Hypoglycemia, or low blood sugars, is the most common, and one of the most feared, complication of diabetes treatment. It must be taken seriously as patients can die from this condition. Having an episode raises the risk of mortality over the next 12 months by 65%.

Hypoglycemia is often triggered when those with uncontrolled diabetes try to achieve “tight control”. You must think of hypoglycemia in a diabetic patient who presents with signs and symptoms of epinephrine release, like shakiness, anxiety, tremor, palpitations and sweating.

Usually patients with neuroglycopenia, or low brain blood sugar, have confusion, seizures and coma.

Severe hypoglycemia is defined as needing the help of another person.

If a patient with diabetes presents with signs suggestive of hypoglycemia... remember the following:

• Consider hypoglycemia even with “normal” sugar levels in a patient with uncontrolled diabetes
• Their glucose may be falling rapidly with better control
• You need to rule out mimicking conditions like acute myocardial ischemia or infection
• If patients need beta blockers for heart problems, counsel them that beta-blockers do not usually eliminate the symptoms of hypoglycemia; most patients on beta-blockers still have profuse "sweats" as a symptom of hypoglycemia