The CGM Blog
How to Manage Hypoglycemia with Greater Peace of Mind
Not all lows feel the same. Learn how to recognize, prevent, and manage hypoglycemia—including hypo unawareness and nighttime lows.
Hypoglycemia is also known as low blood sugar or low glucose. Some people refer to it as “having a hypo.” Avoiding hypoglycemia can be one of the most challenging aspects of diabetes management. Many people experience anxiety around going low because it can lead to serious symptoms.1 Fear or worry about low glucose doesn’t have to stop you from enjoying activities and fully participating in meaningful experiences. Learning how to identify whether you’re going low and ways to prevent hypos from happening can help you feel more empowered to manage your glucose levels.1 With the right glucose management strategies and tools like continuous glucose monitoring (CGM) systems, you can work to reduce the likelihood of experiencing hypoglycemia and focus on doing what you love with a little extra peace of mind.
Why Does Hypoglycemia Happen?
Hypoglycemia happens when there isn’t enough of a sugar called glucose in the bloodstream to meet the body’s needs.2 Our main source of glucose is carbohydrates in the foods and drinks we consume. Every cell in the body uses glucose for fuel, and it’s the brain’s main source of energy. When glucose levels drop too low, the body can’t function properly, and this can lead to a medical emergency.2 In general, Diabetes Canada suggests that individuals aim to keep their glucose levels between 3.9 and 10.0 mmol/L and defines hypoglycemia as glucose levels below 3.9 mmol/L.3,4
People living with either type 1 diabetes (T1D) or type 2 diabetes (T2D) who use insulin therapy or glucose-lowering medications are more likely to experience hypoglycemia because these treatments work to decrease the level of glucose in the blood.2,4 Hypoglycemia might happen if you take too much insulin or medication, take the wrong type of insulin, or have trouble syncing up your dosages with your meal, exercise, and sleep schedule. Lows can also happen when you haven’t eaten a meal in a while, like during a busy workday, while you’re asleep, or when you have trouble eating while you’re sick.2,5
While you may be at higher risk of experiencing hypoglycemia, there are ways to reduce the likelihood of going low and limit how often you have hypos. Building habits that help keep your glucose in your ideal range and using technology like a CGM system to get ahead of lows can give you a greater sense of control over your glucose, reducing some of the stress that comes with worrying about experiencing hypoglycemia.
Spotting the Symptoms of Hypoglycemia
Everyone is unique, and you may not experience lows the same way someone else does. The way that you experience hypoglycemia can change from day to day and over time as you age. Understanding what lows look like for you can help you catch them when they happen, empowering you to take action to prevent or treat them in the moment.
Diabetes Canada generally classifies hypoglycemia into three levels characterized by different symptoms and whether or not a person can treat the hypo themselves:4
Mild Hypoglycemia: Glucose levels are usually between 3.0 and 3.9 mmol/L. A person experiencing mild hypoglycemia can typically treat the low themselves. At this level, individuals may experience physical symptoms that might look like:2,4
- Sweating
- Looking pale
- Shaking
- Tiredness
- Hunger or nausea
- Having a rapid or irregular heartbeat
- Feeling tingling or numbness around the mouth
Moderate Hypoglycemia: Glucose levels are usually lower than 3.0 mmol/L. Generally, someone experiencing moderate hypoglycemia can treat themselves. They may experience mental or behavioural symptoms in addition to physical symptoms, which can include:2,4
- Acting irritable or anxious
- Having difficulty concentrating
- Having a headache
- Feeling dizzy or lightheaded
- Feeling weak or drowsy
Severe Hypoglycemia: This level is characterized by serious symptoms, regardless of where glucose levels are at. When a person experiences severe hypoglycemia, they require help from someone else and urgent medical attention. If severe hypoglycemia isn’t treated, individuals can also experience seizures or a loss of consciousness.2,4 Individuals experiencing this level of hypoglycemia may also experience other symptoms such as:2,4
- Confusion
- Unusual behaviour, such as being unable to complete everyday tasks
- Slurred speech
- Loss of coordination
- Blurry or tunnel vision
- Nightmares
It’s smart to talk to your doctor or diabetes care team about how to prepare to handle a serious low. You may want to put a plan in place with your loved ones or coworkers to let them know what to do in case of a low glucose emergency. If you care for someone living with diabetes, like a coworker, friend, family member, or loved one, it’s a good idea to learn to identify the signs of a serious low so you can help them.
Be Aware of Hypoglycemia Unawareness
About 25% of people living with T1D experience hypo unawareness, while 10 to 15% of those living with T2D experience it.6
Some individuals do not show or feel any of the symptoms usually associated with low glucose until they’re experiencing very serious hypoglycemia. This is known as hypoglycemia unawareness or hypo unawareness.6 It can develop when an individual repeatedly experiences hypoglycemia. Over time, the body becomes desensitized to low glucose and stops sending signals indicating that glucose is dropping. About 25 percent of people living with T1D experience hypo unawareness while 10 to 15 percent of those living with T2D experience it.6 Hypo unawareness is a biological phenomenon, and it isn’t a personal failing. If you think you’re experiencing hypo unawareness, you and your diabetes care team come up with tailored strategies to help you identify and prevent low glucose.
Preventing and Managing Hypoglycemia in Diabetes Routines
With the right tools and support from your diabetes care team, you can get in the driver’s seat of your diabetes management and work to reduce the risk of experiencing low glucose. Here are just a few things you can do to help manage hypoglycemia.
1. Monitor Your Glucose Levels
If you don’t know where your glucose is at or where it’s going, it’s hard to take action to keep your glucose levels within your target range and avoid hypoglycemia. Using a blood glucose meter (BGM) can make it difficult to tell whether you’re headed for a low because it can only give you a snapshot of where your glucose is at when you prick your finger. While BGMs can help you confirm whether you’re experiencing low glucose, they can’t help you proactively avoid lows before they happen.
With a CGM system like the Dexcom G7 CGM System, you can see where your glucose has been, moment to moment, and get insight into whether your levels are starting to go up or down. Dexcom CGM Systems can show your glucose readings on your compatible smartphone, smartwatch, or handheld receiver without the need for routine fingersticks.*† They can provide continuous readings on your device up to every five minutes and display a helpful arrow that lets you know if your glucose is steady or whether it’s getting higher or lower. Studies have shown that using a Dexcom CGM System helps reduce the frequency of hypoglycemia and helps people spend more time in their ideal glucose range.7-12
2. Pay Attention to What Can Lead to Lows
There are many factors that can impact glucose levels and it’s not always easy to tell what causes low glucose. As you monitor your glucose regularly, you might start to notice how certain circumstances and choices affect your levels. This can help you identify what causes hypoglycemia for you.
In addition to your meal and insulin or medication schedule, physical activity has a major impact on your glucose levels. Our muscles use insulin more effectively to absorb glucose when we’re active. As our muscles contract while we move, they don’t need insulin to absorb glucose at all.13 This can lower glucose levels quickly, potentially leading to hypoglycemia after a workout or sports practice, and even everyday physical activities like vacuuming or mopping, carrying groceries or kids upstairs, or doing yard work.13
With Dexcom G7 you can easily keep track of your meals, insulin and medication doses, physical activity, and more right alongside your glucose readings. The Dexcom G7 app also integrates directly with activity-tracking apps like Apple Health and Google Fit, as well as meal-logging apps like RxFood, which allows you to log meals by taking a photo of your plate. This can give you a more holistic view of what affects your glucose levels and contributes to hypoglycemia.
3. Get Ahead of Hypoglycemia Before it Happens
Once you’re aware of what can cause lows, you can take steps to navigate situations that might lead to hypoglycemia. For example, you might want to discuss how to adjust your insulin doses around your workouts if you tend to go low afterwards. You could plan to eat an extra snack during the day if you find you go low between lunch and dinner. It’s also a good idea to create a sick day plan with your doctor to ensure you can manage your glucose if you lose your appetite or experience symptoms like vomiting and diarrhea that can make it hard to keep food down.
Using a Dexcom CGM System can empower you to take action to treat lows faster and work to prevent them before they happen. Dexcom CGM Systems are equipped with a built-in Urgent Low alert that can let you know the moment your glucose drops below 3.1 mmol/L so you can treat hypoglycemia as quickly as possible. Dexcom CGM Systems can also provide a predictive Urgent Low Soon alert that can notify you 20 minutes before you’re likely to experience a low under 3.1 mmol/L.‡§ This gives you some extra time to take steps to keep your glucose within your ideal glucose range and avoid hypoglycemia.14,15 Using the Urgent Low Soon alert is associated with significant reductions in hypoglycemia.12
Those who experience hypoglycemia unawareness can really benefit from using a CGM system because it can give them insight into what’s happening with their glucose, even if their body isn’t showing the signs of hypoglycemia.16 CGM systems can also make it a little easier to know whether you’re experiencing nighttime hypoglycemia. The Urgent Low and Urgent Low Soon alerts can sound and wake you up so that you can address the lows you experience while you sleep.
4. Know How to Treat Hypos and Low Glucose Emergencies
It’s critical to talk to your doctor about how to prepare to manage hypoglycemia. They may suggest taking steps like carrying sugary snacks or beverages with you to treat lows or keeping fruit juice on your bedside table overnight. Diabetes Canada recommends that individuals experiencing mild or moderate hypoglycemia consume 15 g of fast-acting carbohydrates to bring their glucose level back up. Some suggested options include:4
- Three teaspoons or five sugar cubes dissolved in water
- 15 mL or one tablespoon of honey
- 150 mL of juice or sugary soft drink
- Four 4 g glucose tablets
- Six LifeSavers candies
Individuals experiencing severe hypoglycemia and are conscious should consume 20 g of carbohydrates.4 If the person is unable to treat themselves, they need glucagon, which is administered as an injection or nasal spray.17 In a situation that requires glucagon, you should also call 911 and ensure that the person gets emergency medical care.4
Empower Yourself to Reduce Hypoglycemia with Dexcom G7
In addition to guidance from your doctor and the healthy habits that are part of your diabetes management routines, Dexcom G7 is another tool you can use to help manage your glucose levels. With Dexcom G7, you can get more insight into where your glucose levels are headed and get a heads up about whether you’re about to experience a low. This can help you make more informed choices about your next steps and give you the chance to take proactive action to prevent hypoglycemia before it happens.
* For a list of compatible smart devices visit www.dexcom.com/compatibility
† Routine fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.
‡ This predictive alert can be triggered with impending hypoglycemia (glucose of 3.1 mmol/L or below is predicted to occur within the next 20 minutes).
§ Results obtained with a prior-generation Dexcom CGM system with the same Urgent Low Soon alert.
† Routine fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.
‡ This predictive alert can be triggered with impending hypoglycemia (glucose of 3.1 mmol/L or below is predicted to occur within the next 20 minutes).
§ Results obtained with a prior-generation Dexcom CGM system with the same Urgent Low Soon alert.
Sources
- Polonsky WH, et al. The Hypoglycemic Fear Syndrome: Understanding and Addressing This Common Clinical Problem in Adults With Diabetes. Clin Diabetes. 2023; 41 (4): 502–509. https://doi.org/10.2337/cd22-0131
- Diabetic hypoglycemia. Mayo Clinic. May 6, 2022. Accessed November 27, 2024. https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525
- Imran AS, et. al. Can J Diabetes. 2018:42(S42–S46)
- Lega IC, et al. Can J Diabetes. 2023;47(7):548-559
- Planning for Sick Days. American Diabetes Association. Accessed November 27, 2024. https://diabetes.org/getting-sick-with-diabetes/sick-days
- How Hypoglycemia Unawareness Affects People with Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. April 5, 2023. Accessed November 27, 2024. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/how-hypoglycemia-unawareness-affects-people-with-diabetes
- Beck, RW, et al. JAMA. 2017;317(4):371-378.
- Beck RW, et al. Ann Intern Med. 2017;167(6):365-374.
- Martens T, et al. JAMA. 2021;325(22):2262-2272.
- Laffel LM, et al. JAMA. 2020;323(23):2388-2396.
- Welsh JB, et al. J Diabetes Sci Technol. 2024;18(1):143-7.
- Puhr S, et al. Diabetes Technol Ther. 2019;21(4):155-158.
- 1Blood Glucose and Exercise. American Diabetes Association. Accessed November 27, 2024. https://diabetes.org/health-wellness/fitness/blood-glucose-and-exercise
- Dexcom G6 User Guide
- 15 Dexcom G7 User Guide
- 16 Heinemann L, et al. Lancet. 2018;391(10128):1367-1377.
- 17 Glucagon. Cleveland Clinic. Reviewed January 3, 2022. Accessed November 27, 2024. https://my.clevelandclinic.org/health/articles/22283-glucagon