Care During Chemotherapy and Beyond
Hypoglycemia (Low Blood Sugar)
What is hypoglycemia?
Hypoglycemia may be described as low levels of sugar (glucose) in the blood. This
is commonly seen in people who are diabetic, and their blood sugar levels fall too
low - either because they took their medications and did not eat properly, or the
dosage of medication is too high for them.
Normal blood Glucose (sugar) levels are 60-110 mg/dL. Normal values may vary
from laboratory to laboratory. Levels much lower than these can indicate
What causes hypoglycemia?
Causes of hypoglycemia may include:
- Excessive exercise, or lack of food intake
- Certain forms of alcohol may cause low blood sugar levels
- Certain kinds of tumors, affecting the pancreas (insulinomas)
- After stomach surgery
- People with kidney failure, who are on dialysis, may experience hypoglycemia.
- If you have liver disease, you may be at risk for hypoglycemia.
- You may have problems with your thyroid, adrenal, or pituitary glands.
- You may not be absorbing food that you eat very well, thus resulting in hypoglycemia.
What are some symptoms of hypoglycemia
to look for?
- You may feel sweaty, shaky or hungry. You may feel faint.
- Extremely low blood sugar levels may cause you to be confused, or disoriented.
- Severely low levels of blood sugar may cause coma.
- You may have a fast heartbeat, or feel palpitations.
Things you can do about hypoglycemia:
If you are experiencing low blood sugar levels as a result of your treatment of
diabetes, your healthcare provider may instruct you on the use of close blood sugar
monitoring during this time. Follow all of your healthcare provider's instructions.
- Try to exercise. Low blood sugar levels are often temporary. If you are diabetic,
you will have high blood sugars as well. Make a daily walk either alone, or with
a friend or family member a part of your routine. Even light walking or aerobic
activity may help you to promote the flow of oxygen in your lungs and blood (oxygenation),
lower your blood sugar levels, and help to prevent long-term complications of hyperglycemia.
Consistent diet and exercise will help your healthcare provider determine your insulin
or diabetic pill dosages, and help you to obtain better control of your disease.
- Follow the recommended diet. A diabetic diet may be suggested even if you only have
a short-term elevation in blood sugar due to an infection, or the use of steroids.
If you have high blood sugar levels, and take too much insulin, your blood sugar
levels may become too low.
- You will most likely meet with a dietician if you are diagnosed with diabetes, either
Type 2 or gestational, to help you determine a diet that is right for you. This
will help you to gain control over your disease or condition that may be causing
the high or low blood sugar levels. Reading the labels on food is helpful
to know what kinds of calories, fat and protein you are taking in. Some general
dietary recommendations include:
- Limit Carbohydrates - Carbohydrates, either simple (such as fruit and sugar) or
complex, (such as pasta and cereals), have the greatest impact on blood sugar levels.
Your diet should include around than 50% carbohydrates. Avoid sugar, and instead,
use artificial sweeteners, such as nutrasweet, aspartame, or saccharin.
- Protein - your diet should consist of 15-20% protein. Long-term damage to your kidneys
may be corrected by restricting protein - if you are diabetic.
- Increase fresh vegetables and fiber intake - Up to 55 grams of fiber in your diet
per day is recommended. Fiber and fresh vegetables help to decrease blood sugar
levels, maintain regular bowel habits, and may prevent certain cancers.
- There are many types of "good and bad" fats. The easiest thing to remember is to
limit your intake of saturated fats and oils in your diet.
- You will most likely be instructed on obtaining a blood sugar monitor, especially
if you have diabetes, and be asked by your healthcare provider to check your blood
sugar levels at home. At first, you will be required to check your blood sugar levels
up to 4 or more times a day, to make sure that the levels are in the normal range,
without extremely high or low levels. Eventually, with diet, exercise, and the proper
medication regimen, you may be able to check your blood sugar levels less often.
- A sensible bedtime snack may help to prevent low blood sugar levels during the nighttime.
- Alert your friends, family and close contacts about your condition. Explain to them
the symptoms and signs of low blood sugar, including sweatiness, shakiness and confusion.
Keep candy or instant glucose tablets in your pocket in case your blood sugar gets
too low, and instruct them to seek emergency assistance if they are unsure what
- Wear a "medic alert" bracelet, if you have diabetes, or a history of high or low
blood sugars (hyperglycemia or hypoglycemia).
- Make sure you tell your doctor, as well as all healthcare providers, about any other
medications you are taking (including over-the-counter, vitamins, or herbal remedies).
- Remind your doctor or healthcare provider if you have a history of diabetes, liver,
kidney, or heart disease.
- Keep yourself well hydrated. Drink two to three quarts of fluid every 24 hours,
unless you are instructed otherwise.
- Avoid alcohol. Certain forms of alcohol may cause you to have a severely high or
low blood sugar level. If you are taking pills to control your hyperglycemia, alcohol
use may cause life-threatening interaction.
- If you have diabetes, it is important to inspect your feet daily. People with long-term
high blood sugar levels may develop signs of diabetic nephropathy, with a decreased
sensation and blood flow to your feet and toes. If you have neuropathy, you may
be unable to notice if there has been any damage to your feet or toes. If you develop
an infection, or a wound, you may not be able to heal as well.
- Keep your feet clean and dry. Wear white cotton socks.
- Inspect your feet and toes for cracks, hardened areas, or rashes.
- Apply moisturizer daily, but not between the toes.
- If you notice any wounds, or changes, follow up with a podiatrist or your healthcare
- If you have diabetes, you should see an ophthalmologist to have your eyes checked
yearly. Any change in vision should be reported as soon as you notice.
- A most serious side effect of diabetes and long-term high blood sugar levels is
kidney damage. Your urine may be checked periodically for protein (called, proteinuria).
If there is damage to the kidneys, you will have protein in your urine. If your
kidney damage is noticed early, and there is only a low level of protein in your
urine, your healthcare provider may help you to prevent further damage by discussing
diet, exercise and medications. Strict blood sugar control will help to prevent
- A blood test, called Hemoglobin A1C, will measure your average blood sugar levels
for 90 days. Your healthcare provider may order this, every 3 months if you have
- If you experience symptoms or side effects, especially if severe, be sure to discuss
them with your health care team. They can prescribe medications and/or offer
other suggestions that are effective in managing such problems.
- Keep all your appointments.
Drugs that may be prescribed by your doctor:
There are no medications prescribed specifically for low blood sugar. The goal
is to identify and treat the cause of your symptoms. The treatment of
low blood sugars is to identify the underlying cause, and to treat that condition.
If you have a low blood sugar, you will be instructed by your healthcare provider
to take instant glucose tablets, or perhaps 4 oz of orange juice (if you have normal
When to call your doctor or health care provider:
Call your doctor with the following symptoms:
- Nausea that interferes with your ability to eat, and is unrelieved by any prescribed
- Vomiting (vomiting more than 4-5 times in a 24 hour period).
- Diarrhea (4-6 episodes in a 24-hour period), unrelieved with taking anti-diarrhea
medication and diet modification.
- Severe constipation, unrelieved by laxatives, lasting 2 to 3 days.
- Symptoms of muscle twitching, irritability, and/or increased urination.
- Poor appetite that does not improve.
- If you notice excessive sleepiness, confusion.
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Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
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