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Authors: David Drum and Terry Zierenberg, R.N., C.D.E.
Source: The Type 2 Diabetes Sourcebook

It’s quite rare for people with Type 2 diabetes to experience low blood sugar reactions, which can include fainting at unfortunate moments, such as when you are driving a car. Repeated episodes of hypoglycemia can affect mental functioning. Low blood sugar occurs much more frequently in people with Type I diabetes, whose bodies don’t produce any insulin.

Exceptions to this may include people with Type 2 diabetes who are taking hypoglycemic agents, and particularly those who are taking insulin. Striving for tight blood sugar control can increase episodes of low blood sugar. These people need to be aware of the possibility of low blood sugar, particularly when skipping a meal or during bouts of strenuous exercise that can rapidly lower blood sugar levels. You can raise blood sugar by eating a snack, however, if you faint and go into insulin shock, you’ll need an injection of glucagon to snap you out of it, or medical attention in a hospital emergency room.

The possibility of low blood sugar reactions is one reason to take your diabetes medications as prescribed, and to never double up on doses if you miss one. If you’re taking diabetes pills or insulin, skipping a meal can cause low blood sugar, which is another reason you should hew to your regular meal and snacking schedule as closely as possible. Timing of meals is particularly important if you are taking insulin.

Unusually long, strenuous bouts of exercise may cause blood sugar  levels to fall quickly, which is why people who strenuously exercise should carry a snack with them when they work out. Drinking alcohol without eating and taking aspirin, barbiturates, and certain prescription drugs such as those that thin the blood can also lower blood sugar.

Symptoms of low blood sugar vary from person to person. They may include a feeling of being “out of sorts,” sudden mood swings, loss of concentration, irritability, grumpiness weakness, paleness, poor coordination, sweatiness, headache, or a feeling that something is wrong with the way that you’re thinking. Some people experience no symptoms at all when their blood sugar levels drop.

You can easily prepare for and prevent problems with low blood sugar. If you feel low blood sugar coming on, if you anticipate a sudden drop in your blood sugar, or if you test unusually low, just eat something sweet. Glucose tablets or gel, hard candy, raisins, and orange juice or fruit juice all work beautifully to lift and normalize blood sugar. The tablets and gel products have the advantage of being smaller and easier to carry, and you probably won’t be tempted to snack on them.

If you have low blood sugar and don’t respond to it right away, you may need the help of another person because untreated low blood sugar can make you confused, and may eventually cause you to lose consciousness. If this is even a possibility, such as when you are working out, let your exercise partner or trainer know how to recognize the signs of low blood sugar.

If you faint, that person should know that you need an injection of glucagon, a hormone that raises blood sugar. Glucagon comes in a kit containing a syringe and a special bottle of powdered glucagon; kits may be purchased with a doctor’s prescription. It is not possible to overdose on glucagon. If low blood sugar is possible for you, you need to show family members or friends how to give you a shot of glucagon before anything happens, perhaps letting them practice by giving you an insulin injection. People who have never given a shot may not be able to do it in an emergency. If glucagon is not available when you pass out, ask another person in advance to call the paramedics and explain to them that you are diabetic and may have low blood sugar. No one should ever try to pour fruit juice or any liquid down your throat while you are unconscious.

Low blood sugar is rarely a concern for most people with Type 2 diabetes. But the off chance that this or another medical emergency may happen is reason enough to take precautions when you are traveling, such as wearing a medical ID bracelet and making sure your companions know that you have diabetes. Blood testing before you drive a car or fly a plane will alert you to any potential problems. Again, your spouse or significant other should understand how to help you in case of a medical emergency.

Good self-management and blood glucose testing will help you prevent excessively high or low blood sugar.