Hypoglycemia is a dangerous condition in which blood glucose levels fall below 3.9 mmol/L (according to ADA recommendations). In patients with type 2 diabetes, it most often occurs as a result of glucose-lowering medications or insulin therapy, but it can also develop for other reasons.
1. Causes of Hypoglycemia in Type 2 Diabetes
🔹 Medications
Insulin (especially in cases of overdose or missed meals).
Sulfonylureas (glibenclamide, gliclazide) — stimulate insulin release even in the absence of food.
Glinides (repaglinide, nateglinide) — rapidly lower blood glucose but have a short duration of action.
🔹 Other Factors
✔ Skipping or insufficient food intake after taking medications.
✔ Physical activity without adjusting medication doses.
✔ Alcohol consumption (suppresses glucose release from the liver).
✔ Kidney or liver impairment (slower drug clearance).
2. Symptoms of Hypoglycemia
Mild hypoglycemia (3.0–3.9 mmol/L)
Tremor, sweating
Dizziness
Hunger
Palpitations
Severe hypoglycemia (< 3.0 mmol/L)
Confusion
Loss of coordination
Seizures
Loss of consciousness (hypoglycemic coma)
Important: In older adults and patients with long-standing diabetes, symptoms may be blunted or atypical, especially in cases of hypoglycemia unawareness.
3. First Aid for Hypoglycemia
✅ Mild hypoglycemia (patient is conscious)
Consume 15–20 g of fast-acting carbohydrates:
3–4 sugar cubes or 1 tablespoon of honey.
150 ml of fruit juice (not diet!).
Glucose gel (e.g., Dextro4).
Recheck blood glucose after 15 minutes.
If levels have not improved, repeat carbohydrate intake.
After normalization, eat complex carbohydrates (a slice of bread, an apple) to prevent recurrence.
🚨 Severe hypoglycemia (loss of consciousness, seizures)
Do not attempt to give food or drink (risk of aspiration!).
Administer glucagon (1 mg intramuscularly or subcutaneously).
Call emergency medical services.
Once consciousness is regained, give carbohydrates.
4. How to Prevent Hypoglycemia
✔ Monitor blood glucose regularly (especially before bedtime and physical activity).
✔ Follow a regular meal schedule (do not skip meals).
✔ Adjust medication doses with your doctor (especially during weight loss or changes in activity).
✔ Avoid drinking alcohol on an empty stomach.
✔ Carry fast-acting carbohydrates (glucose tablets, juice).
✔ Use continuous glucose monitoring systems (CGMS) if hypoglycemia occurs frequently.
5. When to See a Doctor
Hypoglycemic episodes occurring more than 1–2 times per week.
Nocturnal hypoglycemia (night sweats, nightmares, morning headaches).
Lack of symptoms despite low blood glucose (hypoglycemia unawareness).
Conclusion
Hypoglycemia is a serious complication of type 2 diabetes that requires prompt action. Proper self-monitoring, therapy adjustment, and patient education significantly reduce risks.
Important: If hypoglycemic episodes recur, the treatment plan should be reviewed with an endocrinologist.