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Article by Lahle Wolfe, Founder, Islets of Hope.  For article use and reprint permission please contact:

American Diabetes Association
Diabetes Health Net
EMedicine - Fred Smeeks, MD
EDoctor UK
Nat'l Diabete Info Clearinghouse
UVA Health

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(LOW Blood Glucose)

Onset:  Rapid; sudden, may not be preventable.

Causes Related to Diabetes: Missing snacks or meals, eating too little food, taking too much insulin, too much activity, side effects of medications taken, or a combination of these things.

Causes Unrelated to Diabetes: Reacting fasting hypoglycemia, fasting hypoglycemia (which may indicate an underlying disease).

ALERT:  All lows are potentially dangerous and can lead to seizure, convulsion, unconsciousness, and death if not treated.  If you are unable to test someone's blood glucose, always assume the person is low and treat for low blood glucose.  Call 911 and test blood glucose as soon as possible.

Did You Know?

...that aspirin in large doses, and sulfa drugs used to treat infections can cause low blood glucose?

...that in reactive hypoglycemia, symptoms appear within 4 hours after you eat a meal?

Check out IOH's Diet & Recipe Section for Comparisons and Information on Low-Fat, Low-carb, Low-Glycemic, and Diabetes Exchange Meal Plans

Points to Remember

Diabetes-Related Hypoglycemia

If you think your blood glucose is low, check it and treat the problem right away.

Use the 15-15 rule to treat hypoglycemia

To treat hypoglycemia, take a fast-acting sugars of 15 grams of carbohydrates (or whatever your care plan suggests). Wait 15 minutes, and recheck your blood glucose. Repeat the treatment until your blood glucose is above 70.

Keep fast-acting sugars in the car, at work, school, and home —anywhere you spend time.

Be careful when you are driving. Check your blood glucose frequently and snack as needed to keep your level above 70 mg/dL.

Hypoglycemia Unrelated to Diabetes

In reactive hypoglycemia, symptoms occur within 4 hours of eating. People with this condition are usually advised to follow a healthy eating plan recommended by a registered dietitian.

Fasting hypoglycemia can be caused by certain medications, critical illnesses, hereditary enzyme or hormonal deficiencies, and some kinds of tumors. Treatment targets the underlying problem.


islets of hope diabetes medical library            back to main "Glycemia Information"
Diabetes Information                                                                        
Printable Version of this Article

Hypoglycemia in nondiabetic persons
Reactive hypoglycemia & fasting hypoglycemia

Causes, symptoms, treatment & prevention
(hypoglycemia is also called low blood glucose or low blood sugar)

Mini site index
Hypoglycemia in People Who Do Not Have Diabetes
Symptoms of Non-Diabetes Related Hypoglycemia
Reactive Hypoglycemia
Fasting Hypoglycemia
Conditions Occurring in Childhood and Infancy
More Information

Hypoglycemia in People Who Do Not Have Diabetes

Two types of hypoglycemia can occur in people who do not have diabetes: reactive (postprandial, or after meals) and fasting (postabsorptive). Reactive hypoglycemia is not usually related to any underlying disease; fasting hypoglycemia often is.  

Symptoms of Non-Diabetes Related Hypoglycemia

Symptoms of hypoglycemia in diabetes non-diabetes causes are similar.  It is important to remember that people can react differently to low blood glucose levels.  Children will often become belligerent and weepy but Elizabeth (my daughter), acts like she is drunk; wobbly and silly, laughing hysterically at everything and anything.

Generally, symptoms of hypoglycemia include:

Mild Hypoglycemia

  • Increased or sudden hunger
  • Feeling shaky, dizzy or nervous
  • Pounding heartbeat
  • Drowsiness, feeling tired
  • Sweating (cold and clammy)
  • Numbness or tingling around the mouth
  • Headache or stomachache

Moderate Hypoglycemia

Any of the above mild symptoms, plus: 

  • Headache
  • Personality change
  • Irritability
  • Confusion and/or difficulty concentrating
  • Headache or stomachache
  • Slurred or slow speech
  • Poor coordination

Severe Hypoglycemia                    * * * Give glucagon & CALL 911 ASAP! * * *

Any of the above mild or moderate symptoms, plus:

  • Loss of consciousness
  • Seizures and/or convulsions
  • Death

Severe hypoglycemia requires injection of glucagon to save the person's life!

Hypoglycemia can also happen while you are sleeping. You might:

  • Cry out or have nightmares
  • Find that your pajamas or sheets are damp from perspiration
  • Feel tired, irritable, or confused when you wake up
  • Wake up with high blood glucose or a headache.  

If you are diagnosed with hypoglycemia, your doctor will try to find the cause by using laboratory tests to measure blood glucose, insulin, and other chemicals that play a part in the body's use of energy.  


Reactive Hypoglycemia

Note:  In reactive hypoglycemia, symptoms appear within 4 hours after you eat a meal.


A blood glucose level of less than 70 mg/dL at the time of symptoms and relief after eating will confirm the diagnosis. Because a personal blood glucose monitor cannot be used to diagnose reactive hypoglycemia you need to see your doctor if you feel you might be suffering from non-diabetes related hypoglycemia.  To diagnose reactive hypoglycemia, your doctor may:

  • Ask you about signs and symptoms

  • Test your blood glucose while you are having symptoms (The doctor will take a blood sample from your arm and send it to a laboratory for analysis.

  • Check to see whether your symptoms ease after your blood glucose returns to 70 or above (after eating or drinking).

Note:  The oral glucose tolerance test is no longer used to diagnose hypoglycemia; experts now know that the test can actually trigger hypoglycemic symptoms.

Causes and Treatment of Reactive Hypoglycemia

The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body's normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe that deficiencies in glucagon secretion might lead to hypoglycemia.

A few causes of reactive hypoglycemia are certain, but they are uncommon. Gastric (stomach) surgery, for instance, can cause hypoglycemia because of the rapid passage of food into the small intestine. Also, rare enzyme deficiencies diagnosed early in life, such as hereditary fructose intolerance, may cause reactive hypoglycemia.

To relieve reactive hypoglycemia, some health professionals recommend taking the following steps:

  • Eat small meals and snacks about every 3 hours
  • Exercise regularly
  • Choose high-fiber foods
  • Avoid or limit foods high in sugar, especially on an empty stomach
  • Eat a variety of foods, including meat, poultry, fish, or non-meat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products.

Your doctor can refer you to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet for reactive hypoglycemia.


Fasting Hypoglycemia


Fasting hypoglycemia is diagnosed from a blood sample that shows a blood glucose level of less than 50 mg/dL after an overnight fast, between meals, or after exercise.

Causes and Treatment of Fasting Hypoglycemia

Causes include certain medications, alcohol, critical illnesses, hormonal deficiencies, some kinds of tumors, and certain conditions occurring in infancy and childhood.


Medications, including some used to treat diabetes, are the most common cause of hypoglycemia. Other medications that can cause hypoglycemia include

  • Salicylates, including aspirin, when taken in large doses
  • Sulfa medicines, which are used to treat infections
  • Pentamidine, which treats a very serious kind of pneumonia
  • Quinine, which is used to treat malaria

If using any of these medications causes your blood glucose to drop, your doctor may advise you to stop using the drug or change the dosage.

Other Causes of Fasting Hypoglycemia

  • Alcohol - Drinking, especially binge drinking, can cause hypoglycemia because your body's breakdown of alcohol interferes with your liver's efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be very serious and even fatal.
  • Critical Illnesses - Some illnesses that affect the liver, heart, or kidneys can cause hypoglycemia. Sepsis (overwhelming infection) and starvation are other causes of hypoglycemia. In these cases, treatment targets the underlying cause.
  • Hormonal Deficiencies - Hormonal deficiencies may cause hypoglycemia in very young children, but usually not in adults. Shortages of cortisol, growth hormone, glucagon, or epinephrine can lead to fasting hypoglycemia. Laboratory tests for hormone levels will determine a diagnosis and treatment. Hormone replacement therapy may be advised.
  • Tumors  - Insulinomas, insulin-producing tumors, can cause hypoglycemia by raising your insulin levels too high in relation to your blood glucose level. These tumors are very rare and do not normally spread to other parts of the body. Laboratory tests can pinpoint the exact cause. Treatment involves both short-term steps to correct the hypoglycemia and medical or surgical measures to remove the tumor.  

Conditions Occurring in Infancy and Childhood

Children rarely develop hypoglycemia. If they do, causes may include

  • Brief intolerance to fasting, often in conjunction with an illness that disturbs regular eating patterns. Children usually outgrow this tendency by age 10.

  • Hyperinsulinism, which is the excessive production of insulin. This condition can result in transient neonatal hypoglycemia, which is common in infants of mothers with diabetes. Persistent hyperinsulinism in infants or children is a complex disorder that requires prompt evaluation and treatment by a specialist.

  • Enzyme deficiencies that affect carbohydrate metabolism. These deficiencies can interfere with the body's ability to process natural sugars, such as fructose and galactose, glycogen, or other metabolites.

  • Hormonal deficiencies such as lack of pituitary or adrenal hormones.


More Information About Hypoglycemia

People with diabetes
Symptoms of Hypoglycemia in Diabetes
Causes of Hypoglycemia in Diabetes
Prevention of Hypoglycemia in Diabetes
Printable Hypoglycemia Guides
Normal Blood Glucose Ranges
Normal and Target Blood Glucose Ranges for Diabetics

Related Information
Insulin Shock
Diabetic Seizures and Coma from Hypoglycemia 
Shot Therapy
Insulin Pump Therapy
Types of Insulin
Tips from Others Living With Diabetes
Lifestyle Changes
Diets for Diabetes and Hypoglycemia

Important Medical Disclaimer

All material found on this site is for general information purposes.  You need to seek out the advice of a medical doctor for diagnosis and treatment of any medical concern or problem. Please do not attempt to self-diagnose or treat any medical problem on your own!



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Page Updated 03/10/2006