Severe Hypoglycemia: What to Do

Many of the medications used to treat diabetes may lower your blood sugar too much, resulting in hypoglycemia.

This is typically defined as a blood sugar of <70 mg/dl (3.9 mmol/L).

Once your sugar drops below this value, your body releases hormones, such as epinephrine and glucagon, in an attempt to return your sugar to the normal range.

For every 10 mg/dl (0.6 mmol/l) your sugar drops, the concentration of these hormones doubles.

With their release, the typical symptoms of hypoglycemia ensue: sweating, heart racing, shakes, hunger, head aches and anxiety.

The risk of hypoglycemia is greatest with the sulfonylureas ( examples include Glipizide, Glyburide, and Glimiperide), the meglitinides (Prandin and Starlix), and insulin.

Hypoglycemic risk is significantly reduced with Metformin, the DPP-4 inhibitors (Januvia, Onglyza and Tradjenta), the GLP-1 agonists (Byetta, Victoza, Bydureon), and the thiazolidinediones (Actos).

The hypoglycemic risk of these drugs approaches that of placebo, especially when used alone.

Since the brain requires sugar to function, but is unable to make sugar, low sugar in the blood may result in brain -related symptoms.

These symptoms include personality changes, inappropriate anger, confusion, slurred speech, seizures, and loss of consciousness.

Brain-related changes are most often observed when the blood sugar (BG) is <50 mg/dl (2.8 mmol/L).

It is very unusual for sugars to drop low enough to cause brain-related symptoms, unless food access is limited, since most people eat something as soon as hypoglycemic symptoms occur.