False hypos

A false hypo can be where someone experiences hypo-type symptoms but their blood sugar levels are within what is classed as normal levels, or where a diet-controlled or Metformin treated patient with diabetes experiences slightly lower blood sugar levels.

The name ‘false hypo’ may sound insignificant or dismissive to what a person is experiencing by suggesting it is ‘false’, but it simply means that the patient does not need to eat or drink something sugary to raise the blood sugar levels as the body can self-regulate.

false hypos - woman holding head feeling dizzy

What is a true hypo?

The word hypo is short for hypoglycaemia, or low blood sugar levels.

Hypos are the main side effect of insulin treatment.  This can happen if an insulin-treated patient’s blood sugar levels drop below 4.0mmol/L (although some professionals will advise that hypo levels are below 3.5mmol/L).  A handy phrase to remember once you start insulin is “four is the floor”.

A hypo in an insulin-controlled diabetic should be treated with glucose (something sugary) to assist the body in raising levels back to a normal level.

In most cases, hypos are mild and eating or drinking something high in sugar will raise levels sufficiently. 

Anyone on insulin treatment or taking a sulfonylurea drug (such as Glibenclamide) can have a hypo which could result in them passing out or becoming unconscious due to dangerously low blood sugar levels (a severe hypo) if not treated with glucose.

If you are controlling your gestational diabetes by diet or with Metformin, although you may experience hypo-type symptoms, with levels dropping low, you do not need to treat the hypo with glucose unless advised by a healthcare professional.

I was given apple juice and toast to raise and stabilise my levels whilst admitted to hospital

A false hypo may be experienced in two ways:-

  1. Hypo-type symptoms in someone who is on Metformin or diet controlled
  2. Hypo-type symptoms in any diabetic but once testing, they find blood sugar levels are above 4.0mmol/L
Hypo Symptoms:
  • Shaking
  • Sweating
  • Tingling of the lips or mouth
  • Blurred vision
  • Headache
  • Intense hunger
  • Palpitations (heart beating rapidly)
  • Dizziness
  • Anxiety
  • Irritability or bad temper
  • Confusion
  • Lack of concentration
  • Lack of coordination

The difference between real and false hypos

To explain this further, you need to understand how different medications for diabetes work:

  • Metformin helps to lower blood sugar levels by enabling the body to use insulin better
  • Glibenclamide helps to lower blood sugar levels by increasing insulin production
  • insulin is used as an additional top-up of the body’s own insulin

When blood sugar levels drop low, the liver will automatically release stored glucose into the body to help push blood sugar levels back up and regulate.

In diet or Metformin-controlled patients with diabetes, blood sugar levels will rise by themselves and will self-regulate (although you can eat a normal GD-friendly snack or meal to assist in raising your levels if you are feeling nauseous and feel you need to eat).

If a false hypo is treated with something sugary then blood sugar levels will spike too high and cause a hyper (hyperglycaemia – high blood sugar levels).

In insulin or Glibenclamide-controlled patients, the extra injected insulin or medication can cause levels to continue dropping and they may drop dangerously low despite the body trying to self-regulate, hence the hypo should be treated with glucose to counteract the hypo.

Why am I having a false hypo?

False hypos are often experienced following the diagnosis of gestational diabetes, where the body has been used to running at much higher blood sugar levels for some time. 

Following the diagnosis and after making dietary changes by cutting sugars and reducing carbs, the body notices the drop in blood sugar levels, panics and sends out stress signals as it thinks levels have dropped too low.

Other causes of false hypos in diet and Metformin-controlled diabetics are the same causes of hypos in insulin-controlled diabetics.  The difference being that they should not be treated with high glucose.

Possible causes of lower blood sugar levels include:

  • Missed or delayed meal or snack
  • Eating less food than usual, especially carbohydrates
  • Unplanned or sustained exercise*
  • Drinking alcohol without food*
  • Extremes of temperature
  • Stress
  • Fluctuations in hormones
  • Issues with placenta function

Note: *Hypos may occur many hours after drinking or exercising

What should I do when experiencing a false hypo?

Firstly, always test your blood sugar levels as symptoms of hypers (high levels) and hypos (low levels) can feel the same.

After testing, if the number is high then always wash hands in water and retest to make sure.  To bring high levels down you can walk for 20 mins and drink plenty of water to help flush out the excess sugar.

After testing, if the level is above 4.0mmol/L then no further action is needed.

If the level is below 4.0mmol/L and you are insulin or glibenclamide controlled then you should treat the hypo with something sugary.

If you are diet or metformin controlled then no further action is required.  If you ‘treat’ the hypo symptoms by eating sweets, glucose tablets, or drink coke/OJ etc. this response can be a major barrier to achieving good blood sugars and controlling your gestational diabetes as you will continue to suffer false hypos when your levels drop lower and your body craves the sugar.

If the level if below 2.0mmol/L then it is advisable to seek medical advice.

how to treat a hypo

Is there anything I can do to make myself feel better?

If you feel like you need to do something to deal with the unpleasant symptoms you may experience when your blood sugar drops, then have something to eat that is GD-friendly: a GD suitable snack or meal.  This should raise levels sufficiently to make you feel better.

Apple Nachos

Will I continue to suffer with false hypos?

Once your body is used to running at lower and normalised blood sugar levels you should not experience false hypos that occur when blood sugars are above 4.0mmol/L.