While we often talk about high blood sugar which is increasing among Indians at an alarming rate, low blood sugar somehow seems like a negligent problem.

Dr. Dheeraj Kapoor, Chief – Endocrinology, Artemis Hospital Gurugram explains, “High blood sugars are often talked about because we’ve been told that they cause complications like the cardiac disease, stroke, neuropathy, nephropathy, retinopathy, which means, uh, kidney damage, nerve damage, eye damage. And now liver damage is being talked about. But most of us do not realize the gravity of what a hyperglycemia can do.
Low sugars can be potentially disastrous and catastrophe. And since most of us don’t realize the gravity, we don’t talk about it. The other issue is that we think that lower the better, so if we keep sugar very, very low, we might avoid complications, but at the same time it is important to note that we should not neglect hyperglycemia.”

“Most diabetics are not aware of hypoglycemia”

63-year-old Ganga Thakur who takes insulin to manage her sugar levels was taking her evening walk when she suddenly collapsed. Fortunately, her son was with her to get her back home safely. On diagnosis, she was told her sugar dropped, which left her shocked, “How can my blood sugar drop when I am taking medicines to control high sugar?” She is not alone. Most diabetics are unaware that their sugar can drop and it will need immediate attention.

Hypoglycemia is common in people with diabetes who are taking medication to increase insulin (sulphonylureas) or insulin itself. In such patients, hypoglycemia can occur if there is an imbalance between medication, food and exercise, shares Dr. Ambrish Mithal, Chairman & Head -Endocrinology & Diabetes, Max Healthcare.

Dr Kapoor explains, “
The first is that they are not aware that this condition exists because in the busy OPDs most doctors do not explain this. The second is if the patient’s sugar is persistently low then the body gets used to those low sugars and therefore if there is a marginal decrease, maybe 65 or 60 mg percent of glucose the body might not recognize because it is used to the 75s and 80s, that is called hypoglycemia unawareness. Yes, with long standing diabetes certain hormones may also become low. These are the hormones which produce symptoms of hypoglycemia. So, if those hormones are low the symptoms of Hypoglycemia may not be evident and therefore this may happen. So, we have three causes: the patient has not been educated, blood sugar is below normal and lack of hormones which trigger the symptoms of hypoglycemia.”

Dr. Harish Kumar, Clinical Professor and Head, Centre for Endocrinology and Diabetes, Amrita Hospital, Kochi shares, “Actually, I think all patients with diabetes should be much more careful about low blood sugars. Because when the blood sugar goes low, it can lead to a very dangerous situation and so there must be more awareness about hypoglycemia.
Even if the blood sugars are running high in patients with type II diabetes, there is generally no immediate danger to health or life but if the hypoglycemia goes very low then it can result in a state of unconsciousness and lead to serious consequences. So I think awareness about hypoglycemia is a must. Hypoglycemia is relatively rare but patients should keep in mind that hypoglycemia can occur and certainly awareness about this is extremely important.”

All diabetics should be aware that if they are on treatment for diabetes with either tablets or oral hypoglycemic agents, then if their food is delayed or they miss a meal, then it is quite likely that the blood sugar might drop down a little bit. So they must be always aware of the possibility of hypoglycaemia. Generally, I think they need to look out for symptoms of hypoglycemia. The moment they experience hypoglycemia, then they should do something about it.

What they can do is that if the next meal is due say, you are having a hypoglycemic episode at 12pm, you normally have lunch at 1 or 1:30 in the afternoon, do not wait for lunchtime, you can probably have an early lunch, or if you are not in a situation where you can have an early lunch, then you need to have a snack maybe you can have a cup of tea with sugar or you can have a couple of biscuits or banana or something which will prop up the sugar until your meal time arrives. So you need to take corrective action in order to prevent hypoglycemia from coming more severe,” he adds.

Signs of low blood sugar

Dr. Mithal shares classic symptoms of hypoglycemia

Some initial signs and symptoms of hypoglycemia include:

Looking pale


Dizziness or lightheadedness


Hunger or nausea

An irregular or fast heartbeat

Difficulty concentrating





Tingling or numbness of the lips, tongue or cheek

If hypoglycemia isn’t treated, signs and symptoms of hypoglycemia worsen and can include:


Unusual behaviour

Loss of coordination

Difficulty speaking or slurred speech

Blurred vision

Inability to eat or drink

Muscle weakness


Severe hypoglycemia may cause:

Convulsions or seizures


Treating blood sugar at home

If the patient is suffering from an episode of hypoglycemia, no need to panic. The patient and the caregiver should be aware of ways to manage it at home.

Dr Kumar explains, “Mild hypoglycemia is very easy to treat, just the patient needs to be aware of it so they need to either have a sweet drink or take a small snack. As I mentioned earlier, if the meal time is due, they could probably have the meal early. That will abort mild hypoglycemia. All these can be easily done obviously at home or during your regular routine. Even if you are at work, all these corrective actions can be taken.

But if the hypoglycemia is more severe and the patient is unwell, he may need help. When the patient needs help, that is a more severe degree of hypoglycemia. So the people around him must also be aware that he has diabetes and could possibly develop hypoglycemia. When the patient is unable to help himself and when he is confused and behaving in an odd fashion, people who are with him should encourage him to eat something sweet, have a snack or drink some glucose if the sugar is pretty low. All this can be done at your home, school or office as far as children with type 1 diabetes are concerned. If the episode is more severe and the patient is unconscious, then a glucagon injection has to be injected. So for all patients who are prone to severe hypoglycaemia, it is recommended that glucagon injection should be stored at home and the bystander should be trained in giving a glucagon injection which would bring up the blood sugars rapidly. But in general, blood sugars would rarely go down to that level. Usually, hypoglycaemia is very mild or moderate and can be easily corrected with the intake of calories which would bring the blood sugars up.”

Low sugar can be treated at home. The rule of 15 works in which if the sugars are below 70, in fact between 55 and 69, 15 gms of carbohydrates should be given and sugar should be checked after 15 minutes, and this process should be repeated till the time the sugar is not in the range. Now how to calculate 15 gms of carbohydrate? Roughly one teaspoon of sugar is around 4 and a half grams of carbohydrates. Short of that you could give juice, honey, and glucose. At this point in time, I would suggest that you don’t waste your time making sweet tea or sherbet because first of all every moment is precious, so don’t waste time in preparing. Obviously, the tea is hot, and the person cannot gulp it in one go, therefore it is best avoided. The best way to go is juice, glucose and of course sugar. Now if the patient is unconscious, please do not give him any juice or anything to eat, because it will go into the windpipe and the trachea and may choke the patient. So, by that time what you can do is that you could make a paste out of sugar and rub it on the mouth, below the lips or inside the cheeks, explains Dr Kapoor.


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