Headaches, Thirst, and Irritability: How to Know if You're Experiencing Low or High Blood Sugar Levels

Blood sugar, or glucose, is a sugar present in our bloodstream. In fact, glucose is the primary fuel used by cells. Our pancreas secretes insulin, a hormone that transfers glucose from the blood into the body's cells. But what happens when blood sugar levels are too low or too high, and what can be done about it?

Hypoglycemia

Hypoglycemia, or low blood sugar, is often associated with diabetes. However, it can also occur in individuals without diabetes. Diabetics may experience problems if their blood sugar and insulin levels are not balanced. Typically, steps can be taken to correct what's happening and stop the symptoms, but sometimes it's a problematic and life-threatening condition that goes unnoticed.

Hypoglycemia occurs when blood sugar drops below the normal range, which is about 70 milligrams per deciliter (mg/dL) or less. When blood sugar levels are low, a person may experience various symptoms, such as hunger, irritability or tremors, sweating, dizziness, blurred vision, headaches, fatigue or drowsiness, pale skin, confusion, a feeling of weakness, irritability, lack of coordination, mood changes, irregular or fast heartbeat, personality changes, difficulty concentrating, and more. In severe cases, it can also cause seizures, inability to eat or drink, or loss of consciousness.

Causes of Hypoglycemia

Hypoglycemia is usually linked to diabetes and occurs when there is too much insulin compared to glucose in the blood. It is more common with type 1 diabetes, but individuals with type 2 diabetes taking insulin and other medications to control blood sugar may also experience hypoglycemia. However, people without diabetes might also experience hypoglycemia, such as fasting hypoglycemia, often associated with an underlying illness, or reactive hypoglycemia, which appears within a few hours after a meal. Causes of fasting hypoglycemia might include excessive alcohol consumption, liver, heart, or kidney disease, or certain medications. Causes of reactive hypoglycemia might involve prediabetes, a specific enzyme deficiency, or gastric surgery. Therefore, addressing this condition is crucial once symptoms begin to manifest.

Most people recognize when their blood sugar is low due to early warning signs like shaking and hunger and know they need to act quickly before the situation worsens. However, some people do not feel when their blood sugar drops. This condition is called hypoglycemia unawareness.

The 15-15 Rule

For mild to moderate symptoms of low blood sugar, it is recommended to follow the 15-15 rule.

1. Consume 15 grams of carbohydrates.
2. Wait 15 minutes and check blood sugar levels again.
3. If blood sugar is still below 70 mg/dL, repeat the process.
4. If blood sugar reaches 70 mg/dL, eat a small meal or snack to prevent it from dropping again.

What Can Be Done?

Diabetics experiencing hypoglycemic symptoms while on a treatment plan should speak with their doctor, as medication or diet adjustments may be necessary. They can help prevent future occurrences of low blood sugar by making lifestyle changes and following the treatment schedule. A person without diabetes should consult a doctor if they experience low blood sugar symptoms. Once a doctor identifies the underlying cause, a treatment plan can be devised to minimize or stop future symptoms. Additionally, there are continuous glucose monitoring technologies that help detect when blood sugar levels drop and alert the individual.

Diabetic Ketoacidosis

Diabetic ketoacidosis, or DKA, is a life-threatening emergency caused by relative insulin deficiency in the bloodstream. In this situation, blood sugar levels are very high, and the body starts using its fat stores for the energy it requires. Fatty acids convert to ketone bodies that start accumulating in the bloodstream, increasing acidity levels. This is the most common immediate complication of type 1 diabetes, but it can also occur with type 2 diabetes and gestational diabetes, although it is rare.

Causes include injecting too low a dose of insulin, needing a larger dose, insufficient eating, nocturnal hypoglycemia, surgery, illness, or infection (such as COVID-19). Certain medications or extreme stress events like a heart attack can also lead to ketoacidosis. The event can occur quickly, usually within less than 24 hours.

What are the Symptoms?

Abdominal pain, extreme thirst, dry mouth, frequent urination, nausea, vomiting, persistent fatigue, dry or flushed skin, fruity breath odor, breathing problems, confusion, and disorientation. If a diabetic experiences any of these symptoms, they should check blood ketone levels using a ketone meter.

In conclusion, individuals may experience low or high blood sugar levels if they skip a meal or have too much insulin in their blood. Non-diabetic hypoglycemia can also lead to decreased blood sugar levels. Therefore, it is important to consistently monitor sugar levels using a non-invasive glucose meter to avoid various complications.

Prof. Julio Weinstein is the director of the diabetes unit at Wolfson Medical Center and a senior diabetes physician at DMC Diabetes Care Center.