Low Blood Glucose (Hypoglycemia)
`
`On this page:
`
`What is low blood glucose?
`How common is low blood glucose?
`Who is more likely to develop low blood glucose?
`What are the symptoms of low blood glucose?
`What are the complications of low blood glucose?
`What causes low blood glucose in people with diabetes?
`How can I prevent low blood glucose if I have diabetes?
`How do I treat low blood glucose?
`What if I have severe low blood glucose and can’t treat myself?
`Clinical Trials for Low Blood Glucose
`What is low blood glucose?
`
`Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of
`glucose in your blood drops below what is healthy for you. For many people with diabetes, this
`means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number
`might be dierent, so check with your doctor or health care team to nd out what blood
`glucose level is low for you.
`How common is low blood glucose?
`
`Low blood glucose is common among people with type 1 diabetes and among people with type
`2 diabetes who take insulin or some other diabetes medicines. In a large global study of people
`with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with
`type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2
`
`Severely low blood glucose, dened as when your blood glucose level drops so low you can’t
`treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some
`diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop
`severely low blood glucose each year.3
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00001
`
`

`

`Who is more likely to develop low blood glucose?
`
`You are more likely to develop low blood glucose if you4
`
`have type 1 diabetes
`take insulin or some other diabetes medicines
`are age 65 or older5
`had low blood glucose before
`have other health problems, such as kidney disease, heart disease, or cognitive impairment
`
`
`
`What are the symptoms of low blood glucose?
`
`Symptoms of low blood glucose tend to come on quickly and can vary from person to person.
`As Table 1 below shows, symptoms can range from mild to severe.
`
`Table 1. Symptoms of low blood glucose6
`
`Mild-to-Moderate
`
`Severe
`
`If your blood glucose level is very low, your
`brain may stop working as it should. You
`may
`
`lose consciousness
`have a seizure
`
`Severe hypoglycemia is dangerous and
`needs to be treated right away.
`
`If your blood glucose level is low, you may
`feel
`
`shaky or jittery
`hungry
`tired
`dizzy, lightheaded, confused, or irritable
`your heart is beating too fast or not
`steadily
`you have a headache
`you can’t see or speak clearly
`
`Low blood glucose during sleep
`
`Your blood glucose level can drop while you sleep and stay low for several hours, causing
`serious problems.7 Symptoms of low blood glucose while you sleep can include
`
`crying out or having nightmares
`sweating enough to make your pajamas or sheets damp
`feeling tired, irritable, or confused after waking up
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00002
`
`

`

`Although you may not wake up or notice any symptoms, low blood glucose can interfere with
`your sleep, which may aect your quality of life, mood, and ability to work. Having low blood
`glucose during sleep can also make you less likely to notice and respond to symptoms of low
`blood glucose during the day.
`What are the complications of low blood glucose?
`
`Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can
`cause serious complications, including passing out, coma, or death.
`
`Repeated episodes of low blood glucose can lead to
`
`high blood glucose levels, if worry or fear of low blood glucose keeps you from taking the
`medicines you need to manage your diabetes8
`hypoglycemia unawareness, a condition in which you don’t notice any symptoms of low
`blood glucose until your blood glucose level has dropped very low
`What causes low blood glucose in people with
`diabetes?
`
`Low blood glucose levels can be a side eect of insulin or some other medicines that help your
`pancreas release insulin into your blood. Taking these can lower your blood glucose level.
`
`Insulin and some other diabetes medicines can
`lower your blood glucose level.
`
`Two types of diabetes pills can cause low blood glucose
`
`sulfonylureas, usually taken once or twice per day, which increase insulin over several
`hours
`meglitinides, taken before meals to promote a short-term increase in insulin
`
`The following may also lower your blood glucose level
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00003
`
`

`

`Not eating or drinking enough carbohydrates (carbs). When you eat foods or drink
`beverages that contain carbohydrates, your digestive system breaks down the sugars and
`starches into glucose. Glucose then enters your bloodstream and raises your blood glucose
`level. If you don’t eat enough carbohydrates or skip or delay any meals, your blood glucose
`level could drop lower than what is healthy for you.
`
`Fasting. Continuing to take medicines that lower your glucose level while fasting for a
`medical procedure or for other purposes can also increase the risk for low blood glucose.
`
`Increasing physical activity. Increasing your physical activity level beyond your usual
`routine can lower your blood glucose level for up to 24 hours after the activity. Learn more
`about diabetes, eating, and physical activity.
`
`Drinking too much alcohol without enough food. Alcohol makes it harder for your body to
`keep your blood glucose level steady, especially if you haven’t eaten in a while. Alcohol can
`also keep you from feeling the rst symptoms of low blood glucose, which can lead to
`severe symptoms.
`
`Being sick. When you’re sick, you may not be able to eat as much or keep food down, which
`can lower blood glucose.
`How can I prevent low blood glucose if I have
`diabetes?
`
`If you take insulin or other medicines that lower blood glucose, the following actions may help
`you prevent low blood glucose levels.
`
`Ask your doctor or health care team how to check your blood glucose level. The most
`common way to do so is by using a blood glucose meter. If you have hypoglycemia
`unawareness or have low blood glucose often, a continuous glucose monitor (CGM) may be
`a good option. The CGM measures your blood glucose level at regular times and can sound
`an alarm if it drops below your target range.
`
`Make sure your regular eating plan includes meals, snacks, and beverages with enough
`carbohydrates to help keep your blood glucose level in your target range. Carry a source of
`fast-acting carbohydrate, such as glucose tablets or a juice box, with you. Also, if you drink
`alcoholic beverages, it’s safer to eat some food at the same time.
`
`Be safe during exercise or physical activity. Physical activity can lower your blood glucose
`during the activity and for hours afterward. You may need to check your blood glucose
`before, during, and after physical activity and adjust your medicine or carbohydrate intake
`to prevent low blood glucose. For example, you might eat a snack before physical activity to
`prevent low blood glucose.
`
`Work with your doctor or health care team to prevent low blood glucose. Ask your team if
`any of your diabetes medicines can cause low blood glucose and how you can prevent and
`treat symptoms. Work with your doctor or health care team to adjust your diabetes
`management plan as needed.
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00004
`
`

`

`Some CGMs let you track your blood glucose levels using a small sensor attached to your arm or
`abdomen and view the information on your smartphone.
`How do I treat low blood glucose?
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00005
`
`

`

`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00006
`
`

`

`If your blood glucose is below your target, take 15 to 20 grams of glucose or carbohydrates right
`away.
`
`If you begin to feel one or more symptoms of low blood glucose, check your blood glucose
`level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps
`
`1. Eat or drink 15 to 20 grams of glucose or carbohydrates right away. Examples include
`
`four glucose tablets or one tube of glucose gel.
`
`1/2 cup (4 ounces) of fruit juice—not low-calorie or reduced-sugar juice. If you have
`kidney disease, don’t drink orange juice because it has a lot of potassium. Apple,
`grape, or cranberry juice are good options.
`
`1/2 can (4 to 6 ounces) of soda—not low-calorie or reduced-sugar soda.
`
`1 tablespoon of sugar, honey, or corn syrup.
`
`2. Wait 15 minutes and check your blood glucose level again. If your glucose level is still low,
`eat or drink another 15 to 20 grams of glucose or carbohydrates.
`
`3. Check your blood glucose level again after another 15 minutes. Repeat these steps until your
`glucose level is back to your target range.
`
`4. If your next meal is more than 1 hour away, have a snack to keep your blood glucose level
`within a range that is healthy for you. Try crackers or a piece of fruit.
`Treating low blood glucose if you take medicines that slow down
`digestion
`
`Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose
`levels from rising too high after you eat. If you develop low blood glucose while taking these
`medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking
`other sources of carbohydrates won’t raise your blood glucose level quickly enough.
`What if I have severe low blood glucose and can’t
`treat myself?
`
`Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low
`blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood
`glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency.
`
`If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared
`to address severely low blood glucose by
`
`talking with your doctor or health care team about when and how to use a glucagon
`emergency kit. If you have an emergency kit, regularly check the date on the package to
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00007
`
`

`

`make sure it hasn’t expired.
`teaching your family, friends, and coworkers when and how to give you glucagon. Tell them
`to call 911 right away after giving you glucagon or if you don’t have a glucagon emergency
`kit with you.
`wearing a medical alert identication bracelet or pendant. A medical alert ID tells other
`people that you have diabetes and need care right away. Getting prompt care can help
`prevent the serious problems that low blood glucose levels can cause.
`Clinical Trials for Low Blood Glucose
`
`The NIDDK conducts and supports clinical trials in many diseases and conditions, including
`diabetes. The trials look to nd new ways to prevent, detect, or treat disease and improve
`quality of life.
`What are clinical trials for low blood glucose?
`
`—are part of medical research and
`Clinical trials—and other types of clinical studies
`
`involve people like you. When you volunteer to take part in a clinical study, you help doctors
`and researchers learn more about disease and improve health care for people in the future.
`
`Researchers are studying many aspects of low blood glucose levels in diabetes, such as
`
`how to diagnose and treat low blood glucose among people with diabetes
`medicines that can treat symptoms of low blood glucose in people with hypoglycemia
`unawareness
`educational approaches to reduce fear of low blood glucose, which can make it harder for
`you to control your diabetes
`
`Find out if clinical studies are right for you
`
`.
`
`
`
`Watch a video of NIDDK Director Dr. Grin P. Rodgers explaining the importance of
`participating in clinical trials.
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00008
`
`

`

`
`
`Why Should I Join a Clinical Trial?Why Should I Join a Clinical Trial?
`
`What clinical studies for low blood glucose are looking for
`participants?
`
`You can view a ltered list of clinical studies on low blood glucose that are federally funded,
`open, and recruiting at www.ClinicalTrials.gov
`. You can expand or narrow the list to
`
`include clinical studies from industry, universities, and individuals; however, the National
`Institutes of Health does not review these studies and cannot ensure they are safe. Always talk
`with your health care provider before you participate in a clinical study.
`References
`
`[1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes
`Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006
`
`[2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24
`countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, &
`Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689
`
`[3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American
`patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM)
`network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009
`
`[4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among
`patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports.
`2018;18(8):53. doi: 10.1007/s11892-018-1018-0
`
`[5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes
`Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00009
`
`

`

`[6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical
`Diagnosis & Treatment. McGraw Hill; 2018:1222–1268.
`
`[7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes
`Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012
`
`[8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia.
`Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
`
`Last Reviewed July 2021
`
`
`
`Previous:
`Diabetes, Heart Disease, & Stroke
`
`Diabetic Neuropathy 
`
`Next:
`
`This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),
`part of the National Institutes of Health. NIDDK translates and disseminates research ndings to increase knowledge
`and understanding about health and disease among patients, health professionals, and the public. Content produced
`by NIDDK is carefully reviewed by NIDDK scientists and other experts.
`
`The NIDDK would like to thank:
`Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
`
`Contact Us
`
`Hours: 8:30 a.m. to 5 p.m. ET, Monday - Friday
`Email: healthinfo@niddk.nih.gov
`Phone: 1-800-860-8747
`TTY: 711
`
`   
`
`Novo Nordisk Exhibit 2361
`Mylan Pharms. Inc. v. Novo Nordisk A/S
`IPR2023-00724
`Page 00010
`
`