These days sugar gets a bad rap. Super-sized sodas and too much junk food in the diet are blamed for this country's obesity problem. Eating carbohydrate-rich foods like bread, rice, and pasta—which the body converts to glucose (sugar) for energy—is often frowned upon, but without sugar your body wouldn't function properly.

It's true that too much added sugar (naturally occurring sugars such as those found in fruit and lactose are considered part of a healthy diet; sugars and syrups added during food processing are not) in the diet can make us fat, but too little sugar can have serious—even life-threatening—consequences.

Just What Is Hypoglycemia, and Who Gets It?

Hypoglycemia is low blood sugar. Glucose in the bloodstream is the body's major source of energy, and when blood sugar levels are too low, the body can't function optimally.

Although you may hear the term frequently, hypoglycemia is rare in patients without diabetes. "The fact is, hypoglycemia is not an ordinary condition and many people who say they have it don't," says Robert Hasty, DO, FACOI. "I've heard people casually refer to themselves as being hypoglycemic, like having low blood sugar is somehow sexy. There's a myth that hypoglycemia in people without diabetes is common-but this simply isn't so."

Blood sugar fluctuates throughout the day, but a range between 70 and 100 milligrams per deciliter (mg/dL) of blood is considered normal. "We don't confirm the diagnosis of hypoglycemia unless a patient has a consistent reading of 55 mg/dL," says the Florida-based internist, explaining that an extensive work up—including a 72-hour fasting test—would be required for diagnosis. The low blood sugar level is currently being debated in the medical community. "At the moment 70 mg/dL is controversial. Many experts believe the cut off for low blood sugar should be 63—especially for people with diabetes."

Hypoglycemia in Diabetes Patients and Others

People with diabetes can sometimes make mistakes with their medication, like taking too much, or taking it at the wrong time or without food, which can trigger hypoglycemia. Diabetes patients who take insulin have to be especially wary of signs and symptoms of insulin-induced hypoglycemia, because accidental "Insulin overdose is one of the leading causes of medication-induced death," Hasty warns.

Symptoms of diabetic hypoglycemia include:

  • Confusion or the inability to complete routine tasks
  • Double or blurred vision
  • Heart palpitations
  • Shakiness
  • Anxiety
  • Hunger
  • Tingling sensation around the mouth

While it's possible for people who don't have diabetes to have low blood sugar, it is extremely rare. Possible reasons include:

  • Drinking too much alcohol without eating, which can keep your liver from releasing stored glucose into your bloodstream
  • Insulinoma, a rare tumor of the pancreas that causes it to produce too much insulin
  • Endocrine disorders associated with the adrenal and pituitary glands
  • Hormone deficiencies in the thyroid, which are also involved in glucose production
  • Severe heart, kidney, or liver failure
  • A body-wide infection
  • Bariatric surgery for weight loss, which can change insulin levels in the body
  • Long-term starvation, which can occur in people with eating disorders such as anorexia nervosa

 In people who do not have diabetes, at a blood sugar level of around 70 mg/dL, there may be symptoms such as

  • Shakiness
  • Sweatiness
  • Anxiety
  • Weakness
  • Hunger
  • A racing heart

Usually, having something to eat will remedy the problem right away.

Dangerously low blood sugar (50 mg/dL or less), also known as insulin shock, is a true medical emergency and can cause progressive loss of mental function, seizures, and unconsciousness. If left untreated, some damage to the nervous system can be permanent. Unconscious patients are usually given an injection of glucagon, a hormone that increases blood sugar levels.

The Future of Hypoglycemia

Hasty and others believe the future looks bright for patients with diabetes. "Technology is dramatically improving life for diabetics and we are getting close to the stage where a patient will be attached to a continuous glucose monitor, which would function like substitute pancreas and be much more convenient and reliable than the current system of constant blood sugar monitoring," says Hasty. "I'm confident that in the not-too-distant future having diabetes will be a low burden on the patient's life."

Robert Hasty, DO, FACOI, reviewed this article.




Interview with Robert Hasty, DO, FACOI
Palmetto General Hospital Internal Medicine Residency
Vice Chair and Associate Professor of Internal Medicine
Nova Southeastern University College of Osteopathic Medicine

National Diabetes Information Clearinghouse (NDIC). "Hypoglycemia." The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Web. Page last updated 6 Nov. 2012. Page accessed 22 June 2013.

"Type 1 Diabetes: Complications." The New York Times. Web. Page reviewed 22 May 2012. Page accessed 22 June 2013.

The Mayo Clinic Staff. "Diabetic Hypoglycemia." The Mayo Clinic. Web. Page updated 3 April 2012. Page accessed 22 June 2013.