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Hypoglycemia is a medical emergency and a dangerous condition for type 1 and type 2 diabetics. Sometimes referred to as insulin shock or an insulin reaction, hypoglycemia occurs when blood glucose levels have fallen well below the normal range. Hypoglycemia is rare in those without diabetes.

Patients who have been newly diagnosed with diabetes should learn to recognize the early symptoms of hypoglycemia, as this condition can accelerate very quickly and put the diabetic patient at risk of an accident. One may go from being light-headed and feeling a little "woozy" to involuntary muscle twitching, poor coordination, blurred vision, slurred speech, and possible seizure in a matter of minutes. In severe cases, hypoglycemia may cause coma or death.

What is hypoglycemia?

Technically, hypoglycemia is present when blood sugal levels drop below 60 mg/dl. However, diabetics may start to experience some of these symptoms before their glucose levels fall to that point. The severity of symptoms depends on how long diabetes has been present, and the patient's individual blood glucose target as recommended by their health care provider. Drinking alcohol when diabetic may also cause low blood sugar, as well as certain prescription medicines when taken with your diabetes medication.

Each patient's reaction to hypoglycemia can be different - some exhibit mild symptoms and some quite severe symptoms in a matter of minutes. The early symptoms of the condition may also be confused with those of other illnesses like flu. If any symptoms of hypoglycemia are present, check blood glucose levels as soon as possible.

Symptoms of hypoglycemia:

• Sweating and chills
• Lightheadness or dizziness
• Trembling
• Rapid heartbeat
• Hunger or nausea
• Weakness or fatigue
• Headache
• Sleepiness
• Nightmares (hypoglycemia can occur when you sleep)
• Blurred vision / double vision
• Sudden mood swing
• Anxiety
• Irritability
• Confusion
• Poor coordination
• Poor concentration
• Difficulty speaking
• Irrational behavior
• Tingling or numb senasation in lips or tongue
• Seizure
• Unconsciousness (which may lead to diabetic coma)

If you are diabetic and experience any of the above symptoms, check your blood glucose levels immediately. If your meter isn't close at hand, opt for caution and treat for low blood sugar by consuming 15-20 grams of glucose or simple carbohydrates by any of these methods:

• Glucose tablets (as per package instructions)
• Gel tube (as per packege instructions)
• 1/2 cup (4 ounces) of fruit juice or soda (not diet)
• 1 tablespoon of honey held under the tongue for a few minutes (glucose is absorbed faster)
• 1 tablespoon of sugar or corn syrup
• 1 cup (8 ounces) of non-fat milk
• 2 tablespoons of raisins
• ***Do not attempt to give liquids to a person who is unconscious, as this may cause choking. Call 911

After treatment, wait 15 minutes and check blood glucose levels. If hypoglycemia is still present, treat again. Once blood sugar returns to normal, eat a small meal or small snack as recommended by your diabetes health care provider. If hypoglycemia persists after a second treatment, call 911.

Read: The impact of diabetes on your feet

What causes hypoglycemia?

When your body digests food, it is broken down into various sugar molecules, including glucose, the primary source of energy for your body. This energy is needed not only for physical activity, but for cell function, brain function, and organ function as well. Glucose enters your bloodstream right after you eat, and with the assistance of insulin secreted by the pancreas, enters your cells. In the case of diabetics, insulin production or utilization is compromised, and glucose remains in the bloodstream, causing high blood sugar.

A normally functioning body deals with blood sugar very efficiently. When blood sugar rises after a meal, it signals beta cells in your pancreas to release insulin. Any glucose unused by your cells is stored in the liver and muscles as glycogen. When you skip a meal and your blood sugar level drops, a different hormone in your pancreas, glucagon, signals your liver to release the stored glycogen into your bloodstream as glucose.  This two-fold process keeps glucose from becoming too high or too low at any time. As an added safeguard, your body also creates glucose in your liver and kidneys in a process called gluconeogenesis.

If you have type 1 diabetes, your pancreas does not produce enough insulin. If you have type 2 diabetes, your cells do not respond properly to insulin. To regulate insulin levels, you either take synthetic insulin or an oral medicine to help your cells utilize glucose. Hypoglycemia can be caused by taking too much insulin relative to your blood sugar levels. It can also be caused by taking your oral medicine and not eating a sufficient amount of food to maintain your blood levels. Hypoglycemia may also occur after exercising when not ingesting sufficient glucose to replace what is used by your muscles.

When Hypoglycemia occurs, your glucose blood levels have dropped below what is required for proper brain, cell, and organ function. The brain is particularly sensitive to low blood glucose levels, because sugar is its main energy source.  This is why a diabetic suffering hypoglycemia becomes confused, may have blurred vision, or may display poor coordination.

The body first responds to a fall in the level of glucose in the blood by releasing epinephrine from the adrenal glands. Epinephrine stimulates the release of glucose from body stores but also causes symptoms similar to those of an anxiety attack: sweating, nervousness, shaking, faintness, palpitations, and hunger. More severe hypoglycemia reduces the glucose supply to the brain, causing dizziness, fatigue, weakness, headaches, inability to concentrate, confusion, inappropriate behavior that can be mistaken for drunkenness, slurred speech, blurred vision, seizures, and coma. Severe and prolonged hypoglycemia may permanently damage the brain. Symptoms can begin slowly or suddenly, progressing from mild discomfort to severe confusion or panic within minutes. Sometimes, people who have had diabetes for many years (especially if tightly controlled) are no longer able to sense the early symptoms of hypoglycemia, and faintness or even coma may develop without any other warning.

-Merck Manual Home Edition

How to prevent hypoglycemia

• Check blood glucose levels on a regular basis
• Follow your diabetes management plan
• Learn how to detect the early symptoms of hypoglycemia
• If you experience hypoglycemia, consult with your diabetes health care professional
• Eat meals on schedule which contain foods recommended by your diabetes health care provider/nutritionist
• Avoid drinking alcohol. Alcohol blocks your liver from releasing stored glucose into your bloodstream
• Eat carbohydrate-rich food before exercising
• Be prepared - carry glucose tablets with you and your blood glucose meter at all times
• Advise friends, family, and colleagues of your condition. Explain to them the symptoms of hypoglycemia and what to do if they suspect you're suffering an episode of low blood sugar.
• Wear an ID bracelet identifying you as diabetic. This will help emergency responders diagnose your condition in case of an accident.