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Hypoglycemia means blood sugar below 70 mg/dL (3.9 mmol/L). Treat a mild episode with 15 grams of fast-acting carbohydrate and re-check after 15 minutes. If someone cannot swallow, is unconscious or is seizing, call an ambulance on 998 and give glucagon if it is available. Endocare's endocrinologists in the UAE investigate recurring episodes with and without diabetes.
- Low blood sugar means a level below 70 mg/dL (3.9 mmol/L). The American Diabetes Association calls 54 to below 70 mg/dL Level 1, below 54 mg/dL Level 2, and any episode needing another person's help Level 3, whatever the reading.
- Treat a mild episode with the 15-15 rule: 15 grams of fast-acting carbohydrate, wait 15 minutes, re-check and repeat if still low, then eat a balanced snack or meal.
- If someone is confused, cannot swallow, loses consciousness or has a seizure, call an ambulance on 998. Give glucagon if it is available and you know how to use it, and never put food or drink in the mouth of someone who cannot swallow.
- The US Centers for Disease Control and Prevention states that injectable glucagon is the best way to treat severely low blood sugar. If you take insulin or a sulfonylurea, ask your endocrinologist whether you should carry it.
- Low blood sugar also occurs in people without diabetes, including reactive episodes after meals and after weight-loss surgery. These are recognized conditions that warrant investigation.
- Repeated episodes blunt the warning symptoms, which is why your endocrinologist wants to know about every one.
01 Introduction
An episode of low blood sugar can be frightening: shaking, sweating, a racing heart and difficulty concentrating, sometimes without an obvious reason. Patients who experience these episodes without having diabetes are often examined, reassured and discharged without an explanation. This page covers what low blood sugar is, how to treat an episode, what to do when someone cannot treat themselves, and when a pattern requires investigation.
02 What hypoglycemia is
Hypoglycemia means blood sugar below 70 mg/dL (3.9 mmol/L), and it is one of the four conditions covered on our diabetes treatment in the UAE page. The American Diabetes Association (ADA) classifies it in three levels, and the level determines the response. The third level is defined by what happens to the person rather than by a reading, because someone can need help at a level that would not look alarming on paper.
| Level | Blood sugar | What it means |
|---|---|---|
| Level 1 | 54 to below 70 mg/dL (3.0 to below 3.9 mmol/L) | Low. Treat with the 15-15 rule. |
| Level 2 | Below 54 mg/dL (3.0 mmol/L) | Seriously low. Treat immediately and tell your doctor. |
| Level 3 | Defined by the event rather than by a number: altered mental or physical state needing another person's help, irrespective of the reading | Severe. Call an ambulance on 998. |
03 Symptoms of low blood sugar
Early symptoms are the body's alarm system: shakiness, sweating, sudden hunger, a fast heartbeat, irritability and difficulty concentrating. They appear because the brain runs on glucose and reacts quickly when the supply drops.
Late symptoms mean the level has fallen further. Confusion, slurred speech, drowsiness, blurred vision or clumsiness in a person who was well minutes earlier are warning signs of a serious drop. Treat it immediately, and call an ambulance on 998 if the person cannot treat themselves.
04 How to treat an episode: the 15-15 rule
The 15-15 rule, published by the US Centers for Disease Control and Prevention (CDC), is the standard first response to a mild episode. Take 15 grams of fast-acting carbohydrate, wait 15 minutes, then re-check. If it is still below 70 mg/dL, take another 15 grams. Once the level recovers, eat a balanced snack or meal so it does not fall again.
Any one of these is roughly 15 grams of fast-acting carbohydrate:
- 4 ounces, or half a cup, of fruit juice
- 4 ounces, or half a cup, of regular soda, not the diet version
- 3 or 4 glucose tablets, checking the label for the dose
- 1 tube of glucose gel, checking the label for the dose
- 1 tablespoon of sugar, honey or syrup
- Hard candies, jellybeans or gumdrops, checking the label for how many make up 15 grams
Chocolate and baked goods are poor choices in an episode. The CDC's point is that fat and fiber slow how quickly sugar is absorbed, so foods containing them raise blood sugar more slowly than a fast-acting carbohydrate. Keep something chosen for this in your bag rather than relying on what is nearby. Glucose tablets and gel survive the UAE heat and a hot car, and chocolate does not, which is a second reason it is the wrong choice.
05 Severe low blood sugar, glucagon and when to call an ambulance
A severe episode is one the person cannot treat themselves. They may be confused, unable to swallow safely, unconscious or having a seizure. The 15-15 rule does not apply, because putting food or drink in the mouth of someone who cannot swallow can block their airway.
Glucagon is a hormone given as an emergency treatment in exactly this situation. The CDC states that injectable glucagon is the best way to treat severely low blood sugar. It is a prescription medicine and comes two ways: an injection into a muscle or under the skin, at an adult dose of 1 mg, and a 3 mg nasal powder puffed into one nostril, which needs no injection and no cooperation from the person receiving it. Somebody else gives it, so the training matters as much as the prescription.
If someone has low blood sugar and cannot treat themselves:
- Call an ambulance on 998. The police number, 999, also reaches help, but 998 is the ambulance line
- Do not put food, drink or anything else in their mouth
- Give glucagon if it is available and you know how to use it. Mayo Clinic's guidance is to call for emergency help straight away if you cannot find it or do not know how
- Turn them onto their side, in the recovery position, so their airway stays clear if they vomit. St John Ambulance advises this for anyone who is not responding but is breathing normally
- Stay with them until help arrives, and tell the crew what happened and what medicines the person takes
After any severe episode, tell your doctor even if the person recovered fully, because it changes what the treatment or the investigation needs to cover. If you take insulin or a sulfonylurea, ask your endocrinologist whether you should carry a glucagon prescription, and make sure the people you live and work with know where it is kept and how to give it.
06 Hypoglycemia unawareness and night-time episodes
The early symptoms are a warning system, and it can stop working. After repeated low episodes the body stops releasing the hormones that produce the shaking and sweating, so the first sign a patient notices becomes confusion, at a level low enough to be dangerous. This is hypoglycemia unawareness, and it is more common in people who have had diabetes for many years and in those whose blood sugar runs low often.
It can be reversed. Avoiding low readings for a few weeks, which often means your endocrinologist raising your targets deliberately for a period, allows the warning symptoms to return. A continuous glucose monitor (CGM) helps here more than anywhere else, because it alarms on a falling level before the person feels anything.
Night-time episodes are the ones patients miss altogether. The signs are indirect: waking with damp sheets, a morning headache, vivid dreams or poor sleep, and a waking reading higher than the night before would explain. Tell your endocrinologist if you recognize any of these, because a night-time pattern changes what a safe evening dose looks like.
07 Causes of low blood sugar in people with diabetes
For patients treated for type 2 diabetes, the common causes are practical: more insulin or sulfonylurea effect than the moment needed, a missed or delayed meal, more activity than normal, or alcohol. If episodes are happening, the answer is not to endure them. The adjustment is one your doctor makes, and your endocrinologist will want to know about every episode, because recurring lows change what a safe plan looks like.
08 Do GLP-1 medications cause low blood sugar?
Rarely on their own. GLP-1 receptor agonists stimulate insulin release in a glucose-dependent way, which means the effect fades as blood sugar comes down rather than continuing to push it lower. That mechanism is why the class carries a much lower risk of low blood sugar than insulin or a sulfonylurea does.
The risk changes when they are combined. The prescribing information for these medicines warns that taking them alongside insulin or a sulfonylurea raises the risk of low blood sugar, and the dose of that other medicine is normally reduced when a GLP-1 medicine is added. Your endocrinologist makes that adjustment when starting you, which is one reason a doctor review is critical before beginning a GLP-1 medicine rather than after.
If you take a GLP-1 medicine on its own and you are having repeated low readings, that is worth investigating, because something else is likely driving it.
09 Causes of low blood sugar in people without diabetes
Reactive hypoglycemia
Some people experience drops in the hours after eating, often after meals heavy in refined carbohydrate. This is called reactive hypoglycemia. It is a recognized condition, and it can respond to assessment and to changes in meal composition. Patients who experience it are often told their tests are normal without further investigation. Patients often ask whether reactive episodes point to insulin resistance. That connection is discussed widely and is not established, and an assessment can look at both directly rather than leaving you to guess.
Fasting causes
Mayo Clinic lists the recognized causes of low blood sugar away from meals: certain medications, excessive alcohol, serious illness affecting the liver, kidneys or heart, hormone deficiencies and, rarely, an insulin-producing tumor. These causes are uncommon. A recurring pattern warrants structured investigation so that they can be confirmed or excluded.
10 Low blood sugar after weight-loss surgery
Post-bariatric hypoglycemia is one of the more common causes of low blood sugar in people without diabetes, and it is under-recognized. After sleeve gastrectomy or gastric bypass, food reaches the small intestine faster, the gut hormone response is exaggerated and the insulin release overshoots, so blood sugar falls one to three hours after eating rather than during a fast. It often appears a year or more after surgery, late enough that patients do not connect the two.
A randomized trial that followed patients for a year after surgery found reactive hypoglycemia in 14% of the sleeve gastrectomy group and 29% of the gastric bypass group, a difference that did not reach statistical significance. Neither operation is the safe one on this basis: the trial was small and the two procedures differ in more than this.
A Gulf Cooperation Council consensus statement on managing it was published in 2026, which matters here because sleeve gastrectomy makes up a large share of bariatric surgery in the UAE. Treatment starts with meal composition, splitting carbohydrate across smaller meals and pairing it with protein and fat, and moves to medication where that is not enough. If you have had weight-loss surgery and you get shaky, sweaty or foggy an hour or two after eating, bring it to an endocrinologist rather than to the surgeon alone.
11 Low blood sugar during Ramadan
Fasting itself is not the danger. The medicines are. The EPIDIAR study found that severe low blood sugar requiring hospital treatment rose 7.5-fold in people with type 2 diabetes during Ramadan, and the risk sat with sulfonylureas and insulin rather than with the fast.
The IDF-DAR practical guidelines, first-authored by Mohamed Hassanein, a consultant at Dubai Hospital, set out how to assess that risk. Your endocrinologist works through it with you four to six weeks before Ramadan: which medicines change dose or timing, which move to after sunset, when to test, and the readings at which you break the fast. Religious rulings permit breaking a fast where health requires it, and a fast broken on a low reading is a medical decision.
During the month, test if you feel shaky, sweaty or confused, and break the fast if the reading is below 70 mg/dL. Do not wait to see whether it passes.
12 How to prevent low blood sugar
Most episodes are preventable once the pattern behind them is clear. These are the measures our endocrinologists go through with patients having them:
- Eat on a schedule that matches your medicine rather than skipping or delaying meals, particularly on insulin or a sulfonylurea
- Test before driving, before exercise and at bedtime, and more often on days unlike your normal
- Adjust for activity in advance, with extra carbohydrate or a reduced dose, planned with your endocrinologist rather than guessed on the day
- Take alcohol with food, and note that its effect on blood sugar can arrive hours later, including overnight
- Carry 15 grams of fast-acting carbohydrate on you, not in the car or the desk drawer
- Wear or carry something that identifies you as at risk, so a bystander knows what they are seeing
- Bring every episode to your review, with the time, the reading and what you had eaten, because the pattern is what makes the fix obvious
For people without diabetes who get reactive episodes, prevention runs through meal composition instead: smaller, more frequent meals, carbohydrate paired with protein and fat, and fewer refined carbohydrates on their own. Our clinical nutritionist builds that with you once the investigation has identified what is happening.
13 What repeated episodes of low blood sugar do over time
A single mild episode treated promptly does no lasting harm. A repeating pattern is different, and it is why your endocrinologist wants to hear about episodes you may think too minor to mention.
- The warning symptoms fade, which makes the next episode more dangerous because it arrives without notice
- Severe episodes carry immediate risk: falls, injuries, road accidents and, rarely, seizures
- Fear of another episode leads many patients to run their blood sugar deliberately high, which trades one risk for another
- Research has linked severe episodes to a higher long-term risk of dementia. A cohort study published in Diabetes Care in 2023 reported that association in adults with type 2 diabetes. It shows an association rather than proof that one causes the other, and the conclusion is the same either way: severe episodes are worth preventing
None of this is a reason for alarm after one bad afternoon. It is the reason to treat a pattern as something to solve rather than to live with.
14 How Endocare investigates recurring episodes
Investigation begins with the pattern. Your endocrinologist takes a detailed history of when episodes happen, what you had eaten, what medicines and supplements you take and what they feel like.
Your endocrinologist then selects targeted blood tests, covering glucose, insulin, hormone and organ markers. Our blood test panels include the tests involved. Measuring insulin alongside glucose can help identify the cause: MedlinePlus, the health information service of the US National Library of Medicine, lists finding the cause of hypoglycemia among the uses of the insulin blood test.
Where the pattern is hard to pin down from readings alone, your endocrinologist may suggest wearing a CGM for a period, because it records what happens overnight and between finger-prick tests.
The purpose of the investigation is to identify the cause, because the cause determines the treatment. Treating it can resolve the episodes rather than leaving them managed indefinitely.
15 FAQ
What is the fastest way to treat low blood sugar?
The 15-15 rule: 15 grams of fast-acting carbohydrate such as half a cup of juice or 3 to 4 glucose tablets, wait 15 minutes, re-check and repeat if still below 70 mg/dL. Then eat a balanced snack or meal.
When is low blood sugar an emergency, and what number do I call?
When someone is confused, cannot swallow safely, loses consciousness or has a seizure. Call an ambulance on 998, give glucagon if it is available and you know how to use it, turn the person onto their side, and never put food or drink in the mouth of someone who cannot swallow.
What is glucagon and who should carry it?
Glucagon is a prescription hormone given as an emergency treatment for severely low blood sugar, as an injection or a nasal powder, and somebody else administers it. The CDC calls it the best way to treat severely low blood sugar. If you take insulin or a sulfonylurea, ask your endocrinologist whether you should carry it and make sure the people around you know how to use it.
Do GLP-1 medications cause low blood sugar?
Rarely on their own, because they stimulate insulin release in a glucose-dependent way, so the effect fades as blood sugar falls. The risk rises when they are combined with insulin or a sulfonylurea, and your endocrinologist adjusts that other medicine when starting you.
What causes low blood sugar in someone without diabetes?
Reactive drops after meals, low blood sugar after weight-loss surgery, certain medications, excessive alcohol, serious illness, hormone deficiencies and, rarely, an insulin-producing tumor. A recurring pattern deserves investigation.
What is reactive hypoglycemia?
Low blood sugar in the hours after eating, often after meals heavy in refined carbohydrate. It is a recognized condition, and it can respond to assessment and to changes in meal composition.
How do I know if I am having low blood sugar at night?
The signs are indirect: waking with damp sheets, a morning headache, vivid dreams, poor sleep, or a waking reading that does not match the night before. A continuous glucose monitor worn for a period is the reliable way to confirm it.
Can I fast during Ramadan if I get low blood sugar?
That depends on which medicines you take. Sulfonylureas and insulin carry the real risk, and the EPIDIAR study found severe episodes rose sharply during Ramadan. Book a review four to six weeks beforehand so doses and timing can be adjusted, and break the fast and test if you feel shaky, sweaty or confused.
Which doctor should I see for recurring low blood sugar?
An endocrinologist. Recurring episodes sit at the junction of glucose, hormones and medication effects, and Endocare's endocrinologists investigate both diabetic and non-diabetic patterns.
Can hypoglycemia be cured permanently?
It depends on the cause. Medication-related lows can often be resolved when your doctor adjusts the treatment, and reactive patterns can often improve with changes to meals. Finding the cause is the step that makes the answer knowable.
If low blood sugar keeps happening to you, with or without a diabetes diagnosis, book an assessment and bring whatever readings and notes you have. Your endocrinologist will take the pattern seriously and look for the cause. Endocare sees patients at Building 27, Block B, Unit 504 B, Dubai Healthcare City, Dubai (+971 4 285 3885) and at Al Bateen, Tower C2, Unit 104, Abu Dhabi (+971 2 582 6178). You can also send us a message on WhatsApp.
Book Your Consultation
- Specialist consultation
- Personalized Coaching
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