Diabetic hypoglycemia can cause a number of symptoms. The symptoms depend on factors such as how long you've been getting low blood sugar and how serious it is. Even the time of day can play a role.

Early symptoms

At first, symptoms of diabetic hypoglycemia include:

• Faded skin color, also called pallor.
• Shakiness.
• Dizziness.
• Sweating.
• Hunger or upset stomach.
• A heartbeat that feels fast or irregular.
• Trouble concentrating.
• Weakness and lack of energy, also called fatigue.
• Irritable mood or anxiety.
• Headache.
• Tingling or loss of feeling in the lips, tongue or cheek.

Symptoms at night

If diabetic hypoglycemia happens when you're sleeping, symptoms that may disturb your sleep include:

• Damp sheets or nightclothes due to sweating.
• Nightmares.
• Tiredness, irritable mood or confusion when you wake up.

Severe symptoms

If diabetic hypoglycemia isn't treated, symptoms of low blood sugar get worse. These symptoms can include:

• Confusion, unusual behavior or both, such as not being able to complete routine tasks.
• Clumsiness or loss of coordination.
• Trouble speaking or slurred speech.
• Blurry or tunnel vision.
• Not being able to eat or drink.
• Muscle weakness.
• Drowsiness.

Severe hypoglycemia can cause:

• Uncontrolled shaking, also called convulsions.
• Seizures.
• Loss of consciousness or coma.
• Death, rarely.

Symptoms can differ from person to person. Symptoms also can differ each time a person's blood sugar becomes low. Some people don't have any symptoms that they notice. It's also possible to have no symptoms of hypoglycemia. That makes it important to check your blood sugar regularly. Also, keep track of how you feel when your blood sugar is low.

Severe hypoglycemia can lead to serious medical problems that need emergency care. These include seizures and loss of consciousness. Make sure your family, friends and co-workers know what to do in an emergency.

Teach people you trust how to recognize symptoms of hypoglycemia. If others know what symptoms to look for, they might be able to alert you to early symptoms. It's also important that family members and close friends know how to help you in case of an emergency.

For example, if you pass out due to very low blood sugar, you'll need someone to give you treatment. The treatment for severe hypoglycemia is an injection of glucagon. Glucagon is a hormone that causes the liver to release sugar into the blood. Tell family and friends where you keep glucagon and how to give it to you.

Here's some emergency information to give to others. If you're with someone who loses consciousness or can't swallow due to low blood sugar:

• Don't inject insulin. Insulin is a type of diabetes medicine that lowers blood sugar whether sugar is low or high to begin with. Injecting insulin causes blood sugar to drop even more.
• Don't give fluids or food because they could cause choking.
• Give glucagon by shot or a nasal spray.
• Call 911 or emergency services in your area for treatment right away if you can't find the person's glucagon. Also call emergency services if you don't know how to use glucagon or if the person is not conscious.

If you have symptoms of hypoglycemia several times a week, see your healthcare professional. Your treatment plan may need to be changed.

Diabetic hypoglycemia has a number of causes. Low blood sugar is most common among people who take insulin. But low blood sugar also can happen if you use certain oral diabetes medicines, which are taken by mouth.

Common causes of diabetic hypoglycemia include:

• Taking too much insulin or other diabetes medicine.
• Not eating enough.
• Postponing or skipping a meal or snack.
• Getting more exercise or physical activity without eating more or adjusting your medicines.
• Drinking alcohol.

Blood sugar control

Most of the body's blood sugar comes from food. The hormone insulin lowers blood sugar levels when blood sugar is too high. If you have type 1 or type 2 diabetes and need insulin to control your blood sugar, use insulin carefully. Taking more insulin than you need can cause your blood sugar level to drop too low. Hypoglycemia can happen as a result.

Your blood sugar may drop too low if you eat less than usual after you take your diabetes medicine. A drop in blood sugar also can happen if you exercise more than usual after taking your diabetes medicine. It isn't always easy to find the right balance between insulin, food and physical activity. But you can ask a member of your healthcare team to help you try to prevent low blood sugar levels. You might work with:

• Your primary care healthcare professional.
• A certified diabetes care and education specialist.
• A registered dietitian.

Some people have a greater risk of diabetic hypoglycemia, including:

• People who use insulin, especially those with type 1 diabetes.
• People who take diabetes medicines called sulfonylureas, such as glipizide (Glucotrol XL), glimepiride (Amaryl) or glyburide (Diabeta, Glynase).
• Young children and adults 65 and older.
• Those with conditions that affect how well the liver works or how well the kidneys work.
• People who've had diabetes for a long time.
• People who don't feel low blood sugar symptoms. This is called hypoglycemia unawareness.
• Those taking more than one medicine.
• Anyone with a medical condition that prevents a quick response to falling blood sugar levels.
• People who drink alcohol.

Diabetic hypoglycemia can lead to other medical problems. If you ignore the symptoms of hypoglycemia too long, you may lose consciousness. That's because your brain needs blood sugar to work. So, it's important to spot the symptoms of hypoglycemia early.

Without treatment, hypoglycemia can lead to:

• Seizures.
• Loss of consciousness or coma.
• Death, rarely.

Take early symptoms seriously. Diabetic hypoglycemia can raise the risk of serious — even deadly — accidents.

To help prevent diabetic hypoglycemia:

• Track your blood sugar. Depending on your treatment plan, you may need to check and record your blood sugar level many times each week or each day. This is the only way to make sure that your blood sugar level stays within your target range.
• Don't skip or delay meals or snacks. If you take insulin or oral diabetes medicine, be consistent about the amount you eat. Also be consistent about the timing of your meals and snacks.
• Measure medicine carefully and take it on time. Take any diabetes medicine as recommended by your healthcare professional.
• Adjust your medicine or eat more snacks if you boost your physical activity. The adjustment depends on the blood sugar test results, the type and length of activity, and what medicines you take. Follow your diabetes treatment plan when you make adjustments.
• If you choose to drink, drink alcohol with a meal or snack. Drinking alcohol on an empty stomach can cause hypoglycemia. Alcohol also can cause delayed hypoglycemia hours later. This makes it even more important to check your blood sugar.
• Keep a journal of times when you get low blood sugar. Note what you ate, any diabetes medicines that you took and any physical activity you did. This can help you and your care team find patterns as to why you might get hypoglycemia. It can help your team find ways to prevent bouts of low blood sugar.
• Carry some form of diabetes identification so that in an emergency others can see that you have diabetes. Use a medical identification necklace or bracelet and wallet card.

If you have symptoms of low blood sugar, check your blood sugar level with a blood glucose meter. The meter is a small device that measures and displays your blood sugar level. For many people, hypoglycemia is when blood sugar level drops below 70 mg/dL or 3.9 mmol/L. But your numbers might be different. Ask your healthcare professional about the right range for your blood sugar.

Treatment for diabetic hypoglycemia depends on how serious your low blood sugar becomes.

If you think your blood sugar may be too low, check your blood sugar level with a blood glucose meter. Be extra careful if you have symptoms of low blood sugar but can't check your blood sugar level right away. Assume your blood sugar is low and treat for hypoglycemia.

Managing hypoglycemia

Eat or drink carbohydrates

Eat or drink something that's mostly sugar or carbohydrates to raise your blood sugar level quickly. Pure glucose is the preferred treatment. It comes in tablets, gels and other forms.

Foods with more fat, such as chocolate, don't raise blood sugar as quickly. And diet soft drinks cannot be used to treat hypoglycemia because they don't have any sugar.

Examples of foods that raise your blood sugar level quickly include:

• Glucose tablets. Read the package label for the right amount to take. Glucose tables are sold at most pharmacies without a prescription.
• Glucose gel. Read the package label for the right amount to take.
• Hard candy or jelly beans. A serving usually is about 5 to 6 pieces, but check the food label for the exact serving size.
• Four ounces, or 1/2 cup, of fruit juice.
• A half a can, or about 4 to 6 ounces, of regular soda. Do not use diet soda.
• One tablespoon, or 15 milliliters, of sugar, corn syrup or honey.

In general, aim to have food or drink with 15 to 20 grams of carbohydrates. Often, that is enough to raise blood sugar levels back into a safe range.

Recheck your blood sugar level

Check your blood sugar 15 minutes after eating or drinking something to treat hypoglycemia. If your blood sugar is still low, eat or drink another 15 to 20 grams of carbohydrates. Repeat this pattern until your blood sugar is above 70 mg/dL, or 3.9 mmol/L.

Have a snack or meal

Have a snack or a meal to keep your blood sugar from dropping again. If you usually take insulin with food, keep the following advice in mind. In general, you don't need more insulin if you eat a snack after you have a low blood sugar level. But if you're going to eat a meal, you may need a lower dose of insulin. This helps ensure that your blood sugar doesn't rise too quickly.

It's important to try not to overtreat your low blood sugar. If you do, you may cause your blood sugar level to rise too high. That's likely to make you feel thirsty and tired.

If you have a young child who gets diabetic hypoglycemia, talk with your child's healthcare team. Young children often need less than 15 grams of carbohydrates to treat low blood sugar. Ask your child's healthcare professional what amount your child needs.

Emergency treatment

The treatment for severe hypoglycemia, glucagon, is a hormone that raises blood sugar quickly. It can be lifesaving if someone isn't alert enough to eat or drink something to raise low blood sugar. Glucagon is available only by prescription.

Glucagon comes in an emergency syringe kit, an auto-injector pen or a pre-mixed injection that's ready to use. Glucagon also is available as a powdered nasal spray given in one nostril. Store glucagon as directed on the packaging. Be aware of the expiration date. When given to someone who is not conscious, the person should be turned on the side. This helps prevent choking in case of vomiting.

About 15 minutes after getting glucagon, the person should be alert and able to eat. If someone doesn't respond within 15 minutes, call emergency medical care. If someone quickly responds to glucagon, it's still recommended that you contact the person's diabetes care team promptly.

Talk with your healthcare professional if you needed help from others to treat a bout of low blood sugar. Your healthcare professional likely will want to figure out if your insulin or other diabetes medicine needs to be adjusted. An adjustment might be needed to prevent another serious episode.

Hard-to-manage hypoglycemia

Some people have frequent and severe hypoglycemia despite medicine adjustments. If that happens, your healthcare professional may suggest that you keep your blood sugar in a higher than usual range.

Your healthcare professional also might suggest that you use a device that measures your blood sugar every few minutes. It's called a continuous glucose monitor. It uses a sensor placed under the skin to measure blood sugar. Your healthcare professional likely will recommend that you have glucagon with you at all times too. Teach people you trust, such as family, friends and close co-workers, how to use it.

Hypoglycemia unawareness

Some people don't have or don't feel early symptoms of hypoglycemia. This is called hypoglycemia unawareness. If you have hypoglycemia unawareness, your healthcare professional may recommend a higher glucose target range.

It's very important to regularly check your blood sugar before you go to bed. Have a snack that contains carbohydrates before going to sleep if your blood sugar is lower than your bedtime target range. Your healthcare professional also may recommend a continuous glucose monitor that can sound an alarm when your blood sugar is dropping.

The following tips can help you be prepared for diabetic hypoglycemia and its complications.

Teach people how to help

Tell people you trust about your hypoglycemia. For example, you could talk with family, friends and co-workers. If others know what symptoms to look for, they might be able to alert you to early symptoms. It's important that family members and close friends know where you keep glucagon and how to give it. That way, a serious situation can be easier to safely manage.

Plan ahead

Always carry a low blood sugar treatment with you, such as glucose tablets or gel, hard candy or regular soda. Also carry glucagon if it's prescribed for you.

Wear a medical ID

It's a good idea to wear a necklace or bracelet that identifies you as someone who has diabetes. You also can keep in your wallet a medical alert card that says you have diabetes.

If you have low blood sugar several times a week, make an appointment with your healthcare professional. Together you can determine what's leading to your hypoglycemia and figure out what changes to make to prevent it.

Here's some information to help you get ready for your appointment.

What you can do

• Be aware of restrictions before the appointment. Sometimes you need to stop eating or drinking anything but water for 8 to 12 hours for blood tests. This is called fasting. When you make the appointment, ask if you need to fast. If so, ask what changes you need to make to your diabetes treatment plan because you're not eating or drinking.
• Make a list of your symptoms and how often they happen. It helps to keep a record of your blood sugar readings and low blood sugar reactions. That way, you and your healthcare professional can see patterns that lead to hypoglycemia.
• Make a list of key personal information. Include any major stresses or recent life changes.
• Make a list of medicines, vitamins and supplements you take. Include the amounts you take, also called the doses.
• Keep a record of your blood sugar test results if you track your levels at home. Give your healthcare professional a written or printed record of your blood sugar levels, times and medicines taken.
• Take your blood glucose meter with you. Some meters let your healthcare professional's office download the recorded blood sugar test results.
• Write down questions to ask your healthcare professional. Ask about any parts of your diabetes treatment plan where you need more information.

Questions you may want to ask include:

• How often do I need to check my blood sugar?
• What is my target blood sugar range?
• How do diet, exercise and weight changes affect my blood sugar?
• How can I prevent low blood sugar?
• Do I need to worry about high blood sugar? What are the symptoms I need to watch out for?
• Do I need a prescription for emergency glucagon?
• If I keep having hypoglycemia, when do I need to see you again?

Feel free to ask other questions too.

What to expect from your doctor

Your healthcare professional is likely to ask you questions such as:

• What symptoms do you notice when you have low blood sugar?
• How often do you have these symptoms?
• What do you do to raise your blood sugar levels?
• What's a typical day's diet like?
• Are you exercising? If so, how often?
• Do your family, friends and co-workers know what to do if you have severe hypoglycemia?