How To Talk to Your Doctor About Low Blood Sugar

Greg Kattell, who has lived with type 1 diabetes since high school, said he feels his best when his blood sugar is between 70 and 95 mg/dL.

“Diabetes is personal – it’s different for everyone,” Kattell said. “I’m most alert and balanced when in that range.”

It's a tight target, and one many would find difficult to meet. For most people with diabetes, the recommended time in range is 70-180 mg/dL. But even small shifts in routine – a bit of exercise, a late meal, or a carb miscount – can quickly push blood sugar levels too low.

Hypoglycemia, which occurs when glucose falls below 70 mg/dL, can cause sweating, shakiness, confusion, and anxiety. If untreated, it may lead to loss of consciousness. Long-term, severe hypoglycemia can also lead to impaired awareness of its symptoms.

With severe hypoglycemia, you need someone's assistance to recover. A family member or friend may need to help with fast-acting sugar, like juice, regular soda, glucose tablets or gel, candy, or honey. If unable to eat or drink, an injection of glucagon (also available as a nasal spray) may be needed. If none of these options are available or effective, emergency medical services should be called. 

Despite these risks, research shows people taking insulin rarely discuss low blood sugar episodes with their healthcare team. A 2021 study found hypoglycemia was addressed in just 25% of visits. Other research suggests severe lows happen 2-9 times more often than what’s documented in medical records.

So, why don’t people talk about their hypoglycemia events?

Why hypos fly under the radar

The reasons why hypoglycemia goes unreported are many and varied. People may have difficulty recalling low blood sugar episodes during their appointments, research shows. They may also feel hurried or spend most of their visit focused on high blood sugar, prescriptions, and diabetes supplies. 

Data may be missing from their blood glucose meter, or continuous glucose monitoring (CGM) system due to cost. For example, depending on insurance coverage, some people may not be able to afford a CGM. Others may simply want to take a break from constant alerts. Many people with type 1 diabetes, who rely on external insulin alone, have developed resilience from handling hypos on their own, which may factor into whether they bring up low blood sugar episodes with their doctor.

"You develop a level of independence and confidence that probably shows up in the doctor’s office," said Sean McCrary, who was diagnosed at age 19 while serving in the Kansas Air National Guard. "Why call for a tow truck driver to fix a flat if I already know how to do it? I do try to open up to the doctor, but there's only so much time."

Some people with diabetes may fear that sharing their hypoglycemia could lead to consequences, like losing driving privileges. Others worry about being judged by their doctor.

"People may feel that others blame them for episodes," said Linda Gonder-Frederick, a psychologist at the University of Virginia who has researched fear related to hypoglycemia. "Depending on the circumstances surrounding the episode, there might be some embarrassment as well."

For Claire Sachs, who was diagnosed with type 1 diabetes more than 30 years ago, appointments with her care team can sometimes feel like a classroom.

“You want to please that person in authority, and blood sugars out of range can feel like failures,” Sachs said. “The time between visits feels like one big test.”

Fear itself can become a barrier. Blood glucose awareness training and diabetes-focused therapy may help reduce anxiety and improve confidence in recognizing and managing lows.

The lowdown: different views

Research suggests that men and women may talk to their doctors about hypoglycemia in different ways. For example, men may be less likely than women to report low blood sugar at medical appointments. And while both groups report a similar number of events requiring assistance, women are more likely to bring up overnight lows, readings below 54 mg/dL, and lingering fatigue or anxiety afterward.

Experts encourage healthcare professionals to keep these differences in mind and tailor their responses accordingly. A personalized approach can help address the psychological toll of hypoglycemia, including diabetes distress, anxiety, and burnout.

“I don’t know if a man would feel the need to impress their clinicians the same way I do," Sachs said. "I tend to overanalyze – tracking every gram of macronutrients with apps and wearables as if every calorie burned or label were exact – instead of paying attention to how I actually feel.”

Greg Kattell offered another perspective: “The judgment and oversimplification really pushed me to figure this all out on my own. It’s something my doc and I are working on.”

Limitations of technology  

Even with today’s advanced tools, people with type 1 diabetes still experience low blood sugar. Automated insulin delivery (AID) offers more people greater time in range than daily injections or pump use alone, research shows, yet nearly a third of AID users still fall short of the recommended 70% time in range.

Across all forms of diabetes technology, 1 in 5 people reported a severe hypoglycemia event in the past year. About 15% of AID users reported having severe hypoglycemic events, despite the system’s ability to reduce insulin when glucose is predicted to go low. 

Readings from a CGM – taken from interstitial fluid under the skin – lag behind actual blood glucose levels, which can reduce the ability of AID systems to prevent hypoglycemia. Users also sometimes manually bolus or dose insulin to correct high blood sugar, which can lead to "stacking" and hypoglycemia. And even rapid insulin can't always catch up with the carbs in a meal, leading to autocorrections that come too late, which can lead to lows.

Frequent CGM alarms can exacerbate the problem and lead people with type 1 diabetes to overtreat – or reduce the amount of time they spend wearing the devices.

Why reporting hypoglycemia matters

Open conversations about hypoglycemia can help reduce associated risks, for example, letting blood sugar run too high, said Becky Sulik, director of education at the Rocky Mountain Diabetes Center. Sulik is a certified diabetes care and education specialist (CDCES) who also has type 1. 

“It’s a missed opportunity to discuss possible treatment changes,” she said. “And people with diabetes may end up feeling less understood and less supported.”

Ongoing hypoglycemia events can also lead to hormone changes that result in impaired awareness of low blood sugar. It’s estimated that about a quarter of people with type 1 experience hypoglycemia unawareness – when a person doesn’t notice symptoms, even when glucose falls below 54 mg/dL. Monitoring (ideally, with a CGM) and sharing glucose data with your healthcare team is important for helping avoid hypo unawareness.

That’s why Sulik encourages people with diabetes to be open about their experiences with hypoglycemia. Sharing honestly with your care team can offer advantages, including:

• Reducing diabetes burden. Being open helps build trust and reduces the sense of dealing with the day-to-day challenges of hypoglycemia on your own.
• Shared problem-solving. Honest conversations make it easier to work together on strategies that fit your life and help reduce risks related to low blood sugar events.
• Less fear, more preparation. Building awareness of patterns and situations that can trigger hypoglycemia may ease anxiety and make it easier to respond effectively when lows occur.
• Better treatment options. Providers are more likely to adjust your regimen in ways that actually work when they know the full story.

"I think understanding what increases and decreases risk may reduce fear somewhat," Sulik said. "We handle emergencies more effectively if we know what to do and are prepared."

Reporting hypoglycemia may also present opportunities to join a clinical trial. Trials testing new diabetes therapy, insulins, ways to deliver glucagon, and AID systems often include participants who report frequent hypoglycemia. Studies have defined frequent hypoglycemia as eight to 12 events a month, and severe hypoglycemia as two events in the last year.

Tips for talking to your doctor about hypoglycemia

Sharing openly about low blood sugar episodes can feel worrisome or awkward, but it helps your healthcare team provide support and effective treatment options. Sulik shared some tips for future appointments:

• Give the full picture. Your team can better assist if they know what’s really happening. "Most diabetes providers really want to help you live your best life with diabetes," Sulik said.
• Review data together. Walking through your CGM data or glucometer readings with your provider can lead to better problem-solving. “Uploading and reviewing the data together makes it easier to have meaningful conversations about lows, because we’re not relying on the patient to bring it up,” Sulik said.
• Be honest and open. Share with your doctor or CDCES any concerns related to hypoglycemia – whether that’s fear of going low, challenges you face, fear of judgment, or other reasons that make you hesitant to discuss the issue.. And try to view suggestions from your healthcare team as collaboration, not blame.

The bottom line

Talking about hypoglycemia can be difficult. Worries about judgment and feelings of embarrassment or failure can lead this important part of living with diabetes to go unaddressed. But that means missing chances to stay in range more often, reducing hypoglycemia risk, and feeling more supported day-to-day.

Sharing openly with your care team offers opportunities to live better with diabetes. These sometimes difficult conversations can lead to practical solutions and less fear around low blood sugar.

Sachs described how finding an insightful endocrinologist – and talking honestly about hypoglycemia – has changed her perspective on what she shares.

"I used to cancel my appointments when my numbers weren’t where they were 'supposed to be,'" Sachs said. "When I confessed that, he explained that that’s exactly when I need to see him, so we can figure out steps forward that will work."

Learn more about dealing with hypoglycemia here:

• At Risk for Hypoglycemia? Here’s How to Best Manage It, According to Experts
• Hypoglycemia Preparedness: How to Know Before You Go Low
• Comprehensive Approaches to Addressing Hypoglycemia

This article is supported by a non-IME (Independent Medical Education) grant from Vertex. Sponsored articles are written by diaTribe and are subject to our standard editorial and medical review process to ensure they meet our standards for quality, accuracy, and relevancy.