Low Blood Sugar Without Diabetes – Symptoms, Causes, Treatment

What Is Low Blood Sugar Without Diabetes?

In medical terms, when blood sugar levels deplete below the lower limit of the normal range, it is called Hypoglycemia. Patients having diabetes commonly experience hypoglycemia either due to fasting or from taking a high dose of subcutaneous insulin or oral hypoglycemic agents. Therefore Hypoglycemia is a common complication of diabetes mellitus.

In hypoglycemia, glucose levels within the brain also fall. The brain requires about 120 mg/dL of glucose daily to carry out its normal functions. This means that the brain is unable to function optimally when blood sugar levels fall.
In an apparently healthy individual, when blood sugar levels fall, the following mechanisms operate to reduce peripheral utilization of glucose and increase production of glucose by the liver

• Reduction in Insulin Secretion
• Increase in Glucagon Secretion
• Increased Epinephrin Secretion
• Increased Secretion of Cortisol and Growth Hormone

Low Blood Sugar Without Diabetes Can Occur Due To Following Reasons

1. Failure of the liver to store and produce glucose
2. Excess secretion of insulin
3. A defect in the neuroendocrine function

Non diabetic hypoglycemia is a relatively rare condition. The condition of low blood sugar without diabetes can be divided into 2 types

1. Reactive Hypoglycemia – In this type, the person may have a problem with insulin regulation. Reactive hypoglycemia occurs a few hours after having a meal. Causes for reactive hypoglycemia are
   ➢ Rare digestive enzyme deficiencies
   ➢ Pre-diabetic condition
   ➢ A history of bariatric surgery – Due to altered gastric function and inappropriate regulation of insulin post-surgery
2. Fasting Hypoglycemia – This type of hypoglycemia is often related to some diseases. Some causes for having this type of hypoglycemia are
   ➢ Excess of Alcohol – Alcohol inhibits the process of glucose formation, storage and release by liver cells. This function is also severely impaired in presence of other major liver disorders.
   ➢ Medications like sulfa drugs, salicylates, quinine. Drug-related hypoglycemia generally tends to occur in older individuals who have co-morbidities and are on multiple medications
   ➢ Low levels of hormones like growth hormone, glucagon, cortisol or epinephrine
   ➢ Liver, kidney or heart diseases. Hypoglycemia is generally seen in people with renal diseases even in absence of diabetes.
   ➢ Pancreatic tumors (non-islet cell tumors) which secrete excess IGF-II

It is quite evident from these causes that non-diabetic hypoglycemia present as a diverse disorder right from infancy and childhood to adulthood and old age. Sepsis, trauma and burns are also important causes for hypoglycemia without diabetes.

Hypoglycemia in Newborns

Hypoglycemia is generally seen in neonates during the first 2-3 days after birth. It is present in the case of neonatal stress or from diabetic mothers. It is generally transient and the baby recovers completely.

In newborns, the presentation of hypoglycemia is lethargy, sweating, poor feeding, seizures, irritability, respiratory distress and hypothermia. The family history of diabetes, genetic disorders and environmental factors may be responsible for the development of hypoglycemia in newborns.

Hypoglycemia Without Diabetes in Newborns & Infants

Causes

Symptoms of Low Blood Sugar Without Diabetes

The signs and symptoms of non-diabetic hypoglycemia are similar to that of hypoglycemia in diabetic persons. Signs and symptoms of hypoglycemia are observed when the blood sugar falls below 55 mg/dL.

1. Weakness and Tremors
2. Giddiness, Occasionally Unconsciousness
3. Sweating
4. Hunger, Nausea
5. Confusion and Difficulty in Speaking
6. Seizures
7. Palpitations and Anxiety
8. Hypoglycemic Coma

Usually, people consider milder symptoms to be a part of poor sleep or lack of nutrition and exercise. They are generally unaware of the actual problem until it really tends to obstruct activities of daily routine or until more severe signs and symptoms come into the picture.

How To Evaluate Hypoglycemia Without Diabetes

For evaluation, Whipple’s triad should be evaluated low plasma glucose concentration. Signs and symptoms of hypoglycemia and resolution of signs and symptoms when plasma glucose concentration increases. Diagnosis can be done by testing when patients present with signs and symptoms of hypoglycemia.

• A 72 Hour Monitored Fasting Test
• Mixed Meal Test
• Glucagon Tolerance Test

Further scanning and selective pancreatic calcium stimulation test can be done if the presence of tumors is suspected on evaluation.

Treatment For Low Blood Sugar Without Diabetes

Treatment of non-diabetic hypoglycemia entirely depends upon the cause of hypoglycemia. An elaborate history of the patient including a history of medications and details about a patient’s lifestyle may be needed to guide an appropriate treatment.

• Irrespective of the cause, hypoglycemia should be reversed immediately by giving the patient oral sugar or some sweet food.
• If the patient is conscious enough to eat, 15-20 grams of glucose should be given every 15 minutes until the patient is no more hypoglycemic.
• If unconscious, an infusion of 25% or 50% glucose is given intravenously and monitored closely in an inpatient setting.
• Offending medications, alcohol and drugs need to be stopped immediately and long-term treatment should be aimed at the underlying disorder first.
• Surgery may be indicated if tumors are responsible for the recurrent hypoglycemic episodes in patients, especially insulinomas.
• Chemotherapy and radiotherapy can be considered in non islet cell tumors.
• In some cases, partial surgical removal of the pancreas may also be required.

Some Measures Can Be Taken To Manage Hypoglycemia Yourself

1. Instead of eating 3 large meals at long intervals, divide your meals into several portions to eat at a time interval of every 2-3 hours. This ensures that’s you are neither too full nor starving until your next meal. This also makes sure that your blood sugar levels are managed.
2. Eat a different variety of food in each portion. Some carbohydrates, proteins, fiber-rich food, fatty food, fresh fruits and vegetables. This ensures that you are having a complete diet.
3. Avoid foods which have high-sugar content. In several cases, it is observed that non-diabetic hypoglycemia can turn into diabetes as well.
4. Lifestyle modifications like cutting out on alcohol, drugs, having a regular exercise schedule and dietary modifications can prevent the risk of having hypoglycemia and even developing certain diseases.
5. People who frequently have low blood sugar symptoms without diabetes should always keep an emergency kit handy – including sugar, candies and glucagon injections.