What is hypoglycaemia?
Close Answer
Hypoglycaemia, or low blood sugar, occurs when the blood sugar levels fall to 3.9 mmol/l or below (≤ 70 mg/dl).1 When the blood sugar level is too low, it cannot provide the body’s organs with the energy they need.
What are the health risks of hypoglycaemia?
Close Answer
Hypoglycaemia can cause a range of symptoms including confusion, trembling, sweating, increased heart rate, difficulty with concentration and speech, and in severe cases can lead to a seizure or coma.2-4

People with Diabetes who experience recurrent hypoglycaemia or severe hypoglycaemia may be at an increased risk of cardiovascular complications, such as strokes and heart attacks.5-7

What are the symptoms of hypoglycaemia?
Close Answer
Everyone reacts differently to low blood sugar. If you have a friend or family member living with diabetes you might spot these warning signs8,9:


  • Slurred speech
  • Cool pale skin
  • Shakiness
  • Unusually sweaty
  • Acting nervous or worried
  • Acting irritable or impatient
  • Clumsiness
  • Seizures
  • Crying out during sleep


In addition, if you’re living with diabetes yourself, low blood sugar might also make you feel8,9:


  • Very hungry
  • Nauseous
  • Confused
  • Nervous or anxious
  • Sweaty, chilly and clammy
  • Shaky
  • Fast heartbeat
  • Headache
  • Lightheaded or dizzy
  • Blurry or impaired eyesight
  • Difficulty concentrating
  • Tingling or numbness in lips/tongue or cheeks
  • Sleepy
  • Weak or no energy
  • Nightmares


It’s important to manage low blood sugar straight away when it happens. 
What should I do when I or someone with diabetes has low blood sugar?
Close Answer
A hypo can develop into a serious situation if it is not managed. So, if you think you’re having a hypo – act promptly. 
Treating yourself 8,9
If you think you’re having a hypo, this is what to do:


1. If you have a meter, test your blood glucose. If your blood sugar is less than 3.9 mmol/l (70 mg/dl) or you have hypo symptoms, then eat or drink something with sugar in it – try a glass of fruit juice or some non-diet fizzy drink, a few sweets, or four to five dextrose tablets.
2. Test your blood sugar after 10-15 minutes, and based on your blood sugar values (or symptoms) follow one of the steps below:
a) If the reading is 3.9 mmol/l (70 mg/dl) or above and you’re feeling OK, eat your main meal (containing carbohydrate) if you're about to have it, or have a carbohydrate-containing snack such as some toast with spread, a couple of biscuits or a milky drink. 
b) If your blood sugar remains below 3.9 mmol/l (70 mg/dl) or still feel unwell, have some more sugary drink or snack and retest in another 10–15 minutes.


Treating someone else 8,9
If you think someone is having a hypo and they can’t help themselves because they’re unconscious or drowsy, follow these steps:


1. Put the person in the recovery position
2. Give them an injection of glucagon medicine – if it's available and you know how to use it  or Seek medical assistance / call for an ambulance
3. When the person wakes up and starts to recover, give them a sugary drink or snack, followed by a carbohydrate-containing snack

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1American Diabetes Association. Standards of Medical Care in Diabetes-2019. Diabetes Care 2019;42(Suppl.1): S61-S70.

2Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36:1384-95.

3International Hypoglycaemia Study Group. Diagnosis of hypoglycaemia. Available online at http://ihsgonline.com/understanding-hypoglycaemia/diagnosis. Last accessed: February 2019.

4Cryer PE. Hypoglycemia, functional brain failure, and brain death. J Clin Invest. 2007; 117:868-870.

5Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L, Woodward M, Ninomiya T, Neal B, MacMahon S, Grobbee DE, Kengne AP, Marre M, Heller S for the ADVANCE Collaborative Group. Severe Hypoglycaemia and Risks of Vascular Events and Death. New England Journal of Medicine 2010; 363:1410–1418.

6Heller SR, Bergenstal RM, White WB, Kupfer S, Bakris GL, Cushman WC, Mehta CR, Nissen SE, Wilson CA, Zannad F, Liu Y, Gourlie NM, Cannon CP for the EXAMINE Investigators. Relationship of glycated haemoglobin and reported hypoglycaemia to cardiovascular outcomes in patients with type 2 diabetes and recent acute coronary syndrome events. The EXAMIN trial. Diabetes, Obesity and Metabolism 2017; 19:665–671.

7Zinman B, Marso SP, Christiansen E, et al. Hypoglycemia, cardiovascular outcomes, and death: the LEADER experience. Diabetes Care. 2018 Aug;41(8):1783-1791.

8NHS choices. Low blood sugar (hypoglycaemia). Available at: https://www.nhs.uk/conditions/low-blood-sugar-hypoglycaemia/ Last accessed May 2018.

9American Diabetes Association. Living with Diabetes: Hypoglycemia (Low Blood Glucose). Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html?loc=lwd-slabnav Last accessed May 2018.