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What to know about diabetes and risks of low blood sugar, hypoglycemia

A Mayo Clinic study found thousands of people with diabetes need hospital treatment for hypoglycemia each year.

Diabetes is a serious disease in which blood sugar levels can spike too high and need be controlled.

But some people with diabetes also are at risk for blood sugar to swing in the opposite direction and dip far too low, triggering a dangerous condition called hypoglycemia that can cause disorientation, weakness, seizures or, in severe cases, death.

A recent study by the Mayo Clinic estimated about 20 percent of diabetes patients are treated too intensively with medicines or insulin, which led to thousands of hospital visits for hypoglycemia.

“This is a big problem ... and it’s been around for many years now and unfortunately the number [of cases] hasn’t budged much in the past ten years,” Rozalina McCoy, an endocrinologist at the Mayo Clinic and co-author of the new study, told TODAY.

McCoy and her team at the Mayo Clinic noticed the concerning trend and wanted to find out more. They examined data from more than 10.2 million people with diabetes between 2011 and 2014 from the National Health and Nutrition Examination Survey (NHANES) and the OptumLabs Data Warehouse and found about 2.3 million had likely been overtreated.

Nearly 10,000 people in the study group had severe hypoglycemia incidents related to glucose-lowering therapy and visited emergency rooms or were hospitalized.

The symptoms of dangerously low blood sugar, or hypoglycemia, can be any or all of these.
The symptoms of dangerously low blood sugar, or hypoglycemia, can be any or all of these.Getty Images

“We always thought lower blood sugar levels were better and ... would prevent complications from diabetes,” Rekha Kumar, an endocrinologist at Weill Cornell Medicine and New York-Presbyterian, who was not involved in this study, told TODAY.

She said this study is an important reminder of the risks of hypoglycemia as the diabetes epidemic continues to expand.

Roughly 30 million people have diabetes in the U.S. and only three-quarters may know they do, the Centers for Disease Control and Prevention said.

Hypoglycemia can affect people with both kinds of diabetes: type 1, in which the body makes no insulin, and type 2, in which the body makes some, but not enough insulin. About 95 percent of diabetes patients have type 2, which often begins in adulthood and can be lifestyle-related, according to the CDC.

Normal blood sugar levels range from 80 to 120 mg/dL before meals and less than 180 mg/dL within a couple hours after meals, according to the CDC. Hypoglycemia is defined as blood sugar levels falling below 70 mg/dL.

Diabetes treatment plans are developed based on certain standards and doctors have protocols to assess whether patients are on track.

The vast majority of people with diabetes are not over-treated. In fact, many people aren’t able to receive enough treatment with recent shortages of available insulin. Scientists predict the amount of insulin needed to treat diabetics is expected to rise by more than 20 percent from 2018 to 2030 limiting access to the estimated 40 million people who are likely to need it.

But, it’s not uncommon for standard diabetes treatment to be too aggressive for some individuals and lower blood sugar too much. It can also be complicated when patients are taking a variety of medications for other health issues.

“Low blood sugar mostly affects people with diabetes who are on many medications,” said Jason Baker, an endocrinologist at Weill Cornell Medicine and New York-Presbyterian, who was not involved in the study. “This interferes with our ability to safely get the control that we need to prevent complications that are at the opposite end of the spectrum, which are high blood sugars.”

Some people may mistake hypoglycemia symptoms as typical side effects of having diabetes. But very low blood sugar or other signs of hypoglycemia are not normal, doctors say. People under treatment for diabetes should speak to their doctors if they notice any of these conditions.

The American College of Physicians recommends diabetics maintain a hemoglobin A1c (HbA1c) between 7 and 8 percent. The hemoglobin A1c test is performed by doctors to help them monitor diabetes.

“If a patient is at a low level of HbA1c and they haven’t told their doctor they’re experiencing hypoglycemic events, it’s a problem,” McCoy said, “and patients don’t always tell doctors if they are having difficulty because they see it as just an unavoidable consequence of the disease.”

People with diabetes should regularly check glucose levels to monitor themselves and have an emergency plan in case they dip too low into hypoglycemia:

  1. Make certain to check glucose levels via finger prick test if exhibiting signs of hypoglycemia.
  2. Carry emergency food supplies with high sugar concentrations, such as candy and sugar pills.
  3. Always keep an injection kit nearby with glucagen—which has the opposite effect of insulin and can quickly raise blood sugar levels in a hypoglycemic emergency.
  4. Never use insulin when blood sugar levels are too low, it will drive levels down further.

Diabetes management is complicated, but communication is key. McCoy encourages patients to talk about their day-to-day experiences with their doctors to improve treatment.

“The key to finding the right way to manage diabetes lies in working with your healthcare providers to discover what works best for you,” she said. “Reach out to your doctor and have a candid conversation about your concerns and then work with all the resources at your disposal to push ahead and find your balance.”