Diabetes Knowledge

Can you have low blood sugar with type 2 diabetes?

6/26/2015 by mySugr

A tag-team approach on low blood sugar with type 2 diabetes.

Markus recently wrote an article on our German language blog talking about low blood sugar with type 2 diabetes.

The question ("can I have low blood sugar with type 2 diabetes?") is very common, and it's easy to see why it's of concern.

So I've helped Markus bring his German post to life here in English. I hope it helps! Here's Markus:

Low blood sugar

In 2014, results from the DAWN2 study were announced. It was the largest study of its kind (15,000 participants) on the "fears & needs of people with diabetes and their families." One result stood out: The gravest fears are related to low blood sugars, especially at night. Up to 69% of the participants share this fear!

So! Can you have low blood sugar with type 2 diabetes? Yes! Of course! But let's think about who exactly is at risk – and why.

It's common to think:

Type 1 diabetes = at risk for lows

Type 2 diabetes = not at risk for lows

But that isn't correct at all, so we should wipe it from our mind.

So... what do I need to know?

Maybe it's more accurate to say that people with type 2 diabetes who take certain types of medication are more at risk for lows. We're getting closer! But to get to the truth, we should take a look at someone without diabetes. Is it possible for them to have lows, too?

Theoretically yes, especially if doing long-lasting physical activities without proper food intake. Additionally, extreme stress and binge drinking are also common causes of low blood sugar for people without diabetes.

However, it's pretty rare because as soon as BG's drop below 80 mg/dl (4.4 mmol/L), the natural counterregulatory system kicks in, raising blood sugar back to normal levels.

I've never experienced hypoglycemia (a fancy word for low blood sugar), even though I am very active and eat a rather low carb diet.

Low blood sugar risks with insulin and sulfonylureas

There are different types of drugs used to manage diabetes. They are put into different classes depending on how they work.

Enviably, those who manage their blood sugar with diet and exercise don't have to worry much. The risk of hypoglycemia is the same as non-diabetics.

Reassuringly, those who only take drugs that limit the amount of sugar released from the liver and slow down the absorption of carbohydrates in the intestines (Metformin, for example), also have a very low risk.

Those using insulinotropic agents (sulfonylureas like Glipizide, Glyburide, etc.), which stimulate or affect the production of insulin, need to be especially careful, as does anyone using insulin.

Shockingly, while insulin-dependent diabetics experience many more low blood sugars, it is the patient group using sulfonylureas who have more severe low blood sugars requiring emergency assistance. That may ultimately be because those using insulin understand the risks for lows and are often better prepared for them.

Hypoglycemia symptoms with normal glucose levels

There is such a thing as pseudo-hypoglycemia. This happens when glucose levels are continuously high for a long time then are suddenly brought down to normal. It's as if the body becomes accustomed to the higher range then panics when levels drop to normal, responding with hormones like cortisol and adrenaline.

Info: Hypoglycemia is usually defined as blood glucose levels below 70 mg/dl (or 4.0 mmol/L). However, your doctor may give you a different blood glucose number that is considered too low for you.

Thank you, Markus! This is a great topic and helpful information. There are a couple more things I'd like to add.

What should I do if I experience a hypoglycemia?

Low blood sugar can be treated quickly with fast-acting glucose. If you are at risk for lows, you should always have something fast and sweet with you. Glucose tabs, for example, are available at any pharmacy, are relatively affordable, and are designed to digest quickly and raise blood glucose fast.

Other options are fruit juice, regular (non-diet) soda, candies (before glucose tabs, Life Savers were literal!), or other sources of carbohydrates. It is important that whatever you use to treat the low does not contain a lot of fat or fiber, which slows digestion and takes longer to raise blood sugar.

The general guidelines are to eat 15-20 grams of glucose or simple carbohydrates then check your blood sugar again in 15 minutes. If you are still low, repeat.

If you experience low blood sugars often, talk to your doctor. Together, you'll be able to figure out why they are happening and then make adjustments, so they don't happen so often.

What are the symptoms of low blood sugar? How do I know I'm experiencing a low blood sugar?

All this talk about lows, and we haven't told you what to watch out for! Shame on us.

The signs and symptoms of low blood sugars can vary a lot, and can even be different each time. The American Diabetes Association has a comprehensive list:

Signs and symptoms of hypoglycemia from the ADA

As noted, these can happen quickly. And did you notice that one symptom is confusion? And another is unconsciousness? That's why it's important to treat low blood sugar quickly. You have to take care as fast as possible, or you may not be able to help yourself.


Low blood sugars can be scary, but they don't have to be something to be afraid of. Now you know a little more about them, why they happen, what to watch for, and how to treat them. Being knowledgeable and prepared will help keep you safe.

Have you experienced many low blood sugars with type 2 diabetes? How did you deal with them? Let us know on Facebook or Twitter!


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