Hypoglycemia primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]


The main stay in primary prevention is patient education about symptoms, blood glucose level control, and hypoglycemia treatment. Reactive hypoglycemia prevention depends on changing eating habits to smaller meals and avoiding excessive sugar intake.

Primary Prevention

Patient education:[1]

The main pillar in primary prevention is to educate the patient about symptoms and treatment.

  • Patient should be able to recognize early symptoms.
  • Frequent self-monitoring of blood glucose:[2]
    • Continuous glucose monitoring may facilitate glycemic control avoiding frequent punctures and providing the records over days or weeks depending upon the device used.
    • It should be more restricted for patients using alcohol and B-blockers as B-blockers mask symptoms of hypoglycemia.
    • Glycemic control can minimize complications and prevent cardiovascular events.[3]
  • Long-acting insulin, mixed with short-acting ones as the pre-meal bolus insulin, reduce the risk of hypoglycemia especially before meals and sleep.
  • Bedtime snacks are the best way to prevent nocturnal hypoglycemia.[4]
  • Sensor-augmented insulin pump is a method to measure blood glucose level during sleeping frequently and stop insulin injection in response to hypoglycemia.[5]

Exercise can cause hypoglycemia in patients with insulin-deficient diabetes.[6]

The most effective means of preventing further episodes of hypoglycemia depends on the cause:

  • Reactive hypoglycemia: Change eating patterns by taking smaller meals, avoiding excessive sugar intake and mixed meals.


  1. de Zoysa N, Rogers H, Stadler M, Gianfrancesco C, Beveridge S, Britneff E; et al. (2014). "A psychoeducational program to restore hypoglycemia awareness: the DAFNE-HART pilot study". Diabetes Care. 37 (3): 863–6. doi:10.2337/dc13-1245. PMID 24319119.
  2. Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L; et al. (2013). "Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society". J Clin Endocrinol Metab. 98 (5): 1845–59. doi:10.1210/jc.2012-4127. PMID 23589524.
  3. Cryer PE (2014). "Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia". Diabetes. 63 (7): 2188–95. doi:10.2337/db14-0059. PMID 24962915.
  4. Gray RO, Butler PC, Beers TR, Kryshak EJ, Rizza RA (1996). "Comparison of the ability of bread versus bread plus meat to treat and prevent subsequent hypoglycemia in patients with insulin-dependent diabetes mellitus". J Clin Endocrinol Metab. 81 (4): 1508–11. doi:10.1210/jcem.81.4.8636359. PMID 8636359.
  5. Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH; et al. (2013). "Threshold-based insulin-pump interruption for reduction of hypoglycemia". N Engl J Med. 369 (3): 224–32. doi:10.1056/NEJMoa1303576. PMID 23789889. Review in: Ann Intern Med. 2013 Sep 17;159(6):JC7
  6. Cryer PE, Davis SN, Shamoon H (2003). "Hypoglycemia in diabetes". Diabetes Care. 26 (6): 1902–12. PMID 12766131.