Updated July 25, 2006

Hypoglycemia Symptoms
Why a Short List Is Not Enough

by Celia Kirkman, R.N., C.D.E.

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.

Celia Kirkman is the Diabetes Coordinator at the Anne Arundel Medical Center’s Diabetes Center in Annapolis, Maryland.

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