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Not only are high blood glucose levels (hyperglycemia), but also low blood glucose levels (hypoglycemia) can affect people. Hypoglycemia is defined as a condition in which the plasma glucose concentration or blood glucose reaches below 70 mg/dL, with the normal blood glucose levels ranging between 72 to 108 mg/dL. The symptoms of hypoglycemia, however, may start showing below 55 mg/dL.
According to a study, hypoglycemia is the most neglected complication that has caused a six-fold increase in deaths due to diabetes. The main cause of low blood sugar is glucose-lowering therapies.
People with diabetes are often under medications that help lower their glucose levels in their body. Sometimes, these medications can cause glucose levels to drop below normal and cause hypoglycemia. Also, the condition is three times more prevalent in type 1 diabetics than type 2 diabetics. 
Low blood sugar is always not related to diabetes as other conditions like alcoholism, hormone deficiencies, non-islet cell tumour, sepsis, kidney failure and malnourishment can also cause blood glucose levels to go down.
In this article, we will discuss some of the symptoms of low blood sugar. This will help you identify your condition and get treatment sooner.
1. An irregular or fast heartbeat
According to a study, severe hypoglycemia can cause cardiovascular outcomes such as cardiac arrhythmia (a group of conditions that cause the heart to beat irregular, too quickly or too slowly) or heart palpitations (short-lived arrhythmia due to stress, nicotine or physical activity). 
Recurrent occurrences of low blood sugar mainly due to excessive caffeine or alcohol intake can cause fatigue in some. Fatigue is also recognised as a presenting symptom related to the onset of vascular complications and hormonal changes due to low blood glucose. 
3. Mood change
Acute hypoglycemia can cause mood changes in healthy and non-diabetic adults, says a study. Mood change due to low blood glucose levels is also accompanied by a decline in energy, irritability and tiredness for at least 30 minutes after the restoration of glucose levels. 
4. Pale skin
Cortisol, a steroid hormone plays an important role in managing low blood sugar levels. According to a study, pale skin can be a possible sign of hypoglycemia due to adrenal insufficiency. In conditions such as Addison's diseases, the body is unable to produce enough cortisol which may lead to adrenal insufficiency and cause symptoms such as pale skin. 
Tremor or shakiness often occur as an adrenergic symptom in diabetics due to the side effect of insulin therapy. In non-diabetics, it can also occur as a result of severe alcoholism. However, according to a study, the incidence of shakiness is 3.5 times more in people with hypoglycemia compared to people without hypoglycemia. 
6. Sleep disturbances
Hypoglycemia and sleep are much integrated. There have been incidences of death during sleep in hypoglycemic patients, mainly due to cardiac arrhythmia and hormonal imbalance. However, some patients, especially children with type 1 diabetes experience sleep disturbances such as daytime sleepiness and insomnia. 
Low blood glucose levels in the body can cause an acute increase in epinephrine or adrenaline. This may lead to some neuropsychiatric symptoms such as anxiety. A study says that deficiency of vitamin B6, vitamin B12, proteins and omega-3 fatty acids in non-diabetics can also lead to anxiety. 
Sweating or diaphoresis is the key symptom of hypoglycemia. Low blood sugar levels cause deprivation of glucose in the brain, which leads to neuroglycopenic and neurogenic symptoms such as sweating. 
A study says that in diabetics, sometimes the plasma glucose-lowering therapies cause weight gain by increasing the feelings of hunger and thus, the food intake. However, repeated incidences of low blood sugar may not induce hunger and that's why. The symptom is more common in new diabetics. 
10. Food aversion
As mentioned in the previous point, persistent hypoglycemic incidences can cause food aversion, especially in children or infants with diabetes. Therefore, feeding plays a vital role in the management of hypoglycemia in children. Also, the presence of food aversion is independent of developmental or cognitive delays. 
11. Paresthesia or abnormal sensations on the skin
Paresthesia is referred to as abnormal sensations in the skin such as tingling, numbness, burning and prickling, especially on the lips, tongue and cheek. A study says that low blood sugar can sometimes cause alterations both in the central and peripheral nervous system which may lead to paresthesia. 
A study talks about the prevalence of headache in diabetics due to hypoglycemia. It says that the symptoms may occur occasionally in people with unstable diabetes as a result of a rebound phenomenon. Hypnic headache was also observed in a few cases. 
13. Shivering or chills
Shivering or chills occurs in type 1 and 2 diabetes mainly because low glucose levels cause changes in body temperature regulation. Also, impairments in body temperature due to low sugar occurs more during climate change or when the prevalence of heat waves are high. 
14. Hormonal imbalance
As the concentration of glucose in the blood declines, peripheral and central glucose sensors send the information to neuroendocrine and autonomic nervous systems to decrease the progression of hypoglycemia. In cases when the glucose levels are not managed and fall below the normal range, two hormones called growth hormone and cortisol are released. These hormones manage glucose levels but may also cause hormonal imbalance as a side effect when produced in high amounts. 
15. Muscle ache
Acute hypoglycemia can cause painful neuropathy such as muscle ache in some. A study says that insulin injections can sometimes cause low blood glucose in people with diabetes mellitus. However, the study also adds that hypoglycemia cannot be considered as a sole factor for the development of neuropathy in diabetics. 
Nocturia is referred to as nighttime urination or say, frequent need to urinate in the night. Though nocturia is mainly associated with high blood sugar levels, it can also occur in low blood glucose mainly due to sleep disturbance or diabetes medications.
17. Gastrointestinal discomforts
A study talks about gastrointestinal discomforts in hypoglycemic patients. The condition is mainly caused due to the dysfunction of beta cells and abnormalities in the glucose regulation by insulin and glucagon. The symptoms include gastric, bloating and diarrhoea. 
Low blood sugar levels can sometimes become severe and cause symptoms such as:
Deprivation of glucose is directly related to neuroglycopenic symptoms such as confusion and abnormal behaviour or both. It includes trouble in thinking, inability to complete routine tasks or brain fog. It occurs mainly when the hypoglycemia is left untreated, giving way to a serious central nervous system disorder. 
19. Visual disturbances
Severe or prolonged hypoglycemia can cause problems in retinal functions and sensitivity, in both diabetics and non-diabetics. It includes problems such as blurred vision, diplopia and loss of contrast sensitivity (a factor that helps with driving at night). A study says that low blood sugar causes a decrease in retinal response and increase retinal cell death, leading to visual disturbances. 
20. Seizures And Coma
A data-based study has shown that seizures can occur as an early symptom of hypoglycemia due to insulin administration. Insulin drugs or injections can temporarily decrease glucose or glutamate supply to the brain and cause seizures, accompanied by coma probably after 108 minutes. 
21. Poor coordination
Sometimes, in recurrent episodes of low blood glucose, the cerebral blood flow to the thalamus and hypothalamus reduces, causing a decrease in the neuronal activation in these regions of the brain. As coordination is controlled by the cerebellum, low blood flow to the area due to low blood glucose can cause poor coordination. 
22. Loss of consciousness
Impaired awareness or loss of consciousness has been reported in many patients with hypoglycemia. It is reported mainly in people over 50 years, with diabetes longer than 10 years and in people with infrequent self-monitoring of glucose levels. A study says that loss of consciousness affects around 20-25 per cent of people with type 1 diabetes and around 10 per cent of type 2 diabetics who are in insulin.