Hypoglycemia (low blood sugar) is a condition in which there is an abnormally low level of glucose (sugar) in your blood. Normally your body keeps blood sugar levels within a narrow range through the coordinated work of several organs and glands and their hormones, primarily insulin and glucagon. But factors such as disease or a poor diet can disrupt the mechanisms that regulate your sugar levels. Too much glucose results in hyperglycemia, one of the major symptoms of diabetes. However, hypoglycemia is most common among people with diabetes, as too much insulin can cause blood sugar levels to fall (an insulin reaction).

Because glucose (sugar) is the brain's primary fuel, your brain feels the effects of hypoglycemia. The effects include the following:

• Headache
• Excessive sweating
• Blurred vision, dizziness
• Trembling, lack of coordination
• Depression, anxiety
• Mental confusion, irritability
• Heart palpitations
• Slurred speech
• Seizures
• Fatigue
• Irritability
• Coma

Hypoglycemia can be caused by the following conditions:

• In diabetics, from taking too much insulin, skipping a meal, exercising too strenuously, drinking too much alcohol
• Critical organ failure (kidney, heart, or liver)
• Hormone deficiencies
• Tumors
• Fasting
• Inherited abnormalities
• Lack of an appropriate diet, especially with a critical illness
• With strenuous exercise
• After gastrointestinal surgery

If your symptoms are not severe, your health care provider will order a blood test called a glucose tolerance test (GTT), the same test used to diagnose diabetes. If your levels are only slightly below normal, your provider may recommend diet and lifestyle changes. If your symptoms are severe, your provider will immediately give you glucose in either an oral or injectable form to bring your blood sugar level back to normal as quickly as possible. Additional tests may determine the cause of your low blood sugar.

It is important to treat low blood sugar immediately to avoid long-term serious effects. Hypoglycemia resulting from exercise several hours after a meal rarely produces serious symptoms. A glass of orange juice and a piece of bread can correct your blood sugar levels within minutes. However, in people with underlying diseases, fluctuating blood sugar levels are more serious and must be treated with oral or injectable forms of glucose. You can take oral glucose if you are able to swallow. If not, your health care provider can give you an injection.

Drug Therapies

• Oral glucose for people who are able to swallow (10 - 20 g carbohydrate)
• Intravenous glucose for people who are unable to swallow
• Subcutaneous or intramuscular injection of glucagon is an alternative to the above treatments, but the individual must also eat because the effect of glucagon is short
• Intravenous mannitol and glucocorticoids may be used to treat an individual who remains in a coma after glucose levels return to normal

Complementary and Alternative Therapies

Long-term treatment is aimed at the cause of the hypoglycemia, but alternative therapies may also be useful in regulating blood sugar in the short term. Nutritional support should be part of treatment.

Nutrition and Supplements

Dietary modification should form the core of any treatment for hypoglycemia. Small frequent meals that are high in fiber and complex carbohydrates are best, preferably five or six a day. Cut down on simple carbohydrates, including sugar, refined foods, juices, and fruit. Foods high in fiber include whole grains, fruits and vegetables, and nuts. Eliminate all caffeine, alcohol, and tobacco.

Some doctors may suggest a high-protein diet, although evidence is mixed on the benefits. A "Zone" style diet, based on the work of Dr. Barry Sears, combines proteins, fats, and carbohydrates in a 30/30/40 ratio and can be very helpful in maintaining stable blood sugar throughout the day.

Soluble fiber, such as flaxseed and pure oat bran, can slow the rate at which dietary sugars enter the blood and help regulate blood sugars throughout the day. Consume 1 - 3 tsp. of either of these fiber sources before meals. Talk to your doctor first if you have a history of digestive disorders.

Vitamins and minerals that are important for regulating glucose levels include the following. If you are diabetic, talk to your health care provider before adding these to your diet:

• Chromium: 100 - 200 mcg per day with meals. Chromium may interact with insulin, vitamin C, and horsetail (Equisetum arvense), so talk to your doctor before combining it with any of these substances
• Magnesium: 340 mg per day
• Zinc: 15 - 30 mg per day
• B complex: 50 - 100 mg per day
• Niacinamide: 500 mg per day
• Pyridoxine (B6): 100 mg per day
• Vitamin C: 250 - 500 mg two times per day
• Vitamin E: 400 IU per day
• Glucomannan (1 - 4 g per day in divided doses, with plenty of fluids), a type of soluble fiber, may help regulate blood sugar.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to work with your provider on getting your problem diagnosed before you start any treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted.

• Gentian (Gentiana lutea) may help stimulate the endocrine system and regulate hormone production. Boil 1/2 teaspoon of shredded root in one cup water. Strain and drink warm before meals. Do not take gentian if you take blood pressure medication.
• Licorice root (Glycyrrhiza glabra), 1 tsp. in one cup boiling water. Strain and cool. Drink three times per day. Do not take licorice if you have high blood pressure or congestive heart failure.

Acupuncture

May be beneficial in decreasing stress, increasing coping skills, and regulating hormone function.

Any underlying condition that may be causing your hypoglycemia must be aggressively treated so that your episodes do not recur. If you have hypoglycemia when you exercise, carry a healthy snack with you.

Do not ignore the signs and symptoms of hypoglycemia. Untreated, it can cause irreversible brain damage, coma, or even death.

Anderson RA, Polansky MM, Bryden NA, Bhathena SJ, Canary JJ. Effects of supplemental chromium on patients with symptoms of reactive hypoglycemia. Metabolism. 1987;36:351-355.

Branch WT Jr. Office Practice of Medicine. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1994:574-575.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:2069-2071.

Hofeldt FD. Reactive hypoglycemia. Metabolism. 1975;24:1193-208.

Hopman WP, Houben PG, Speth PA, Lamers CB. Glucomannan prevents postprandial hypoglycemia in patients with previous gastric surgery. Gut. 1988;29:930-4.

Mowry DB. The Scientific Validation of Herbal Medicine. New Canaan, Conn: Keats Publishing; 1986:25.

Stebbing JB, et al. Reactive hypoglycemia and magnesium. Magnesium Bull. 1982;2:131-4.

Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press; 1994:141.

Wilson JD, Foster DW. Williams Textbook of Endocrinology. 8th ed. Philadelphia, Pa: WB Saunders Co; 1992:1232-1248.

Wyngaarden JB, Smith LH Jr. Cecil Textbook of Medicine. 17th ed. Philadelphia, Pa: WB Saunders Co; 1985:1342-1348.