Hypoglycemia

What is Hypoglycemia?

Hypoglycemia is a low blood glucose level that causes symptoms and improves when glucose is restored. It is often defined as a plasma glucose below 70 milligrams per deciliter, although symptoms may not begin until it falls below about 55.^[1] Doctors confirm it with the Whipple triad: symptoms of hypoglycemia, a documented low glucose, and relief when the glucose is corrected.^{[1, 2]}

Common symptoms

Early symptoms come from the body's alarm response and include shaking, sweating, hunger, anxiety and a racing heart. As the brain is affected there may be confusion, trouble concentrating, loss of coordination, seizures or loss of consciousness.^{[1, 3]}

Repeated episodes in people with diabetes can lead to hypoglycemia unawareness, in which warning signs fade, and impaired counterregulatory responses are a main risk factor for severe episodes.^[4]

Causes and risk factors

Hypoglycemia is most often seen in people with diabetes who are treated with medicines such as insulin, sulfonylureas or glinides.^{[1, 4]} It is uncommon in people without diabetes and then has a range of causes, including insulin-producing tumors, bariatric surgery, critical illness, liver or kidney disease, hormone deficiencies and some non-diabetes medicines.^[5]

How it is diagnosed and treated conventionally

When hypoglycemia is suspected in a person without diabetes, doctors confirm it with a glucose test taken during symptoms and then look for the cause, sometimes with a supervised fast or mixed-meal test.^{[2, 5]} Treatment depends on the cause.^[2]

In diabetes, prevention rests on patient education, personalized glucose goals and attention to risk factors and early warning signs.^[4] Your physician or diabetes team should give you a written plan for treating low blood sugar, including what to do if you cannot swallow or become unconscious.

Why Hypoglycemia calls for a whole-person approach

Hypoglycemia is a sign of how glucose, hormones, medicines, meals and the liver are working together, not a problem with one cause. The cause has to be found by a physician, and the same low reading can mean very different things in different people.^{[2, 5]}

Supportive care can address how stressful, tiring and frightening repeated episodes feel, without taking the place of that work.

Medicines and diabetes treatment

The commonest setting is glucose-lowering drug treatment. Balancing medicine, meals and activity is a medical decision made with your physician.^{[1, 4]}

Hormones and organs

Hormone deficiencies, liver disease and kidney disease can all impair the body's defenses against low glucose.^[5]

Fear and stress

Episodes cause physical and psychological harm, and the fear of hypoglycemia can itself interfere with a person's ability to reach good glucose control.^[4]

Acupuncture as supportive care in Hypoglycemia

What the research shows

We found no clinical trials of acupuncture for hypoglycemia. All of the research we found studied acupuncture as a way to lower glucose in people with type 2 diabetes, which is the opposite goal.

A meta-analysis of 21 randomized trials with 1,943 people found that acupuncture added to usual treatment lowered fasting glucose, 2-hour glucose and HbA1c more than sham or no acupuncture. The authors said the trials were small and of poor methodological quality.^[6] Another meta-analysis of 21 trials (1,188 people) found a small drop in fasting glucose when acupuncture was added to antidiabetic drugs, with uncertain effects on HbA1c, and reported only mild adverse events.^[7]

For this reason, anyone who takes insulin or other glucose-lowering drugs should tell their physician and us before starting acupuncture, so glucose can be monitored. For symptoms that often come with this condition, a systematic review of 24 trials compared acupuncture with medication or sham for insomnia. In the 15 trials against medication, acupuncture improved sleep scores, though results varied considerably and these were not studies in people with low blood sugar.^[8]

How acupuncture may work

No studies explain how acupuncture might affect hypoglycemia, and we do not claim that it does. Any benefit we would expect is limited to relaxation and sleep, based on the insomnia research above.^[8]

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points chosen for the individual, usually left in place for about 20 to 40 minutes, with a reassessment after a short series of visits. Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had at least one minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[9] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Hypoglycemia

The Ayurvedic view

Ayurveda has no direct counterpart to hypoglycemia. A practitioner may describe weakness, trembling and dizziness after long gaps between meals as a Vata pattern. This is a traditional framework for planning care, not a biomedical diagnosis.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Regular, balanced meals and steady daily routine, which also matches standard advice to avoid long gaps between meals when on glucose-lowering medicine
• Gentle yoga, breathing practices and meditation for stress
• Warm oil massage for relaxation

Panchakarma procedures, which involve fasting or purging therapies, are not suitable for people with hypoglycemia, and not appropriate during pregnancy, acute illness or frailty.

What the research shows

We found no clinical trials of Ayurvedic treatment for hypoglycemia, so there is no evidence for it. A Cochrane review of Ayurvedic treatments for diabetes found only a few small trials of herbal mixtures with methodological weaknesses and concluded that no firm conclusions could be drawn. Some mixtures lowered glucose, and one trial reported a mild hypoglycemic episode in a participant on treatment.^[10]

Product quality also matters with Ayurvedic medicines. In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[11]

Herbal medicine as supportive care in Hypoglycemia

Herbs and formulas that have been studied

No herb has been studied as a treatment for hypoglycemia. Herbs have instead been studied for the opposite aim, lowering blood sugar in type 2 diabetes, including ginger, turmeric, Berberis vulgaris, Nigella sativa and Chinese formulas such as Jinlida granules and Gegen Qinlian decoction.^[12] Cinnamon, bitter melon, fenugreek and gymnema are other widely used products reported to have hypoglycemic effects.^{[13, 14]}

What the research shows

There is no evidence that herbs help hypoglycemia. In diabetes, an umbrella review found that ginger, turmeric and Jinlida granules lowered HbA1c compared with placebo, but confidence was limited by the low quality of the included reviews.^[12] Trials of cinnamon, bitter gourd and fenugreek showed conflicting results and were short and small.^[14]

Safety and herb-drug interactions

This is the main concern. Many natural health products exert hypoglycemic effects, and when used together with conventional diabetes medicines they may add to the glucose-lowering effect and cause hypoglycemia.^[13] The umbrella review likewise advised careful monitoring for hypoglycemia when herbs are used with antidiabetic drugs, noting a lack of data on herb-drug interactions.^[12] Herbs of this kind should therefore not be added for a person with low blood sugar without their physician's guidance.

More generally, herbs can interact with prescribed medicines, sometimes with serious consequences.^[15] In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[11] Herbal and dietary supplements are also a recognized cause of liver injury, and liver disease can itself cause low blood sugar.^{[5, 16]} Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine may describe shakiness, sweating and fatigue between meals as qi deficiency or a weak spleen, and Ayurveda may call it a Vata imbalance. Biologically, the same experience reflects the body's counterregulatory hormone and nervous system response to a falling glucose level.^{[1, 5]}

No study has shown that a TCM pattern or a dosha corresponds to a specific biological process in hypoglycemia.

How this care fits with your medical care

Hypoglycemia needs medical evaluation to find the cause. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change insulin or other diabetes medicines, or skip meals, without your prescriber's guidance.

We do not diagnose the cause of low blood sugar or adjust medicines. Please bring your diagnosis, a log of low-glucose episodes if you keep one, a full list of medicines and supplements, and recent test results.

When to seek urgent medical care

Severe hypoglycemia can cause seizures, loss of consciousness and brain injury, and needs emergency treatment.^[1]

• Confusion, slurred speech or behavior that is unusual for the person
• A seizure
• Fainting or being unable to wake or to swallow safely
• Low glucose that does not improve after treatment, or that returns repeatedly
• Frequent episodes without warning signs

If any of these occur, call 911 or go to the nearest emergency department.