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diabete

Hypoglycemia: Symptoms, Causes, and What to Do Immediately

TTeam VitaeChek·25 August 2026·3 min di lettura
Ipoglicemia: Sintomi, Cause e Cosa Fare Immediatamente

Hypoglycemia — low blood sugar — is the most common metabolic emergency in diabetics on therapy. It can be frightening the first time, but it is manageable if you know what to do and have a glucometer at hand.

What is Hypoglycemia

Hypoglycemia occurs when blood sugar drops below 70 mg/dL (3.9 mmol/L). It is classified into three degrees of severity:

Grade Blood Sugar Symptoms Action
Mild 54–70 mg/dL Tremors, sweating, hunger Rule of 15-15
Moderate 40–54 mg/dL Confusion, difficulty concentrating Rule of 15-15 repeated
Severe < 40 mg/dL or loss of consciousness Seizures, loss of consciousness Glucagon + call 118

Symptoms of Hypoglycemia

Symptoms are divided into two categories:

Adrenergic symptoms (first to appear)

  • Hand tremors
  • Sudden cold sweats
  • Palpitations and rapid heartbeat
  • Pallor
  • Sudden hunger
  • Anxiety and irritability

Neuroglycopenic symptoms (lower blood sugar — the brain lacks glucose)

  • Mental confusion, difficulty concentrating
  • Blurred or double vision
  • Headache
  • Strange or aggressive behavior (often noticed by those nearby)
  • Difficulty speaking
  • In severe cases: loss of consciousness, seizures

Beware of hypoglycemia unawareness: people who have experienced many episodes of hypoglycemia over time may lose the ability to recognize early adrenergic symptoms. In these cases, frequent monitoring — or CGM — is essential.

Causes of Hypoglycemia

In diabetics on therapy (most common causes)

  • Insulin dose too high compared to the meal consumed
  • Missed or delayed meal after taking medication
  • Unplanned physical activity (consumes extra glucose)
  • Alcohol on an empty stomach (blocks hepatic glucose production)
  • Error in the dose of secretagogue drugs (sulfonylureas, glinides)

In non-diabetics

  • Prolonged fasting or very restrictive diets
  • Intense physical activity without adequate nutrition
  • Reactive postprandial hypoglycemia (2–4h after meals rich in high GI carbohydrates)
  • Use of certain medications (high-dose aspirin, beta-blockers, quinolones)
  • Rare conditions: insulinoma, adrenal insufficiency, severe malnutrition

What to Do: The Rule of 15-15

The 15-15 rule is the standard protocol for treating mild-to-moderate hypoglycemia (blood sugar 40–70 mg/dL with a conscious patient):

  1. Consume 15 g of fast-acting carbohydrates (see list below)
  2. Wait 15 minutes without eating anything else
  3. Check blood sugar again
  4. If it is still below 70 mg/dL: repeat the cycle (another 15 g + 15 minutes)
  5. When blood sugar is above 70 mg/dL: consume a small protein snack to stabilize it (crackers + cheese, or dried fruit)

15 grams of fast carbohydrates are equivalent to:

  • 3–4 glucose tablets (always carry them with you)
  • 150 mL of fruit juice or sugary drink (not light)
  • 1 tablespoon of sugar or honey dissolved in water
  • 100 mL of Coca-Cola or similar (not zero)

What NOT to do: do not eat chocolate, ice cream, or fatty foods — fat slows down carbohydrate absorption and blood sugar rises slowly. Do not eat "until you feel better" — you risk a rebound too high.

Severe Hypoglycemia: Glucagon and Emergency Services

If the person is unconscious or unable to swallow: DO NOT attempt to give them anything to drink — risk of choking.

  • Place them on their side (recovery position)
  • Administer intramuscular glucagon if available (prescription kit for diabetics on insulin therapy)
  • Call 118 immediately

Prevention: How to Avoid Hypoglycemia

  • Check blood sugar before and after intense physical activity
  • Do not skip meals after taking secretagogue medications or insulin
  • Always carry glucose or fruit juice with you
  • Inform family members or colleagues that you are diabetic and where you keep emergency glucagon
  • Set the low blood sugar alarm on the app if you use a Bluetooth glucometer

The VitaeChek G1 Pro with the integrated app allows you to set personalized alarm thresholds: when blood sugar drops below your chosen threshold (e.g., 80 mg/dL), the app sends a notification — a useful reminder to act before the situation becomes critical.

Frequently Asked Questions

Blood sugar 65 without symptoms: should I treat it?

Yes. Even if you don't feel symptoms, blood sugar below 70 mg/dL requires the 15-15 rule. The absence of symptoms may indicate hypoglycemia unawareness — a condition that requires discussion with your diabetologist.

Does hypoglycemia cause diabetes?

No. Hypoglycemia does not cause diabetes. In non-diabetics, recurrent hypoglycemic episodes may indicate conditions that warrant medical evaluation.

Can I drive with low blood sugar?

No. Never drive if your blood sugar is below 90 mg/dL. Before driving, always check your blood sugar and treat any low values before starting your journey.

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