Hypoglycemia is low blood sugar due to glucose being used up too quickly or released too slowly into blood, or when excess insulin is released into blood. Causes include insufficient glucose intake (eg missing meals), alcohol and excess diabetic insulin. Principal problems arise from an inadequate supply of glucose to the brain.


Blood glucose below 65 mg/dL (3.6 mM). Hormonal defense mechanisms (adrenaline and glucagon) are normally activated as it drops below a threshold level (about 55 mg/dL (3.0 mM) for most people), producing the typical hypoglycemic symptoms of shakiness and dysphoria

Hypoglycemic symptoms and manifestations can be divided into those produced by the counterregulatory hormones (epinephrine/adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar.

  • Adrenergic manifestations: Shakiness, anxiety, nervousness; Palpitations, tachycardia; Sweating, Pallor, coldness, clamminess, Dilated pupils, Feeling of numbness “pins and needles”
  • Glucagon manifestations: Hunger; Nausea, vomiting, abdominal discomfort; Headache
  • Neuroglycopenic manifestations: Abnormal mentation, impaired judgment; Nonspecific dysphoria, moodiness, depression, crying, exaggerated concerns; Negativism, irritability, belligerence, combativeness, rage; Personality change, emotional lability; Fatigue, weakness, apathy, lethargy, daydreaming, sleep; Confusion, amnesia, dizziness, delirium; Staring, “glassy” look, blurred vision, double vision; Flashes of light in the field of vision; Automatic behavior, also known as automatism; Difficulty speaking, slurred speech; Ataxia, incoordination, sometimes mistaken for “drunkenness”; Focal or general motor deficit, paralysis, hemiparesis; Paresthesia, headache; Stupor, coma, abnormal breathing; Generalized or focal seizures; Dysmenorrhea

Hypoglycemic symptoms can occur during sleep causing sweating, nightmares and morning tiredness and irritability (and damp bed sheets or clothes from perspiration)


  • Diabetic hypoglycemia: more meticulous attention to blood sugar balance during unusual hours, higher levels of exercise, or alcohol intake
  • Reactive hypoglycemia (non-diabetic individuals): consume fat and protein with carbohydrates, add morning or afternoon snacks, reduce alcohol intake
  • Postprandial hypoglycemia: change eating patterns (smaller meals, avoiding excessive sugar, mixed meals rather than carbohydrates by themselves), reduce intake of stimulants such as caffeine, make lifestyle changes to reduce stress

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