When The Blood Sugar Goes Low, Here’s What To Do and What Not To Do

There are 2 major life-threatening conditions in a patient with regards to the blood sugar.

  • Hypoglycemia (when the blood sugar is lesser than 70 mg/dl)
  • Hyperglycemia (when the blood sugar is more than 200 mg/dl)

It is classified into 3 types:

  • Mild: CBG between 50-70 mg/dl + Neurogenic Symptoms
  • Moderate: CBG between 50 – 70 mg/dl + Neuro-glycopenic Symptoms
  • Severe: CBG < 50 mg/dl

What can cause it?

  • Too little food or carbohydrates (poor oral intake)
  • Skipped or delayed meals
  • More active than usual
  • Too much insulin or too many diabetic pills
  • Infection

How does one recognize the signs and symptoms of hypoglycemia?

Depending on the blood glucose levels, patients can be asymptomatic or symptomatic with varying degrees of severity of signs & symptoms secondary to low blood glucose levels.


Patients with Mild Hypoglycemia present with the following symptoms:

  • Palpitations / fast heart beat
  • Tremors
  • Sweating
  • Anxiety
  • Hunger
  • Paraesthesia / numbness

Patients with Moderate Hypoglycemia present with the following symptoms:

  • Behavioural Changes
  • Confusion
  • Altered Mentation
  • Headache
  • Nausea
  • Extreme Sweating
  • Irritability
  • Dizzy / Giddiness

Patients with Severe Hypoglycemia present with the following symptoms:

  • Severe confusion
  • Lack of coordination
  • Extreme fatigue
  • Seizures / fits
  • Impaired Vision
  • Coma
  • Unconsciousness
  • Death

What to do when the blood sugar goes low?

  • Check the CBG if a capillary blood glucose testing machine is available.
  • If the patient is conscious and alert or talking and responding, yet symptomatic – Oral sugars (1-2 spoons of sugar mixed in 1 glass of milk or chocolate bar) can be given.
  • If the Patient is semi-conscious or unconscious – Pl take the patient to the hospital for IV dextrose correction and observation.

What should not be done?

  • Never Give Oral sugar water / ORS / water – to an unconscious or semi-conscious patient as one can aspirate these contents into the lungs causing further complications.
  • Do not ignore assuming patient is sleeping.
  • Do not delay to review with the Physician or Diabetologist.

Treatment of Hypoglycemic Episode:

  • For mild symptomatic hypoglycemic episodes – oral sugars (1-2 spoons with 1 glass of milk or Chocolate bar) can be given.
  • For Moderate and Severe Hypoglycemic Episodes – IV dextrose is suggested at hospital.
  • Review of medications by the Physician or Diabetologist.
  • Treatment of the cause:
    • If the precipitating factor is an infection – treat with appropriate antibiotics
    • If the precipitating factor is poor oral intake – improve nutrition
  • Prevent recurrent attacks by close monitoring of blood sugar levels.

Article by Dr. Aslesha Vijaay Sheth, MBBS., MRCEM (UK)
Consultant & In-Charge Emergency Medicine Department
Kauvery Hospital, Chennai