you learn how to control your blood sugar and how to manage your diet to tolerate higher intensity exercise.

You may address nutritional deficiencies with the following supplements:

• A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tbs. of oil daily, to help decrease inflammation and help with immunity. Omega-3 fatty acids can have a blood thinning effect. People taking blood thinning medications should speak to their doctor before taking omega-3 fatty acids.
• Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• Magnesium, 250 - 750 mg daily, for nutrient support. If you are taking blood pressure medication or other heart medication, speak to your doctor before taking magnesium.
• Chromium, 250 - 800 mcg daily, for blood sugar regulation.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- read labels carefully.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures singly or in combination as noted. If you are pregnant or nursing, talk to your doctor before using any herbal products.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant effects. You may also prepare teas from the leaf of this herb. Caffeine free products are available.
• Holy basil (Ocimum sanctum) standardized extract, 400 mg daily, for stress balance. You can also prepare teas from the plant.

Acupuncture

Acupuncture may decrease stress, increase coping skills, and regulate hormone function.

Following Up:

Any underlying condition that may be causing your hypoglycemia must be aggressively treated so that your episodes do not recur. If you have hypoglycemia when you exercise, carry a healthy snack with you.

Special Considerations:

Do not ignore the signs and symptoms of hypoglycemia. Untreated, it can cause irreversible brain damage, coma, or even death.

Alternative Names:

Blood sugar - low; Low blood sugar