Hypoglycaemia management


April 3rd, 2023

Hypoglycaemia management

1. What is hypoglycaemia?

Hypoglycaemia occurs when the blood glucose level is too low that it falls below 70 mg/dl (4.0 mmol/l).
Hypoglycaemia is common and nearly all people with Type 1 Diabetes experience them.
Sometimes hypoglycaemia can become very serious and they may faint or have seizures. If this happens, you must immediately seek medical treatment for the person with diabetes.

2. How to recognize hypoglycaemia?

The signs and symptoms of low blood glucose can vary depending on the person and how quickly the level of glucose falls.
Warning signs of low blood glucose include:

  • Sweating
  • Hunger
  • Rapid heart rate
  • Difficulty talking
  • Irritability
  • Dizziness
  • Tiredness
  • Blurred vision
  • Crying without reason
  • Trembling

Remember: These feelings are not always because of low blood glucose. Encourage them to always test their blood glucose level when they feel unwell. DO NOT GUESS! Those with Type 1 Diabetes can have nocturnal hypoglycaemia and may have bouts of crying, nightmares, or night sweats (with damp bedsheets and/or pyjamas). They may wake up irritable or with a headache.

3. Causes of low blood glucose levels.

Hypoglycaemia can happen at any time, but it is more likely if the person with Type 1 Diabetes:

  • Skips or delays meals or snacks or doesn’t eat as much carbohydrate-containing food as expected after taking insulin.
  • Takes too much insulin, takes the wrong type of insulin, or takes insulin at the wrong time
  • Exercises more than usual without eating additional snacks or adjusting the dosage of insulin

A low blood glucose level can also happen:

  • During sleep, known as nocturnal hypoglycaemia
  • Several hours after exercise, known as delayed post-exercise hypoglycaemia
  • After someone drinks alcohol, the alcohol hurts the body’s ability to keep blood glucose in a normal range, which can cause a sudden drop in blood sugar. Talk to those with diabetes about the health risks of alcohol and drug use.

4. Checking for low blood glucose levels.

The only way to know for sure if someone has low blood glucose levels is to test it with a glucometer. However, if the situation makes it impossible or inconvenient to quickly check the blood glucose, it’s important to treat the hypoglycaemia immediately to prevent symptoms from getting worse.
It’s important to discuss the signs and symptoms of low blood glucose with those affected with Type 1 Diabetes. They need to understand the connection between symptoms and the need for treatment. Diabetic children in particular should know when and how to find an adult for help.

5. How to treat low blood glucose level (Hypoglycaemia)?

If blood glucose is below 4.0 mmol/l (72mg/dL) action must be taken quickly.
Here are the steps you have to follow:
– Give 1 tablespoon of syrup or drink half a cup of sweet drink (e.g. pure fruit juice or cola (not diet cola) then let them rest for 15 min before checking their blood glucose
– If the blood glucose level is higher than 4.0 mmol/L (72mg/dL), retest 20-30 minutes later to confirm target glucose (>4.0 mmol/L) is maintained
– If the blood glucose level is still below 4.0 mmol/l (72mg/dL) then give again syrup or drink half a cup of sweet drink (e.g. pure fruit juice or cola (not diet cola) then let them rest for 15 min before

If hypo happens just before a meal time (when insulin is usually given) the hypo should be treated first and once the blood glucose is >4.0 mmol/L (>72mg/dL) the insulin should be given as usual. DO NOT OMIT INSULIN, especially important with an early morning hypo.

If someone is experiencing seizure or is unconscious do not attempt to feed them as this could present a risk of choking or aspiration (food going into the airways can cause serious pneumonia). You must go to the hospital in an emergency.


HelloType1 content is based on published, internationally recognised guidelines and then reviewed by local experts to ensure it fits local context. The translation is based on simplified English language to ensure it conveys the safest and clearest possible message in regional languages. Basic insulin and blood glucose testing access is still an issue in the South-East Asia region and our chief aim is to address this. HelloType1 content is not intended to replace the advice of individual healthcare professionals but as a collaborative tool to help them improve the outcomes of disadvantaged people with Type 1 Diabetes in the region.

HelloType1 content is curated for the topics using information only taken from accredited sources such as the International Diabetes Foundation (IDF) and the International Society for Paediatric and Adolescent Diabetes (ISPAD).

This content is then reviewed and adapted by a panel consisting of healthcare experts (e.g. endocrinologist, nutritionist, diabetes nurse, psychologist) and members of the South-East Asia T1D communities, helping ensure the information is appropriate in a local context.

Writers of HelloType1 content:
Anne-Charlotte Ficheroulle, Pharmacist, Digital Innovation Manager at A4D
Charlotte O’Brian Gore, Research assistant ImmunoEngineering, King’s College. UK

Content Reviewers – healthcare professionals:
Dr. May Ng, Paediatric Endocrinologist, Chief Medical Advisor A4D, UK
Dr. Yeow Toh Peng, Endocrinologist, Malaysia
Dr Jaturat Petchkul, Paediatric Endocrinologist, Thailand
Dianna Culbertson, Physician Assistant T1D care, US
Prof Dr Malene Iv, Endocrinologist, Kantha Bopha Hospital, Cambodia
Steffen Tange, Consultant Psychology, Denmark
Soe Nyi Nyi, Nutritionist, Myanmar
Lucas Lim, Dietician, Malaysia

Content Reviewers – people with Type 1 Diabetes:
Jerry Gore, Co-Founder A4D, Mountaineer, UK
Diana Maynard, T1D advocate, UK
Emelyne Carmen Ho, College Student, Malaysia
Molly Seal, College Student, UK

Content Reviewers – parents with T1D child:
Samantha Seal, Teacher, Thailand
Kim Than, Deputy Country Director – Plan International, Cambodia

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