Hypoglycemia

Hypoglycemia (Low Blood Sugar) in Grand Rapids, MI

Hypoglycemia (often called a “hypo”) means your blood glucose (blood sugar) is too low. For most adults, this is a blood glucose level of 4.0 mmol/L (about 72 mg/dL) or less.

People in Grand Rapids living with diabetes who use insulin or certain diabetes tablets (sulfonylureas) are at the highest risk. Recognizing early warning signs and treating low blood sugar right away can help prevent severe hypoglycemia and emergency room visits.

In West Michigan, where cold winters, icy roads, and variable activity levels are common, it is especially important to understand how daily routines, exercise, and meals affect your blood sugar.

What Is Hypoglycemia?

Hypoglycemia means there is not enough glucose in your blood for your body and brain to work properly.

• For most people: low blood glucose is 4.0 mmol/L (≈72 mg/dL) or less
• For frail older adults: low may be considered under 6.0 mmol/L (≈108 mg/dL)

Hypoglycemia is often simply called “a hypo.”

Mild vs Severe Hypoglycemia

• Mild hypoglycemia
  You are awake, can think clearly enough, and can treat yourself.
• Severe hypoglycemia
  Your brain is not getting enough glucose. You may be confused, unable to follow instructions, or unconscious. You cannot treat yourself and need urgent help.

Who Is at Risk of Hypoglycemia in Grand Rapids?

You are more likely to have low blood sugar if you:

• Have type 1 or type 2 diabetes and:
  • Inject insulin, or
  • Take sulfonylurea tablets (for example: glipizide, glyburide, glimepiride)
• Have other medical conditions that cause your body to produce too much insulin
• Are an older adult, especially if you live alone or have memory problems
• Have had diabetes for many years
• Have had frequent hypos or have not treated them correctly in the past

If you do not take insulin or sulfonylureas but still get symptoms of low blood sugar, it is important to see a doctor in Grand Rapids (such as your primary care provider at Corewell Health (formerly Spectrum Health), Trinity Health Grand Rapids, or University of Michigan Health-West (formerly Metro Health)) to investigate the cause.

Common Causes of Hypoglycemia

In people with diabetes, blood sugar can drop too low when:

• You take too much insulin or diabetes medication
• You lose weight but your medication doses are not adjusted
• You miss a meal or eat less carbohydrate than usual
• You exercise more or more intensely than usual (for example, shoveling heavy snow in a Michigan winter or biking the Grand River trail on a warm day)
• You drink alcohol without enough food
• You inject insulin into a new area or an area that becomes warmer with exercise, causing faster absorption
• You have kidney or liver problems affecting how your body handles insulin and medication

Understanding which activities or situations trigger your low blood sugar helps you plan ahead and reduce your risk.

Symptoms of Mild Hypoglycemia

Typical early warning signs include:

• Sweating
• Feeling shaky or jittery
• Fast heartbeat
• Sudden intense hunger
• Headache
• Feeling anxious or irritable
• Difficulty concentrating

Do not ignore these signs. Treat symptoms immediately so your blood glucose does not continue to drop.

How to Treat Mild Hypoglycemia (When You Can Swallow)

If your blood glucose is 4.0 mmol/L (≈72 mg/dL) or less and you are awake and able to swallow, follow these steps:

Step 1: Take 15–20 grams of fast-acting carbohydrate

Examples:

• 3 teaspoons of sugar or honey, or
• 6–7 regular jelly beans, or
• 100–120 mL (about ½ cup) of a regular energy drink (not “sport” or sugar-free), or
• 150–200 mL (about 1 cup) of regular soft drink (not diet) or fruit juice, or
• 15 grams of glucose gel or glucose tablets (check the label)

Step 2: Recheck your blood glucose in 15 minutes

• If your blood glucose is still 4.0 mmol/L or less, repeat Step 1.
• Check again in another 15 minutes.

Step 3: Have a longer-acting carbohydrate

Once your blood glucose is above 4.0 mmol/L:

• If your next meal is more than an hour away, have a snack with carbohydrate, such as:
  • A piece of fruit
  • A slice of bread or toast
  • A few plain crackers
  • A glass of milk
  • A small tub of low-fat yogurt
• If it is time for a meal, make sure your meal includes some carbohydrate (for example, whole grains, fruit, milk, or starchy vegetables).

This helps maintain your blood glucose and prevents it from dropping again.

After a Mild Hypo: What to Do Next

After treating low blood sugar:

• Check your blood glucose more often for the rest of the day.
• Try to work out what caused it:
  • Did you do more exercise than usual (shoveling snow, walking more downtown, yardwork)?
  • Did you skip or delay a meal?
  • Did you take extra insulin or tablets by mistake?
  • Did you inject into a new or warmed-up area?
  • Does it tend to happen at a particular time of day?

Tell your doctor or diabetes educator in Grand Rapids if:

• You have frequent hypos, or
• You have had a severe hypo

Your insulin or diabetes medication may need to be adjusted.

Symptoms of Severe Hypoglycemia

Severe hypoglycemia happens when the brain is not getting enough glucose. Symptoms may include:

• Inability to think clearly
• Confusion or being unable to follow instructions
• Slurred speech
• Appearing drunk
• Extreme drowsiness
• Fitting (seizures)
• Becoming unconscious

In severe hypoglycemia, the person cannot treat themselves and needs help from someone else.

Emergency Treatment for Severe (or Unconscious) Hypoglycemia

If someone with diabetes in Grand Rapids has severe hypoglycemia:

1. Call 911 immediately.
   Tell the operator the person has diabetes and low blood sugar.

2. Do NOT give anything by mouth if the person:

   • Is unconscious
   • Cannot swallow safely
   • Cannot follow simple instructions

   They are at risk of choking.

3. Glucagon injection (if available and trained)

   • If you have been trained to use a GlucaGen HypoKit or another glucagon injection and feel comfortable:
     • Prepare and inject glucagon as instructed.
   • Glucagon helps release stored glucose from the liver into the blood, raising blood sugar.

4. Wait for paramedics

   • Ambulance paramedics in Kent County have the equipment and medications needed to manage severe hypoglycemia.
   • Always call 911 even if glucagon is given.

After the Person Wakes Up

Once the person is conscious and able to swallow:

• Give a fast-acting carbohydrate:
  • Fruit juice
  • Regular soft drink
  • Glucose tablets or gel
• Follow with a longer-acting carbohydrate:
  • A sandwich
  • Yogurt
  • A glass of milk
  • Crackers with cheese or peanut butter

They should not exercise for the rest of the day after a severe hypo.

Ongoing Checks After a Severe Hypo

• Check blood glucose more often for the next 24 hours.
• Because having one hypo makes another more likely, frequent testing helps catch drops early.
• Contact your Grand Rapids diabetes team (endocrinologist, primary care provider, or diabetes educator) as soon as possible to review:
  • Recent insulin or medication doses
  • Meals and snacks
  • Physical activity
  • Any illness or stress

Hypoglycemia in Older Adults

Older adults in Grand Rapids, especially those living alone or in care facilities, may not show typical warning signs of low blood sugar.

They may:

• Feel or appear disoriented
• Be unusually irritable
• Have slurred speech
• Seem confused or “not themselves”
• Be unable to explain how they feel

They may need family members, caregivers, or nursing staff to:

• Recognize these changes as possible hypoglycemia
• Check their blood glucose promptly
• Help them treat low blood sugar safely

What If I Don’t Feel Any Warning Signs?

Some people with diabetes do not notice the usual symptoms of hypoglycemia. This is called hypoglycemia unawareness and can be dangerous.

It may happen if you:

• Have had diabetes for many years
• Have had many recent hypos
• Have ignored or not treated early warning signs in the past

In this situation:

• The only way to know if your blood glucose is low is to check it more often.
• Many Grand Rapids residents use continuous glucose monitors (CGMs), which can:
  • Show your current glucose level
  • Show your trend (rising or falling)
  • Give alarms for low or rapidly dropping levels

It is sometimes possible to regain awareness of symptoms by:

• Avoiding hypoglycemia for a period of time
• Adjusting medication with your diabetes specialist

Talk with your endocrinologist or diabetes educator at Corewell Health, Trinity Health Grand Rapids, or University of Michigan Health-West for a plan tailored to you.

Driving, Diabetes, and Hypoglycemia in Michigan

Driving with low blood sugar is dangerous for you and others on the road, especially in Grand Rapids winters, where icy roads and poor visibility already increase risk.

Before You Drive

• Always check your blood glucose level before driving.
• It is recommended that your blood glucose be above 5.0 mmol/L (≈90 mg/dL) before you drive.
• If your blood glucose is 4.0–5.0 mmol/L and you are at risk of hypos:
  • Have a snack containing carbohydrate before driving.

If You Feel Low While Driving

1. Pull over safely as soon as possible.
2. Turn on your hazard lights.
3. Turn the car off and remove the keys from the ignition.
4. Check your blood glucose if you can.
5. If it is low, treat it as a mild hypo (see steps above).
6. Do not start driving again until:
   • Your blood glucose is safely above 5.0 mmol/L, and
   • You feel fully recovered.

Creating a Hypoglycemia Management Plan in Grand Rapids

Working closely with your healthcare team is essential. This may include:

• Your primary care doctor/primary care doctor
• A diabetes specialist (endocrinologist)
• A credentialed diabetes educator
• A dietitian

Together, you should:

• Develop a personal plan for:
  • Preventing hypoglycemia
  • Recognizing early symptoms
  • Treating mild and severe episodes
• Review your:
  • Blood glucose readings
  • Insulin and medication doses
  • Meal patterns and carbohydrate intake
  • Physical activity (including seasonal changes—more indoor time in winter, more outdoor activity in summer)
• Schedule regular follow-ups at a Grand Rapids clinic or hospital.

Local Resources for People With Diabetes in Grand Rapids, MI

If you live in the Grand Rapids area, you can get help and education about hypoglycemia and diabetes management from:

• Corewell Health / Corewell Health – Diabetes and Endocrinology services
• Trinity Health Grand Rapids – Diabetes education and outpatient clinics
• University of Michigan Health-West – Endocrinology and nutrition services
• Trinity Health Grand Rapids – Primary care and diabetes care teams
• Kent County Health Department – Community health programs, nutrition and chronic disease support
• Grand Rapids Public Health and local community clinics – Education, screening, and referrals
• American Diabetes Association – Information, support, and online tools for people living with diabetes

In an emergency, always call 911.

Key Points About Hypoglycemia in Grand Rapids

• Hypoglycemia is a low blood glucose level (4.0 mmol/L or less) and is most common in people with diabetes who use insulin or sulfonylureas.
• Early recognition and immediate treatment of mild symptoms can prevent severe hypoglycemia and emergency visits.
• You need a personal hypoglycemia management plan developed with your Grand Rapids healthcare team.
• Regular follow-up for blood glucose and medication review is essential, especially with seasonal changes in activity common in Michigan.
• If you have symptoms of low blood sugar and do not use insulin or sulfonylureas, or if you do not feel any warning signs, it is important to have this investigated by your doctor.