There are many reasons for hypoglycemia. The patient may have diabetes or it may not be related to diabetes. The common reasons are as follow:

1. Irregular diet.
2. Excess of insulin or oral hypoglycemic agent.
3. Delayed eating after taking medication.
4. Unbalanced diet.
5. Drink alcohol during fasting period.
6. Excess exercise.
7. Non-diabetic related factors: abnormal thyroid function, insulinoma, insulin autoimmune syndrome, etc.
8. High risk factor: History of severe hypoglycemia, long-term history of diabetes, multiple comorbidities, abnormal liver and kidney function, depression or mental stress, etc.

Symptoms of hypoglycemia will vary from person to person, and may have different symptoms each time.

1. Autonomic symptoms(Neurogenic): mild symptoms of hypoglycemia, hungry, trembling, cold sweating, palpitations, nervous and anxiety.
2. Neuroglycopenic symptoms: slurred speech, inability to concentrate, general weakness, dizziness, blurred vision, drowsiness, conscious change, weird behavior, cramps, and unconsciousness.
3. Unaware hypoglycemia: patients diagnosed as diabetes mellitus for a long time, the elderly, or patients who have severe hypoglycemia in recent days. These patients may have neuroglycopenic symptoms without autonomic symptoms.

1. While suspecting hypoglycemia, blood sugar level should be monitored immediately (if blood glucose monitor machine is not available at the moment, and patient’s consciousness is clear, it is recommended that intake food immediately.) and ingest 15-20 grams of sugary food such as juice around 120 -180cc, a tablespoon of honey or 3 to 4 cubes of sugar are all recommended. After 15 minutes, the blood glucose level should be rechecked again. If hypoglycemia persists, please repeat recommended management. If symptoms sustain, please go to hospital and seek medical attention immediately.
2. When the condition improves, the patient still needs to eat one serving of carbohydrate food, such as one slice of thin toast or three slices of crackers in order to preserve energy, keep blood glucose level steady,and prevent hypoglycemia recurrent.
3. If hypoglycemia occurs while patients taking oral hypoglycemic agents, Acarbose (Glucobay®), patients should take monosaccharides, such milk or glucose tablets, should be intake, instead of cube sugar or candy.
4. Avoid saccharin and aspartame while hypoglycemia occurs because saccharin and aspartame are not effective in elevating blood sugar. Avoid high-fat foods, such as chocolate and ice cream, because fat will delay the absorption of sugar.
5. When hypoglycemia occurs before a meal, the patient should eat food first, then take hypoglycemic drugs according to the amount of food and blood sugar level. Especially for patients with type 1 diabetes, the insulin injections should not be discontinued without doctor’s advice.
6. When patients are unconscious, they should be taken to the hospital immediately. Family members should proceed with the following steps:
   1. Do not inject insulin.
   2. Family should help the patient's head turn to one side in order to keep the airway open, not forcibly fed. Give the patient sugar syrup or honey 1-1.5 tablespoon applied directly into the oral mucosa with plastic dropper and massage till it is absorbed. The patient should be taken to hospital immediately.
   3. When a patient's consciousness recovers, the family should provide food (juice, drink, low fat milk), with carbohydrate to keep blood glucose level steady.

1. Learn how to recognize the symptoms of hypoglycemia and follow the medical plan.
2. Self-monitoring blood glucose level regularly, maintaining exercise habits, keeping a balanced diet and following doctors’ guidance.
3. Do not take oral hypoglycemic agents after delay intake time, sleep or exercise.
4. Before exercising you should take some food; in case of strenuous exercise, one serving of food should be taken every 30 minutes.
5. If blood glucose level is less than 120 mg/dl before going to sleep, snacks should be eaten, such as three pieces of biscuits and a cup of milk.
6. Learn how to recognize the symptoms and reasons for hypoglycemia to prevent further hypoglycemia occurrence.
7. When having diarrhea or poor appetite, it is recommended that the patient drink sports drinks, milk, and monitor blood glucose level closely. In addition, inform the doctor of diabetes mellitus history when seeking medical attention.
8. Avoid drink alcohol during fasting period.
9. When going out, individuals carry sugar tablets, and bring the diabetes mellitus identification card at all times.
10. Friends and relatives should know about your diabetes mellitus history in case to deal with hypoglycemia condition.
11. Friends and relatives should also recognition the symptoms of hypoglycemia and what to do in an emergency situation.

1. American Diabetes Association (2021). Standards of medical care in diabetes-2021 abridged for primary care providers. Clinical Diabetes, 39(1), 14-43.https://doi.org/10.2337/cd21-as01
2. Lebras, M., & Laubscher, T. (2021). Hypoglycemia in type 2 diabetes. Canadian Family Physician, 67, 35-38. https://doi.org/10.46747/cfp.670135
3. Ortiz, M. R. (2017). Hypoglycemia in diabetes. The Nursing Clinics of North America, 52(4), 565-574.https://doi.org/10.1016/j.cnur.2017.07.006
4. Taiwanese Association of Diabetes Educators (2020). 2020 Diabetes education core textbook. Taipei: Taiwanese Association of Diabetes Educators.
5. The Diabetes Association of the Republic of China (2018). Clinical practice guidelines for diabetes care 2018. Taipei: The Diabetes Association of the Republic of China.