Type 2 Diabetes And Hypoglycemia

Living with diabetes can present many challenges. Along with having to pay close attention to what you eat, how you exercise, and what medications you take, it's important to closely monitor your blood sugar levels.

Hypoglycemia is a condition that occurs when your blood sugar (or blood glucose) level is too low. It affects many people with either type 1 or type 2 diabetes, usually those who take insulin. While it is common, hypoglycemia can be dangerous if not treated quickly.

Here's what you need to know about type 2 diabetes and hypoglycemia.

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What is type 2 diabetes?

Type 2 diabetes is a disease that affects up to 37 million people in the US. It occurs when your body doesn't make or use insulin as it should.

Your pancreas is responsible for making insulin, a hormone that helps the cells in your blood convert sugar into energy. If you're diagnosed with type 2 diabetes, your cells don't correctly respond to insulin, and high blood sugar (hyperglycemia) is the result.

While type 2 diabetes is relatively common, it should be taken seriously and closely monitored to prevent other health complications, such as eye problems, kidney failure, and heart disease.

What are the signs of type 2 diabetes?

The symptoms of type 2 diabetes can vary from person to person. While one person may not experience any symptoms, another may notice signs that their blood sugar is high.

Common signs of type 2 diabetes include:

If you experience one or more type 2 diabetes symptoms, it's important to schedule a check-up with your healthcare provider as soon as possible. Getting a diagnosis early can help manage your symptoms and prevent serious complications from occurring, including vision problems and heart disease.

What is hypoglycemia?

Hypoglycemia occurs when your blood glucose level is lower than it should be. For people with diabetes, this usually means their blood sugar level is below 70 milligrams per deciliter (mg/dL), although this can vary between individuals.

Hypoglycemia is common in people diagnosed with type 1 diabetes or who have type 2 diabetes and take diabetic medication, such as insulin. In rare cases, your blood sugar may become so low that you cannot treat it without professional help.

Types of hypoglycemia

There are two types of non-diabetic hypoglycemia:

  • Reactive hypoglycemia: This happens because of too much insulin in your blood and occurs within a few hours after you have eaten. It can also be caused by being prediabetic, stomach surgery, or some rare enzyme defects.

  • Fasting hypoglycemia: This can be caused by certain medications; disease of the liver, kidney, heart, or pancreas; low levels of certain hormones; excessive alcohol use; and certain tumors.

As mentioned above, diabetic hypoglycemia can be experienced by people with diabetes if their blood sugar is too low. This is usually a result of their insulin levels being too high.

Risk factors of hypoglycemia for people with diabetes

If you have diabetes, there are certain risk factors that may increase the chances of you developing hypoglycemia. These include:

  • Age: The older you are, the more likely you are to experience hypoglycemia if you're diabetic.

  • Eating habits: If you skip meals or eat erratically throughout the day, this can upset your blood sugar levels.

  • Exercise: Heavy exercise can increase your sensitivity to insulin. It also uses up the glucose in your blood faster than when you are at rest.

  • Weight loss: Losing weight can heighten your sensitivity to insulin, so you'll need to talk with your doctor about adjusting your insulin levels if you need to lose weight.

  • Alcohol: Drinking alcohol prevents the production of glucose in the liver, causing blood sugar levels to drop.

  • Pregnancy: Due to changes in hormone levels, pregnant women may experience a drop in glucose levels during the first half of their pregnancy.

  • Underactive thyroid: Low levels of thyroid hormone can slow your metabolism, so your diabetes medications stay in your body for longer.

  • Not rotating your injection site: If you inject too often in the same spot, fat and scar tissue can build up under the skin, which affects how your body absorbs insulin. This can lead to either hypoglycemia or hyperglycemia.

Symptoms of hypoglycemia

Recognizing the signs of hypoglycemia is crucial so that you can get the help you need to restore a healthy blood sugar level

Early signs

The first signs that your blood sugar level may be lower than normal include:

  • Rapid or irregular heartbeat

  • Pale skin

  • Fatigue

  • Anxiety

  • Shakiness

  • Irritability

  • Hunger

  • Numb or tingly tongue, lips, and/or cheeks

  • Sweating

Severe symptoms

If hypoglycemia goes untreated, it could get worse and cause more serious symptoms, such as:

  • Feeling confused or experiencing unusual behavior, such as not being able to finish familiar tasks

  • Having seizures

  • Blurred vision

  • Losing consciousness

Symptoms of night-time hypoglycemia

Some people experience hypoglycemia at night, which can be harder to diagnose because you're asleep! Some signs that you may have low blood sugar at night include:

  • A headache on waking

  • Nightmares

  • Sweating

  • Being extra tired in the morning

  • A higher than normal glucose level on waking

What to do if you experience symptoms of hypoglycemia

If you have any of these symptoms and have not been diagnosed with diabetes, or if you have diabetes and your body is not responding to your usual treatment to resolve the hypoglycemia, it's important to seek medical attention right away.

If you witness someone you know with diabetes having a severe hypoglycemic episode or even losing consciousness, seek emergency professional care immediately.

What is hypoglycemia unawareness?

It's possible for your blood sugar level to be low, but you don't notice any symptoms of hypoglycemia. This experience is called hypoglycemia unawareness. Usually, when an insulin-dependent diabetic notices signs of hypoglycemia, they can resolve the problem by normalizing their blood sugar before it progresses.

In the case of hypoglycemia, unawareness and a lack of symptoms make it very difficult to know that there is an issue with your blood sugar levels. You may become confused or even unconscious before you recognize that something isn't right.

How to deal with symptoms of hypoglycemia

If you suspect that your blood sugar level is low, check it right away. If you're unable to check it, assume that it is low and treat it since low blood sugar can be dangerous if left untreated for an extended period of time. If your blood sugar level is between 55 and 69mg/dL, the 15-15 rule is an easy way to help you get back to normal levels and resolve your hypoglycemic symptoms.

The 15-15 rule includes eating 15g of carbohydrates, then eating 15 minutes later. If your blood sugar level is still lower than your target range after taking this step, eat another 15g of carbohydrates and check again after another 15 minutes.

Repeat these steps until you achieve your target blood sugar range. After you've restored your blood sugar to a healthy level, be sure to eat a balanced meal or healthy snack to prevent it from dropping again.

Foods that have around 15g of carbs include:

  • 4oz of soda or juice

  • Jellybeans, gumdrops, or other hard candies (read the package to determine serving sizes)

  • 1 tablespoon of honey, syrup, or sugar

  • 1 dose of glucose gel (read the instructions before consuming)

  • 3–4 glucose tablets (read the instructions before consuming)

If your child is experiencing a hypoglycemic episode, they may need to consume less than 15g of carbs to achieve their target blood sugar range. Be sure to consult their healthcare provider about the appropriate amount of carbs to give them.

It's best to avoid carbs that also have a lot of fiber or fat, such as beans or chocolate. Fiber and fat can prevent your body from absorbing sugar quickly.

If you're in a situation where you're more likely to experience hypoglycemia, such as when you're traveling, exercising, or the weather is hot, be sure to check your blood sugar levels frequently.

How to treat severe hypoglycemia

Blood sugar that is below 55 mg/dL is considered severely low. In this case, the 15-15 rule won't be enough to help you achieve your target blood sugar range, and you may not be coherent enough to treat your condition yourself. It's beneficial to carry a pre-filled syringe that contains glucagon wherever you go. Glucagon¹ is a hormone that will make your liver release sugar into your bloodstream.

If you experience a severe hypoglycemic episode where you are unable to administer the medication yourself, someone else can do it for you. Be sure to let your family and friends know where you keep your glucagon kit and how to use it in case of an emergency.

It's important for the person who is treating your severe hypoglycemia to call 911 immediately if any of the following occur:

  • You pass out from low blood sugar, and there's no glucagon available

  • You took glucagon but are still showing signs of low blood sugar, such as confusion

  • You have to take a second dose of glucagon

  • Your blood sugar doesn't respond to treatment or stays too low 20 minutes after taking the glucagon

How to prevent hypoglycemia

If you have type 2 diabetes, the best way to avoid an episode of hypoglycemia is to follow your treatment plan as agreed with your medical professional. This will include aspects of medication, diet, and exercise.

Remember to test your blood sugar levels regularly, so you'll know if they're starting to dip. If you're taking insulin for your diabetes, aim to check your blood sugar at least four times a day. It will help to do this at the same time each day, so you get into the habit of monitoring it.

Let your medical professional know if your blood sugar levels aren't in the target range, as your medication may need to be adjusted. Don't make any changes to your medication yourself without first consulting your doctor.

The lowdown

Hypoglycemia occurs when a person's blood sugar level is too low. While it can happen to anyone, it's most common in people who have type 1 diabetes or type 2 diabetes that is treated with insulin. Hypoglycemia can occur as a result of taking too much insulin, the wrong type of insulin, being active, or what you eat, among other factors.

In many cases, low blood sugar causes symptoms that are recognizable, such as sweating, anxiety, shakiness, and rapid heartbeats, which let you know that you should treat it right away. 

Sometimes, hypoglycemia doesn't present with any signs at all, also known as hypoglycemia unawareness, or occurs so quickly that it becomes severe. In these cases, it's important for the person you're with to administer emergency medication, such as glucagon, or call 911.

  1. Hyperglycemia and hypoglycemia in type 2 diabetes | Informed Health

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