Hypoglycaemia (low blood glucose) in non-diabetic people

Reviewed by Dr Patrick Davey, cardiologist

What is hypoglycaemia (low blood glucose)?

Hypoglycaemia or low blood glucose is a condition in which the level of glucose (sugar) in the blood, drops below a certain point (about 2.5mmol/l). The condition manifests itself by a number of symptoms that usually disappear 10 to 15 minutes after eating sugar.

People differ slightly in the exact level of blood glucose at which they begin to feel symptoms of low blood sugar.

What causes hypoglycaemia?

Insulin is normally produced in the pancreas and helps the cells in the body absorb glucose from the blood. Normally, the glucose level rises after a meal.

Too much insulin in the blood and other diseases can cause hypoglycaemic episodes (also known as 'hypos').

What can cause hypoglycaemic episodes in non-diabetic patients?

Too much insulin in the blood:

reactive hypoglycaemia (see below)

a tumour - very often benign - in the insulin-producing pancreas

an overdose of insulin or diabetic tablets either by mistake or on purpose.

Other diseases:

a disease in the adrenal glands (Addison's disease)

a weakened pituitary gland

a severe reduction in liver function

patients who have had their stomach removed

sometimes cancer

fasting, malnutrition

following alcohol ingestion.

Reactive hypoglycaemia

Reactive hypoglycaemia is possibly the most common reason for hypoglycaemia in non-diabetics but is often overdiagnosed. This form of hypoglycaemia is probably caused by an overproduction of insulin from the pancreas after a large meal with a lot of carbohydrates. The insulin can still be detected even after several hours, although the level should be back to normal at this time. This condition is probably most common in overweight people and those with Type 2 diabetes, where the large demand for insulin can sometimes cause too much insulin to be produced in the pancreas. There is some evidence to suggest that reactive hypoglycaemia can precede Type 2 diabetes.

What happens during a hypoglycaemic episode?

Hypoglycaemia can cause some or all of the following symptoms:

paleness

trembling

perspiration

a feeling of weakness

rapid heartbeat

hunger

agitation

difficulty concentrating

irritability

fatigue

blurred vision

temporary loss of consciousness

convulsions

coma.

These symptoms will often occur about three to four hours after a meal.

What can you do yourself?

If hypoglycaemia is suspected with the symptoms similar to those above coming on three to four hours after a meal and going away after eating sugar, it should be confirmed that the symptoms are caused by low blood glucose.

Many people say they have hypoglycaemia without having low blood glucose diagnosed!

The doctor should be contacted and, if possible, a home blood glucose apparatus obtained.

When the symptoms occur, measure the blood glucose level. If all three of the criteria below are met, you should be referred for further examination at a hospital.

Blood glucose level below 2.5mmol/l (millimole per litre) - or sometimes slightly higher.

Some or all of the symptoms listed above.

The symptoms go away within 10 minutes of eating sugar.

How is the diagnosis made?

The diagnosis is made by measuring the blood glucose level. If the glucose level is below 2.5mmol/l, you have hypoglycaemia. If a tumour in the pancreas is suspected, the patient is admitted to a hospital for observation for three days, where the glucose level is closely monitored.

If this drops below a certain point, the insulin level in the blood is measured. If this is high, it suggests a tumour in the pancreas, which will be looked for, and if found, removed.

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