Cold sweats and shakes

“Low blood sugar” is one of those terms we’ve all heard thrown around a bunch but probably don’t know much about. But how do you know if your symptoms are due to low blood sugar or if your irritability is due to regular old hanger?

First of all, what is low blood sugar?

Low blood sugar, a.k.a. hypoglycemia, happens when the level of glucose in your blood drops below normal, according to the National Institutes of Health.

“This is a topic that actually comes up quite a bit for me with patients and clients,” Jessica Cording, a New York-based R.D., tells SELF. “Because our bodies require glucose for fuel, maintaining a steady stream of blood glucose is critical to keep your body functioning,” Karen Ansel, R.D.N., tells SELF.

The people who are most at risk for hypoglycemia are those with diabetes, especially people who are taking medication for their diabetes that lowers their blood sugar (including insulin), Deena Adimoolam, M.D., assistant professor of endocrinology at the Icahn School of Medicine at Mount Sinai, tells SELF. Other rare conditions, including hormone deficiencies, liver and kidney disorders, and pancreatic tumors, can cause hypoglycemia. And otherwise healthy adults may experience low blood sugar if they’ve been fasting or if they work out after not eating for a while, Dr. Adimoolam says. So it’s unlikely you’d have low blood sugar signs without diabetes.

That said, a true hypoglycemic attack is a serious situation and a warning sign that something’s not quite right.

So, what are the signs and symptoms of low blood sugar?

The early warning signs tend to be non-specific, Dr. Adimoolam says, meaning that they could indicate someone with high or low blood sugar or could be due to something totally different. But if any of the following symptoms is concerning, check in with your doctor.

1. Feeling shaky or weak.

2. Fatigue.

3. Feeling lightheaded or dizzy.

4. Irritability.

5. Feeling anxious.

6. Headaches.

7. Sweating.

There are also a few more serious low blood sugar signs that can happen when your blood sugar levels continue to decrease and your brain is less able to function properly.

In this case, you might experience severe cognitive symptoms, Dr. Adimoolam says. Those symptoms are definitely signs of an emergency and can include:

8. Slurred speech. According to the Mayo Clinic, slurred speech that occurs with hypoglycemia might make it seem like you’re intoxicated.

9. Blurred vision. Having blurred vision and eye floaters are also symptoms of diabetes on their own.

10. Confusion. As your brain is deprived of glucose, it’s main energy source, thinking becomes more difficult, Dr. Adimoolam explains.

11. Seizures. In the severe stages of hypoglycemia, Dr. Adimoolam says that you may start to have seizures.

12. Passing out. If you go long enough without treatment, it’s possible to lose consciousness, Dr. Adimoolam says.

You can treat a hypoglycemic attack by eating or drinking something with sugar that can be quickly processed by your body.

If you do have diabetes, your doctor has probably already discussed methods of alleviating hypoglycemia, including drinking fruit juice, eating a sugary snack, or taking a glucose tablet, Dr. Adimoolam explains. You should also be sure to monitor your glucose levels closely to prevent low blood sugar as much as possible.

But for those who are “healthy overall and just losing steam, it’s good to have something that provides a bit of carbohydrates to get your blood sugar up,” Cording says. Adding protein—like an apple with peanut butter—can also help stabilize your blood sugar levels and keep them that way until your next meal, she adds.

5 Reasons For Heavy Sweating With Diabetes

In this article we will review the following five reasons someone with diabetes may experience excessive sweating.

  1. Blood glucose levels
  2. Hyperthyroidism
  3. Heart Problems
  4. Outdoor Heat
  5. Stress

Whether you are sitting in a stuffy room, working in the garden or working out at the gym, excessive sweating can be noticeably uncomfortable. People with diabetes can be prone to excessive sweating, which can also lead to dehydration and other health complications. Discover 5 reasons for heavy sweating with diabetes and what you can do about them. Understand that heavy sweating can also signal poor diabetes control.

1. Blood Glucose Levels

Excessive sweating in diabetes can be linked to low blood glucose levels known as hypoglycemia. When blood glucose levels plummet, it triggers a “fight or flight” response from your body. As a result, your body produces additional hormones known as norepinephrine and adrenaline. This can lead to symptoms of hypoglycemia such as heavy sweating, shakiness, hunger, stomach cramping, blurred vision, fast heartbeat, headaches, nausea, weakness, confusion, anxiety and tingling around the mouth and lips. If low blood sugar or hypoglycemia is ignored, it could lead to coma and even death. Causes of hypoglycemia can vary from too much diabetes medication such as sulfonylurea pills or insulin, too much exercise or not eating enough carbohydrates. It is important to get your blood sugar back to normal as soon as possible to alleviate these symptoms including sweating. Keep glucose tablets, a few pieces of hard candy or a can of regular soda handy to increase your blood sugar levels quickly.

It is best to use the “Rule of 15” which is suggested by the ADA (American Diabetes Association). Although individual targets may vary, a level of 70mg/dl or below should be treated as hypoglycemia. Eat 15 grams of a simple carbohydrate like 3-4 glucose tablets to be chewed, wait 15 minutes and recheck your blood glucose level. If it is still below 80mg/dl, retreat with 15 grams of simple carbohydrate. Follow this with a small snack of 15 grams of a carbohydrate such as 1-2 whole grain crackers plus a small amount of protein like a slice of cheese or a tablespoon of peanut butter if you are not planning to eat a meal within 30 minutes. Try to maintain better blood sugar control by taking medications and insulin as directed, eating regular meals and snacks and exercising daily. Use a blood sugar monitor to gauge your glucose levels.

2. Hyperthyroidism

Another reason for heavy sweating is hyperthyroidism, a metabolic condition that people with diabetes may be prone to as 10% of people with diabetes will develop a thyroid disorder in their lifetime. Hyperthyroidism can affect any age group but is much more common in women. Thyroid hormones have an affect on almost every system of your body. The thyroid gland plays an important role in maintaining insulin levels and blood glucose levels. The thyroid gland, found in the front of your neck, produces key hormones in response to signals sent by your brain. These hormones work to increase or decrease your metabolic rate. When the thyroid gland is overactive, it is referred to as hyperthyroidism. More hormones are secreted than usual, which boosts your metabolic rate. This can cause heavy sweating, heat sensitivity, neck swelling, weight loss, hair loss, fragile nails, heart palpitations, dry eyes, tremors, irritability, increased appetite, insomnia, frequent bowel movements, shaking hands, and nervousness. Some people might also have difficulty breathing or swallowing. In young women, hyperthyroidism can cause irregular periods, miscarriages and infertility. Excessive thyroid hormones can cause increased glucose produced in the liver and insulin resistance leading to poorly controlled diabetes. People with diabetes should be periodically checked for thyroid disease with a simple blood test. Treatments may include medication, radioactive iodine and in advanced cases, surgery. The combination of diabetes and hyperthyroidism can worsen diabetes symptoms and lead to further complications especially neuropathy or nerve damage. Hyperthyroidism also plays a role in bone loss or osteoporosis. Neuropathy can lead to foot numbness, a decrease in proprioception (where to place feet) and an increase in falls causing bone fractures. It is important to seek treatment immediately, especially with diabetes to decrease these problems.

3. Heart Problems

There is a strong correlation between diabetes and heart disease and it is the leading cause of death in people with diabetes. People with diabetes have an increased risk of developing cardiovascular disease which is defined as: a myocardial infarction or a heart attack, heart failure and having a stroke. The longer you have diabetes, the higher the risk of developing heart disease. This risk may be increased when a person with diabetes is overweight or obese especially when carrying fat in the belly area (a waist line of 35 inches or more for a woman, 40 inches or more for a man), hypertension or high blood pressure, high LDL levels (bad cholesterol), high triglycerides, smoking, inactivity and elevated or uncontrolled glucose levels. Uncontrolled blood sugars can damage the heart and blood vessels. A heart attack is when, “the blood supply that normally nourishes the heart with oxygen is cut off and the heart muscle dies.” Heart attacks are caused by plaque build- up, blood clots and coronary spasm. Knowing the symptoms of a heart attack can save your life. Some people have no symptoms, but most people suffer from one or more of these symptoms including:

  1. Sweating
  2. Hot flashes
  3. Shortness of breath
  4. Jaw, shoulder, back or arm pain
  5. Chest pain, squeezing sensation, tightness, fullness, heaviness or pressure
  6. Men and women may have different symptoms

Act immediately by calling 911. Talk to your physician about lowering your chance of heart disease when you have diabetes by exercising, quitting smoking, eating a healthy diet, reducing stress and possibly taking medications.

Manage your ABCs:

  • lower your A1C level
  • get control of your Blood pressure
  • lower your bad LDL Cholesterol.
  • Outdoor Heat

4. Outdoor Heat

Outdoor heat, haze and humidity while exercising can be difficult on the heart and cause excessive sweating. Older people, people with chronic diseases such as diabetes or heart disease may have a dulled response to dehydration and may suffer from heat stroke faster and more often. Sweating helps the body cool down by dropping the body temperature through evaporation. When the humidity is 75% or higher, it is difficult to cool down by sweating since there is too much water vapor in the air. Sweating is hard on the system because it pulls out sodium, potassium and other minerals needed for nerve conduction, water balance and muscle contraction. Sweating also increases blood flow to the skin when you are over-heated. Stay in an air-conditioned environment such as a gym, a yoga class or community center when exercising in the summer heat and humidity. Find a shady spot if you choose to stay outdoors. Use an indoor pool or one that is covered by shade. Stay inside from 10AM-4PM when you do decide to exercise outdoors. Go to an air-conditioned movie or indoor mall mid-day. Eat light meals, do not turn on the oven and try to drink a few ounces of cool water every hour. Consult with your doctor about how and when to exercise. Never push yourself to the point of fatigue or heavy sweating which could possibly lead to heat stroke.

Symptoms of heat stroke include:

  1. Confusion
  2. Muscle twitching
  3. Nausea and vomiting
  4. Headaches
  5. Reduced or no sweating at all
  6. Stress

5. Stress

Another reason for heavy sweating is emotional or physical stress. The stress response occurs when the body perceives a threat. A hormone called adrenalin floods the body and increases the heart rate, blood pressure, breathing rate, blood sugar and perspiration. Sweat comes from the sweat glands which are mainly located in the armpits and groin. Many people also sweat heavily on their feet and palms of their hands. It is a normal response when you are anxious about anything, ranging from a job interview, a near accident, to a first date. Wear natural, breathable fibers like cotton, avoid spicy foods, lose weight, avoid nicotine, caffeine and alcohol to reduce sweating. Take several deep breaths when you start to sweat. Utilize progressive muscle relaxation by tensing and relaxing all muscle groups, write in a daily journal, listen to relaxing music, carry a change of clothing and if all else fails, consider a support group or therapist to help deal with your stress. Use an antiperspirant to minimize perspiration under your arms. Apply Gold Bond powder to the crevices of your body that might get sweaty, such as under your breasts and stomach. Use on your feet including between the toes to reduce the risk of fungus from the heavy sweating. Drink water to stay hydrated.

If you experience heavy sweating, you are not alone. Take measures to make yourself comfortable when you sweat. If you continue to suffer from excessive sweating, consult with your health care team to find out the reasons why and how to treat them.

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If you’re a woman approaching or in menopause, hot flashes may be the bane of your existence. Those all-too-familiar bursts of heat can mean discomfort and much misery. Women who have diabetes may have hot flashes that can be linked with low blood sugars, too. Read on to learn more about hot flashes and what you can do to help keep them at bay.


What exactly are hot flashes?
Hot flashes are sudden feelings of intense warmth that can come on over a few minutes or, more likely, all of a sudden. They are often accompanied by other symptoms, such as redness of the face or neck, sweating, rapid heartbeat, headache, and then feeling chilled once the flash has passed.

“Night sweats,” or hot flashes that occur at night and result in excessive sweating, can be particularly disruptive to sleep. Recurring night sweats can lead to insomnia.

While hot flashes can occur in anyone for a variety of reasons, they’re very common in women who are approaching menopause (perimenopause) or who are menopausal. (Men can also have hot flashes due to androgen deprivation therapy.) There’s no rhyme or reason to them, either: they can vary in intensity, they can come and go quickly or linger, and they can persist for months or even for years. Hot flashes are also more likely to occur in women who are overweight or who smoke. African-American women are more likely to get hot flashes than Caucasian women; women of Asian descent are less likely to experience them.

What causes hot flashes?
The cause of hot flashes is somewhat of a mystery. However, scientists believe that they’re related to imbalanced levels of hormones, such as estrogen and progesterone, and changes in the body’s thermostat, which is located in the hypothalamus in the brain. When a hot flash occurs, blood vessels in the skin dilate, causing blood to move into the area — hence, the redness and heat.

While hot flashes can sometimes appear to occur for no particular reason (other than to be annoying), there are certain factors that seem to trigger them. These include:

• Spicy foods
• Alcohol
• Hot beverages
• Caffeine
• MSG (monosodium glutamate)
• Smoking
• Warm temperatures
• Stress
• Anxiety
• Hyperthyroidism
• High blood pressure
• Certain medicines, such as raloxifene (brand name Evista), tamoxifen (Nolvadex, Tamoxen, Tamofen, Soltamox), tramadol (Ultram, Conzip, Rybix ODT, Ultram ER), and nitroglycerin (Nitro-Bid, Nitro-Dur, and others)

What’s the link between diabetes and hot flashes?
It’s not uncommon for women who are perimenopausal to have a higher risk of developing diabetes. Fluctuating hormone levels may lead to spikes and dips in blood sugar levels, and can also lead to insulin resistance. Add insult to injury: many women find that they develop food cravings and sleep poorly during this time of their life, which can cause weight gain and raise the risk of diabetes.

Women who have diabetes and who have hot flashes may find that, on top of the usual symptoms, they may feel shaky, confused, and/or weak. Why? It’s likely that low blood sugar is a trigger for hot flashes. Pay close attention to when your hot flashes occur, such as before a meal or after exercising, especially if you take insulin or certain types of diabetes pills that can cause lows, including sulfonylureas and meglitinides. Also, it’s a good idea to check your blood sugar if you have a hot flash that’s accompanied by typical symptoms of lows.

How to deal with hot flashes
There are many suggested ways to handle hot flashes. Lifestyle changes are often recommended first, such as:

• Trying to avoid or minimize triggers (see above)
• Dressing in layers
• Sipping on ice water
• Sleeping with a fan or the air conditioner turned on
• Using a “cooling” pillow and sheets
• Exercising regularly

Natural remedies are often touted, too. These include the use of herbs and essential oils. Black cohosh, dong quai, evening primrose oil, and soy are popular, as well as peppermint, lavender, geranium, and clary sage oils. Be careful using these remedies, however. Most of them are not well tested, and all of them can have potential harmful side effects. Talk with your health-care provider about the risks and benefits of using these.

The “big guns” are medications. Hormone replacement therapy (HRT) is probably the most effective way to treat hot flashes. Estrogen, with or without progesterone, helps to balance out hormone levels in the body, thus reducing or even eliminating hot flashes and improving quality of life. And HRT can help with other menopausal symptoms, such as vaginal dryness and discomfort. However, HRT hasn’t been without its controversies, and it may not be appropriate for some women. The good news is that a low dose of HRT for a short period of time is believed to be safe, along with being effective. Weigh the pros and cons of using HRT with your provider.

If you choose not to or cannot use HRT, there are non-hormonal medicines that may work. For example, certain antidepressants (fluoxetine , paroxetine , venlafaxine ) can help minimize hot flashes. Brisdelle is a newer medicine that contains paroxetine and is specifically aimed at hot flash treatment. Other medicines may help too, such as those used to treat nerve pain (gabapentin , pregabalin ), and clonidine (Catapres, Kapvay, Nexiclon, Clophelin, and others), a blood pressure medicine. Of course, all medicines have potential side effects, so decide with your provider if any of these are an option for you.

What else can you try? Acupuncture has been found to be effective in managing hot flashes and night sweats. And research indicates that managing stress through meditation is also helpful in easing hot flashes, as well.

Also, don’t overlook nutrition: following a Mediterranean diet (which emphasizes fruits, vegetables, beans, and whole grains) is beneficial, as is getting plenty of omega-3 fatty acids in your diet (found in foods such as salmon, tuna, mackerel, flaxseed). Soy foods may also help — these include unsweetened soy milk, soy nuts, and tofu.

For more information about hot flashes and menopause, in general, visit The North American Menopause Society’s website.

Want to learn more about staying healthy as an older woman with diabetes? Read “Menopause: What to Expect, How to Cope,” and “Top 10 Health Tips for Women Over 65.”

How to stop shivering

Shivering occurs most commonly when a person is cold. It is usually temporary and should stop once the individual warms up.

However, shivering can also be a symptom of physical or mental illness.

Below are eight potential causes of shivering:

1. Fever

Share on PinterestA fever may cause shivering.

Other than being cold, the most common cause of shivering is fever, which doctors define as a body temperature higher than 100°F.

Fever usually occurs as a result of infection, but inflammation or an allergic reaction can also increase body temperature. Some people with a fever may also have signs of flu, but others will have no additional symptoms.

Drinking plenty of fluids and taking nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce a temperature.

If a person has other symptoms, particularly a stiff neck, rapid heartbeat, or shallow breathing, they should seek medical advice within 24 hours. If they have no other symptoms, they will only need to visit a doctor if the fever lasts for more than 3 days.

2. Psychogenic movement disorders

For some people, stress or mental health factors can cause shivering and other involuntary movements. This usually occurs due to a psychogenic movement disorder, which can affect any part of the body.

A doctor who specializes in medical conditions affecting the brain, called a neurologist, will usually diagnose psychogenic movement disorders. They may look for the following characteristics when making a diagnosis:

  • movements happening suddenly, without warning
  • memories of a traumatic event triggering movements
  • movements stopping if a person is distracted
  • underlying mental health issues, such as depression

There is often no underlying brain or nerve damage. Instead, shivering is the body’s response to stress.

Doctors will often treat psychogenic movement disorders with a combination of mental health therapy and physical therapy.

3. Postanesthetic shivering

Share on PinterestA person may shiver when recovering from an anesthetic.

Shivering can occur when a person regains consciousness after a general anesthetic.

A person’s temperature may drop during a surgical procedure, which can cause them to shiver when they wake up after the operation is over.

Anesthetics can also affect the body’s ability to regulate temperature, which can make it difficult for the body to warm up quickly after an operation.

Doctors will usually check a person’s temperature and provide them with blankets or heaters if necessary.

4. Fear, excitement, or stress

Strong emotions can cause a person to shake or shiver. This is often due to a surge of adrenaline in the body. Adrenaline is a hormone that triggers the body’s fight-or-flight response.

Shivering should stop after the adrenaline leaves the body. For many people, this will happen very rarely, perhaps during a particularly exciting or frightening moment. For those who experience chronic stress, adrenaline surges and shaking can be more frequent.

5. Tremor

Involuntary trembling, shaking, or shivering can be due to a medical condition called essential tremor. Essential tremor is a neurological condition, meaning that it relates to the brain.

This condition affects approximately 10 million people in the United States and can cause trembling in the hands, legs, body, or voice.

Tremors can also be a symptom of Parkinson’s disease. This is a disorder that affects an area of the brain and tends to develop gradually.

6. Low blood sugar

If a person has not had food or water for a long time, the level of glucose in their blood can drop. This low blood sugar can cause shivering or shaking.

For people who have diabetes, this will be known as hypoglycemia, and it can be severe. People with diabetes should check their blood glucose regularly to prevent their levels from dropping too low.

7. Anxiety

Anxiety is a mental health condition that can affect the body as well as the mind. It can cause physical symptoms, such as nausea, increased heart rate, and shivering or shaking.

Treatment for anxiety may include therapy, medication, and lifestyle changes. Activities that might help a person to manage their anxiety include exercising, listening to music, and spending time with supportive friends and family.

8. Sepsis

Share on PinterestSepsis may require hospital treatment.

Sepsis is an overwhelming response of the body to infection, and it often occurs in connection with lung, skin, gut, or urinary tract infections.

One of the symptoms of sepsis is shivering. Other symptoms include confusion, feeling sweaty or clammy, pain, raised heart rate, and shortness of breath.

Sepsis is a medical emergency. People with sepsis will need prompt treatment with antibiotics in a hospital.

Hypoglycemia is a common side effect of using insulin, and it can also occur in people who take pills that cause the pancreas to release more insulin. Pills that have this effect include the oral drugs chlorpropamide (brand name Diabinese), glyburide (DiaBeta, Glynase, and Micronase), glipizide (Glucotrol, Glucotrol XL), glimepiride (Amaryl), combination drugs that contain glyburide, glipizide, or glimepiride (such as Glucovance, Metaglip, Avandaryl, and Duetact), repaglinide (Prandin), combination drugs that contain repaglinide (Prandimet), and nateglinide (Starlix). It is therefore important that anyone who uses one of these drugs know what causes hypoglycemia, how to prevent it, how to recognize it, and how to treat it.


Often, however, the most education a person receives on the signs and symptoms of hypoglycemia is a handout listing its 10 most common symptoms. This is particularly true for adults. But, as any longtime user of insulin will tell you, such a list does not go far enough in describing how those common symptoms can feel, and it misses some important, albeit not-so-common, symptoms of hypoglycemia.

This article attempts to fill in some of the blanks by describing what those common symptoms really feel like — in a variety of situations, including driving and sleeping — and by describing some less common symptoms. Once you (and your friends, coworkers, and family members) are better equipped to recognize hypoglycemia, you will be able treat low blood glucose faster and avert more severe hypoglycemia and its sometimes serious consequences.

What is hypoglycemia

Low blood glucose, or hypoglycemia, is a condition in which the brain does not have enough glucose to carry out its many functions. In a person with diabetes, it most often results when there is an imbalance in food, insulin, and exercise. In other words, eating raises blood glucose level. Insulin (whether injected or secreted by the pancreas) lowers blood glucose level. Exercise usually lowers blood glucose level (unless there is not enough insulin circulating in the bloodstream, in which case it may raise it). Hypoglycemia results if not enough food is eaten for the amount of insulin present and exercise done.

— Learn More About Blood Glucose Management >>

When a person’s blood glucose level begins to drop, his body starts a series of reactions intended to raise its blood glucose level. Hormones are produced that cause the release of stored glucose from the liver. These hormones also produce some of the symptoms typically associated with hypoglycemia, such as trembling. If the body cannot reverse the low blood glucose on its own (which can happen if the liver’s supply of stored glucose has been depleted by, say, vigorous exercise) and the person does not recognize the symptoms of low blood glucose and does not consume some carbohydrate, the blood glucose level will drop further. If it goes low enough, a person may become confused or even pass out.

Health-care providers often recommend treating for hypoglycemia if blood glucose is below 70 mg/dl. (For children and elderly people, however, the recommended treatment level may be higher.) Treatment generally involves consuming 15 grams of carbohydrate (the amount in 1/2 cup fruit juice or regular soft drink, 3–4 glucose tablets, 1 tablespoon sugar, or 6–8 Life Savers), waiting about 15 minutes, then checking your blood glucose level with your meter to see if it has risen to a safe level. Some experts also recommend checking blood glucose levels again an hour after the last treatment to see whether additional food is necessary.

Hypoglycemia that you can treat yourself is usually referred to as mild hypoglycemia. If others have to assist you in obtaining and consuming a source of carbohydrate, you would generally be considered to have moderate hypoglycemia. In moderate hypoglycemia, your ability to communicate, pick an appropriate food, or realize that you should do something to raise your blood glucose level may be impaired. Severe hypoglycemia occurs when you have lost consciousness, are having a seizure, or cannot be awakened. To revive you, someone must give you an injection of glucagon, a hormone that stimulates the release of glycogen, a form of stored glucose, from the liver, or emergency services must be called to give you glucose intravenously.

Common symptoms explained

Given the potential consequences of severe hypoglycemia, it’s worth doing your best to avert it by treating mild hypoglycemia as quickly as possible. In addition, the earlier you treat mild hypoglycemia, the faster your symptoms will go away. The following are some common signs and symptoms of hypoglycemia. Just because they’re common, however, doesn’t mean that everyone experiences them. You may have your own, unique indicators of hypoglycemia that don’t appear on this list. In addition, your experience of a common symptom may be somewhat different from someone else’s, or it may be different from what you might have expected. That’s why it’s important to pay attention to any feeling, sensation, emotion, or behavior that might be attributable to hypoglycemia.


A common early symptom of hypoglycemia, shaking does not refer to the full-body shakes of someone having a seizure but instead to a more subtle trembling that may initially be sensed by the person experiencing it without being visible to an observer. It may progress to fine tremors of the fingers so that if you are trying to perform fine motor tasks with your hands, such as writing or threading a needle, you may notice that the task is more difficult. If you are not using your hands, however, you may not notice any trembling.


Another common symptom of the early stages of hypoglycemia, sweating typically occurs all over the body — not just in the armpits — and can progress from mild to drenching. Many people notice the sweating on their face first. You may also feel warmer than usual at first but have chills later. While in some situations you may be keenly aware that your sweating is unusual, there are others in which you may not realize you’re sweating because of hypoglycemia. For example, you would expect to sweat during exercise or while outside on a hot day. If sweating occurred while swimming, taking a shower, or sleeping, you might not even realize you were sweating.

For some people who take beta-blockers, a type of blood pressure medicine, sweating may be the only early symptom of hypoglycemia, because beta-blockers can prevent the body from shaking or having other hypoglycemia symptoms such as a fast heartbeat.

Fast heartbeat

Many things in addition to hypoglycemia can cause a fast heartbeat, including excitement, stress, exercise, or ketones associated with high blood glucose. This can make it harder to notice fast heartbeat as a potential sign of hypoglycemia, but if you are having a fast heartbeat when there is no apparent reason for this to occur, you should check your blood glucose level.

Looking pale

You or those around you may notice that you are paler than usual during hypoglycemia.


Hunger is a useful symptom of hypoglycemia since it usually leads a person to eat and consequently raise his blood glucose level. However, you may be in the habit of ignoring the initial symptoms of hunger at work or school if you’re in a meeting, engrossed in studying, or attending a lecture. This is a dangerous habit to have, because the longer you ignore hunger, the hungrier you get and the more likely you are to overeat when you finally eat. In addition, if you wait until you have moderate hypoglycemia, your judgment may be affected such that you eat the first thing you find, whether or not it will quickly raise your blood glucose level.

Weakness and fatigue

These symptoms are directly related to your body not having enough energy (glucose) for both physical and mental needs. It may be tempting to take a nap when you feel weak and tired, but it’s important to monitor your blood glucose level if you feel this way at a time of day when you are not usually tired. If hypoglycemia is causing your feeling of fatigue, your blood glucose level may go even lower during your nap, and you are unlikely to be able to detect other symptoms of hypoglycemia while asleep.


Having a headache often signals that you had hypoglycemia earlier in the day or have had it for some time. For example, if you wake up with a headache or leave a movie theater with a headache, you may have been hypoglycemic for some time. If the headache is severe enough, you may have nausea. You should treat yourself with carbohydrate and plan to monitor more frequently for the rest of the day. If the hypoglycemia has lasted a long time, the body’s stored sugar may have been used up, and you are more prone to repeat episodes of hypoglycemia that day.

Impaired vision

Double vision and tunnel vision are two types of visual disturbances that may occur with hypoglycemia. Like headache, impaired vision also often signals that your blood glucose has been low for quite some time. Your brain routinely takes two pictures from two eyes and formulates the pictures into a single image. When your brain does not have enough glucose, the brain loses the ability to coordinate vision. You may see fine with one eye closed, but quick action is needed to prevent the confused state that will follow if you don’t raise your blood glucose level.

Enlarged pupils can also be a symptom of hypoglycemia, but you are unlikely to notice them unless you’re looking in a mirror or someone else takes a close look at your eyes. If you are becoming hypoglycemic while reading, you may notice that you cannot find the correct line or that you see fewer words with each glance.

Difficulty communicating

Difficulties with communication can range from not being able to remember a word, to speaking in a monotone, to only responding in simple words such as “yes” or “no.” Some people describe feeling that the words they want to use are just out of their reach.

Difficulty absorbing new information

Without adequate glucose, your brain has trouble taking in new information. If you find yourself reading the same paragraph over and over or listening to someone speak then realizing you missed what was said, perhaps because you were daydreaming, you may have hypoglycemia.


Dizziness is another symptom that occurs after a person has been hypoglycemic for some time. You may have trouble walking a straight line or changing body positions. This is one of many symptoms of hypoglycemia that may be misinterpreted as drunkenness. If strangers or the police find you swerving while walking, medical identification in the form of a bracelet, necklace, or wallet card may save you from a misunderstanding and get you the treatment needed to stave off severe hypoglycemia.

Numbness or tingling

Numbness or tingling in the face or hands may be symptoms of hypoglycemia. Sometimes the numbness is first noticed in one spot, such as the upper lip, then it spreads across the face.

Unusual behavior

Anxious, giddy, confused, and irritable behaviors are important symptoms for friends, coworkers, and family members to learn about. These symptoms may occur when you can no longer judge that you are in danger. Your blood glucose may be so low that you no longer recognize family members or authority figures such as the police. You may argue, cry, yell, or fight.

It can be difficult to help a person who has reached this stage. Often, a person in this stage of hypoglycemia wants to perform a particular task and finds that a “stranger” (the person trying to help) is keeping him from performing that task by trying to get him to consume some carbohydrate.

It may help to talk over the possibility of this happening with your friends, coworkers, and family members before it happens and to brief them on what to do if it does. You might ask your potential helpers to remain calm, to refrain from raising their voices (which can feel threatening), and to place a container of juice or some glucose tablets in your hand or on the table or desk in front of you. Remind them that you may not recognize them when you’re in an agitated or confused state and that you may say potentially hurtful things you don’t mean.

Typically, a person passes from an agitated stage to a more docile stage, when it may be easier to get him to drink juice or to eat something. But the docile stage precedes the passing out stage, leaving little room for comfort. Even though dealing with an agitated person is difficult, it is better to at least try to get him to eat or drink than to simply wait until his blood glucose level drops even lower. Keep in mind that it will take a while for a person’s blood glucose level to rise and that anyone who has needed assistance treating hypoglycemia should not be left alone until his blood glucose is in a safe range and he shows signs of good judgment.

Hypoglycemia while driving

For obvious reasons, it is important for people with diabetes to recognize symptoms of hypoglycemia while driving and to pull over to treat it. However, two common early symptoms of hypoglycemia, shaking and sweating, are often not noticed while driving. Why? If you are gripping the steering wheel, you may not notice fine tremors in your fingers, and if you are driving in hot weather, you may assume that sweating is due to the weather.

One way to lower your chances of experiencing low blood glucose while driving is to establish a minimum safe blood glucose level for driving with the help of your health-care provider and to always check your blood glucose level before driving. If you’re taking a long trip, plan to pull over and check your blood glucose level every two hours, eat all snacks and meals on schedule, and share the driving with someone else.

Taking such steps greatly increases the likelihood of a safe drive, but unfortunately, even the best prevention can’t guarantee that you won’t develop hypoglycemia. That’s why it’s good to know about some symptoms of hypoglycemia that are typical of (if not unique to) driving. Two typical characteristics of a driver with hypoglycemia are that he develops a sort of one-track mind, in which continuing to drive becomes the sole goal, and that he loses the ability to remember where he is or how to get to his final destination. A driver may, for example, miss the exit to a familiar destination, drive steadily in one direction with no change in driving speed, or drive for many miles beyond his destination. Other peculiar driving behavior reported by family members of people driving with hypoglycemia include stopping at all traffic lights no matter what the color of the light.

Often, passengers are the first to notice that something is awry. However, if you are alone in the car and have the sense that you’re lost or don’t know where you’re going, you should pull over as soon as it’s safe and check your blood glucose level. (If you don’t have a meter with you when you experience symptoms of hypoglycemia, you should go ahead and treat without checking.) You should do the same if you recognize any other possible symptoms of hypoglycemia such as double vision.

Because of the increased responsibility that comes with driving, you should confirm that your blood glucose has returned to a safe level after consuming some carbohydrate before resuming driving. Even if you’re in a hurry, you need to change your priorities, especially before resuming a long trip, to ensure your safety and the safety of others.

Wearing or carrying medical identification specifying that you have diabetes is always a good idea, and it’s especially true while driving. If you pass out at the wheel or are driving erratically because of hypoglycemia, other drivers and the police may assume that you’re drunk. In addition, if your blood glucose level is so low that you do not recognize the authority of the police, you may argue or fight with an officer who pulls you over or approaches you, increasing the likelihood that he’ll think you’re under the influence of alcohol or other drugs.

However, the police are required to look at a person’s wrist, neck, and wallet for medical identification. If you have it, you have a better chance of getting the treatment you need. If you don’t have it, you may be placed in a holding room at a jail and not receive any help.

Because others could mistake hypoglycemia for something else, many parents of teenagers with diabetes require that their teens get in the habit of wearing identification before they are allowed to take driver’s education. Parents are also demanding that teens check their blood glucose level before driving and delay driving until their blood glucose is in a safe range. These same rules should be followed by drivers of any age who are at risk for hypoglycemia. If you frequently experience severe hypoglycemia, however, you may not receive a physician’s clearance for a driver’s license until you have proven that your diabetes is under control.

Hypoglycemia while sleeping

Detecting hypoglycemia while sleeping poses many challenges for people with diabetes. When you are asleep, you cannot tell if your fingers are shaking. In addition, you may not realize that you have double vision or notice weakness or fatigue. But there are some symptoms that may wake you up or partially arouse you, including the following:

• Sweating may alert you or your spouse that you are having hypoglycemia, especially if profuse sweating has made you cold or made your pillow or sheets cold and wet. If you awaken to cold, wet sheets or pajamas, you may be tempted to just change clothes or get a dry sheet and go back to sleep as quickly as possible. But you need to consume some carbohydrate and do a thorough job of treating your low blood sugar to avoid more problems later. Avoid the desire to ignore the problem.

• A fast heartbeat may not be apparent to someone in deep sleep, but it may catch your attention when you roll over. For this symptom to be useful, you have to learn to recognize that a fast heartbeat is a symptom of something very wrong and take action.

• Having a headache in the middle of the night or upon waking is a symptom of hypoglycemia that requires prompt action and more frequent monitoring during the day.

• Nightmares or simply strange dreams can be a symptom of hypoglycemia. Some people describe being “stuck in the same dream.” Others remember having “a long dream,” “an intense dream,” or “daydreaming at night.” What is important is to recognize how your dreams are different during nighttime hypoglycemia and to respond by getting up and checking your blood glucose level if you notice such dreams.

• A person experiencing severe hypoglycemia during sleep would be unable to help himself, but his condition would be evident to others if they were unable to arouse him or if he were having convulsions.

Treatment for mild nighttime hypoglycemia includes eating or drinking some carbohydrate. If it will be many hours before you wake up for breakfast, you should also have a substantial snack containing carbohydrate so that your blood glucose doesn’t go low again during the night. Usually, treatment for severe hypoglycemia during the day is to either call an ambulance or give glucagon. In contrast, for severe nighttime hypoglycemia, many health-care providers recommend doing both: giving glucagon and calling an ambulance, because the person may have been severely low for some time before anyone realized there was a problem. If so, glucagon may not be effective because the liver’s supply of glycogen may be depleted.

After an episode of nighttime hypoglycemia, it’s important to think about how to prevent future episodes. Review your exercise, food intake, and medicine intake from the previous evening or day to look for clues to the cause of your hypoglycemia. If you cannot readily determine the cause or correct the problem on your own, contact your health-care provider for help.

Preventing hypoglycemia

When you were first informed about hypoglycemia by your doctor or diabetes educator, you may not have paid a lot of attention or felt too concerned about it. It is often not until the first mild or moderate hypoglycemia episode that you or your family members learn the value of avoiding low blood glucose.

You can reduce your chances of developing hypoglycemia by learning to make adjustments in your diabetes control regimen to accommodate different activities and circumstances. For example, if you find you tend to develop hypoglycemia after a certain type of exercise, you can learn (with the help of your doctor or diabetes educator) how to adjust your food or medicine on the days you perform that exercise. Keeping a blood glucose monitoring log and regularly reviewing it with your health-care provider can help to determine where problems may be occurring and how to fix them.

Your goal is to find a healthy balance to keep your blood glucose level in target range most of the time. You should not have low blood glucose frequently, but you also should not maintain high blood glucose to avoid hypoglycemia, because having chronically high blood glucose has consequences, too. By learning about the many symptoms of hypoglycemia and paying attention to the symptoms you experience, you have empowered yourself to seek treatment faster. You should not have to give up the things that are important to you such as exercise, playing with your children, or driving just because you could develop hypoglycemia. And with adequate education, planning, and attention, you won’t have to.

Want to learn more about how to handle low blood sugar? Read “Treating Hypoglycemia: No One-Size-Fits-All Solution” and “Understanding Hypoglycemia.”

Know the Signs of Hypoglycemia

Hypoglycemia can be a very serious condition, with extreme cases causing seizures, coma, and even death. It occurs when blood sugar levels drop too low, and it is most often experienced by people with diabetes.

As you learn about diabetes management, being well versed in low blood sugar symptoms will enable you to detect the signs of impending hypoglycemia and act quickly to head it off or minimize its impact.

Diabetes Type and Hypoglycemia Risk

Hypoglycemia risk varies across the three different types of diabetes:

Type 1 Diabetes People with type 1 diabetes experience hypoglycemia most often, as their diabetes management often requires a lot of attention and careful planning. The average person with type 1 diabetes who is attempting aggressive disease control may still experience low blood sugar symptoms frequently, and a full-blown case of hypoglycemia will require close medical attention.

“When it comes to type 1 diabetes, the body can’t make insulin on its own, so it must be administered,” notes Erin Palinski-Wade, RD, CDE, Everyday Health contributor and author of Belly Fat for Dummies. Paying close attention to your diet is important, too. “If the correct amount of insulin is given based on the amount of carbohydrates consumed, blood sugar levels can remain in a healthy range.”

Type 2 Diabetes These patients experience hypoglycemia less frequently than people with type 1 diabetes; the rate of hypoglycemia for type 2 diabetes patients taking insulin is about one-third that of type 1 diabetes patients. But research shows that the frequency of hypoglycemia in people with type 2 diabetes increases as the disease becomes more advanced.

“In people with type 2 diabetes, the body may produce adequate insulin, yet the cells are resistant to it, making the insulin ineffective at transferring blood glucose into the cells to be used as energy,” says Palinski-Wade.

People with both types of diabetes should aim to eat complex carbohydrates. “Avoiding refined carbohydrates and simple sugars is key in reducing insulin resistance, so that the body can better process blood glucose levels,” she says.

Gestational Diabetes This type of diabetes only happens during pregnancy, and occurs when your pancreas can’t make enough insulin, often due to changes in hormones. Gestational diabetes patients may experience hypolgycemia even if they take insulin during their pregnancy. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), your chances of getting this type of diabetes is higher if you’re overweight, though there are other factors, too.

Low Blood Sugar Symptoms

The warning signs of hypoglycemia may vary from person to person, but it’s important to know about and be alert to all of them, including:

  • Feeling very shaky or trembling
  • Weakness or dizziness
  • Sweating or feeling cold and clammy
  • Extreme hunger pangs
  • Trouble keeping your balance or staggering when you walk
  • Pale or gray skin
  • A bad headache
  • Becoming confused and unable to think or concentrate
  • Feeling uncharacteristically moody or cranky
  • A tingling sensation around your mouth
  • Double vision or vision that has grown blurry
  • A quickening heartbeat

Some people will experience an episode of hypoglycemia in their sleep. Signs of nocturnal hypoglycemia include:

  • Waking up with your pajamas or sheets soaked with sweat
  • Feeling cranky, irritable, tired, or confused after waking up
  • Having nightmares or crying out in your sleep

People with extreme hypoglycemia may pass out or experience seizures as a result of low blood sugar. These people are in danger of lapsing into a coma and could die if not treated.

What You Should Do

Still, there are steps you can take to help prevent your blood sugar from dropping too low. “Take the time to schedule frequent meals and snacks,” advises Palinski-Wade. “Going long periods of time without eating, especially after physical activity, is one of the main reasons for drops in blood sugar levels. If you’re prone to frequent lows, testing blood sugar levels often is also an effective way to prevent this.”

If you have diabetes and think you’re experiencing hypoglycemia, you should test your blood sugar levels as soon as possible using a glucose meter. Levels below 70 milligrams per deciliter will require immediate treatment.

The best way to treat hypoglycemia is to eat some form of sugar. The American Diabetes Association (ADA) recommends getting between 15 and 20 grams (g) of sugars or carbohydrates with each snack, and between 40 and 65 g at each meal.

Although the ADA recommendation can offer a helpful framework, Palinski-Wade notes that counting and restricting carbs isn’t a one-size-fits-all approach. “Someone who is more prone to hypoglycemia may have different per-meal carbohydrate goals than another individual,” she says. “Getting 15 to 30 g of carbs per snack and 45 to 60 g per meal is a good starting point, but you should work together with your diabetes treatment team to see what carbohydrate goals work best for your own individual needs.”

If your blood sugar drops drastically, you can take a few immediate steps to address the situation. “Once you know your blood sugar is low, use the 15/15 rule,” Palinski-Wade says. “Consume 15g of quick acting carbs (such as orange juice), wait 15 minutes, and retest your blood sugar. Continue to repeat this until your blood sugar levels are within a healthy range.” By following this advice, Palinski-Wade says you may be better able to prevent yourself from eating too many carbs at once, which may spike blood sugar levels. Some other quick-acting sources of carbs include:

  • Fruit juice, 1/2 cup
  • Regular (non-diet) soda, 1/2 cup
  • Milk, 1 cup
  • Hard candy, 5 or 6 pieces
  • Saltine crackers, 4 or 5
  • Raisins, 2 tablespoons (tbsp)
  • Sugar or honey, 1 tbsp
  • Glucose tablets, 3 or 4
  • Glucose gel, 1 serving

If you pass out or experience seizures, you need to see your doctor or call 911 to get to an emergency room for treatment.

To help manage diabetes and keep hypoglycemia from occurring, Palinski-Wade recommends staying focused on eating a diet high in fiber, vegetables, fruits, whole grains, lean proteins, and healthy fats, and limiting large amounts of added sugars and saturated fats. Also, “frequently testing blood glucose levels and tracking carbohydrate intake, exercise, stress levels, and sleep patterns — and sharing this data with your diabetes care team — is the most effective way to help you best manage diabetes and prevent spikes and crashes in blood glucose levels,” she says.

NCLEX-RN Exam Cram: Care of the Client with Endocrine Disorders

Diabetes Mellitus

There are two types of diabetes: type 1 and type 2. Type 1, also called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, is a condition where the islets of Langerhans in the pancreas do not produce needed insulin. Insulin is necessary for food to be metabolized. Antibodies have been found in the majority of clients with type 1 diabetes. These antibodies are proteins in the blood that are part of the client’s immune system. It is believed that type 1 diabetes is in part genetically transmitted from parent to child. At stressful times in life, such as when infection is present, pregnancy or environmental toxins might trigger abnormal antibody responses that result in this autoimmune response. When this happens, the client’s body stops producing insulin. Type 1 diabetes tends to occur in young, lean individuals, usually before 30 years of age; however, it can occur in older individuals. These individuals are referred to as latent autoimmune diabetes in adults (LADA). Diabetes occurs in about 6% of Caucasians, 10% of African Americans, 20–50% of Native Americans, and 15% of Hispanics.

Type 2 diabetes was referred to as non–insulin-dependent, adult-onset diabetes mellitus (ADDM). However, in recent years, more and more children have been diagnosed with ADDM. This trend can be attributed to obesity and sedentary lifestyle. In ADDM, the cells of the body, particularly fat and muscle cells, become resistant to insulin. This leads to increased insulin production with increased insulin resistance. Tests have also shown that this increased insulin resistance leads to a steady decline in beta cell production further worsening glucose control. This problem along with gluconeogenesis, a process in which the liver continues to produce glucose, leads to further hyperglycemia, metabolic acidosis, and deterioration of the client’s health.

Signs and symptoms associated with diabetes mellitus include

  • Weight loss: Insulin is required for carbohydrates to be converted into useable glucose; a lack of insulin results in a lack of glucose with cellular starvation.
  • Ketonuria: The breakdown of fats leads to the production of ketones that causes characteristic fruity breath.
  • Polyphagia: Cellular starvation causes the diabetic to increase food consumption.
  • Polyuria: The kidneys attempt to regulate pH by increasing urinary output of ketones and glucose.
  • Polydipsia: The loss of large amounts of fluid leads to metabolic acidosis and dehydration. To compensate for the fluid loss, the client drinks large amounts of water.
  • Delayed wound healing: Increased blood sugar contributes to poor wound healing.
  • Elevated blood glucose: Normal is 70–110 mg/dl. Uncorrected or improperly managed diabetes mellitus leads to coma and death.

Diagnosis of diabetes mellitus is made by checking blood glucose levels. Several diagnostic tests that can be performed to determine the presence and extent of diabetes are as follows:

  • Glucose tolerance test: The glucose tolerance test is the most reliable diagnostic test for diabetes. Prior to the glucose tolerance test, the client should be instructed to eat a diet high in carbohydrates for three days and remain NPO after midnight the day of the test. The client should come to the office for a fasting blood glucose level, drink a solution high in glucose, and have the blood tested at one and two hours after drinking the glucose solution (glucola) for a test of glucose in the serum. A diagnosis of diabetes is made when the venous blood glucose is greater than 200 mg/dl two hours after the test.
  • Fasting blood glucose levels: The normal fasting blood glucose is 70–110 mg/dl. A diagnosis of diabetes can be made if the fasting blood glucose level is above 140 mg/dl or above on two occasions. A blood glucose level of 800 mg/dl or more, especially if ketones are present, indicates a diagnosis of hyperosmolar hyperglycemic nonketoic syndrome (HHNKS).
  • Two-hour post-prandial: Blood testing for glucose two hours after a meal.
  • Dextrostix: Blood testing for glucose.
  • Glycosylated hemoglobin assays (HbA1c): The best indicator of the average blood glucose for approximately 90–120 days. A finding greater than 7% indicates non-compliance.
  • Glycosylated serum proteins and albumin levels: Become elevated in the same way that HbA1c does. Because serum proteins and albumin turn over in 14 days, however, glycosylated serum albumin (GSA) can be used to indicate blood glucose control over a shorter time.
  • Urine checks for glucose: Ketonuria occurs if blood glucose levels exceed 240 mg/dl.
  • Antibodies: Checked to determine risk factors for the development of type 1 diabetes. Measurement of the cells’ antibodies can also determine the rate of progression to diabetes.

Management of the client with diabetes mellitus includes the following:

  • Diet: The diet should contain a proper balance of carbohydrates, fats, and proteins.
  • Exercise: The client should follow a regular exercise program. He should not exercise if his blood glucose is above 240 mg/dl. He should wait until his blood glucose level returns to normal.
  • Medications: Oral antidiabetic agents or insulin. Medications used to treat diabetes mellitus include sulfanylurea agents, alpha-glucosidase inhibitors, nonsulfanylurea agents, D-phenylalanine derivatives, and thiazolidinediones. Insulins are also used to treat clients with type 1 diabetes. Insulin can be administered subcutaneously, intravenously, or by insulin pump. An insulin pump administers a metered dose of insulin and can provide a bolus of insulin as needed. Byetta is an injectable medicine used to improve blood sugar control in adults with type 2 diabetes. This drug can be used with metformin (Glucophage) or other sulfonylureas. Other more recent medications used to treat type II diabetes mellitus are Januvia (sitagliptin), Onglyza (saxagliptin), Prandin (repaglinide), Starlix (nateglinide), and Victoza (liraglutide).


When there is lack of the hormone insulin, the glucose can’t move from the outside of the cell to the inside of the cell where it can be used. It is very important that the nurse be aware of the signs of hyperglycemia to teach the client and family. Signs and symptoms of hyperglycemia are as follows:

  • Headache
  • Nausea/vomiting
  • Coma
  • Flushed, dry skin
  • Glucose and acetone in urine


When there is a lack of glucose, cell starvation occurs. This results in hypoxemia and cell death. Signs and symptoms of hypoglycemia are as follows:

  • Headache
  • Irritability
  • Disorientation
  • Nausea/vomiting
  • Diaphoresis
  • Pallor
  • Weakness
  • Convulsions

Managing Hyperglycemia and Hypoglycemia

Management of hypoglycemia includes giving glucose. Glucagon, a 50% glucose solution, is an injectable form of glucose given in emergency. Cake icing, orange juice, or a similar carbohydrate can be administered if the client is still conscious. The best bedtime snack is milk and a protein source, such as peanut butter and crackers. Fluid and electrolyte regulation is also a part of the treatment of both hyperglycemia and hypoglycemia.

Unchecked hyperglycemia leads to microangiopathic and macroangiopathic changes. These lead to retinopathies, nephropathy, renal failure, cardiovascular changes, and peripheral vascular problems.

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