From the Guidelines
If you are experiencing tingling sensations, particularly in the extremities, and suspect hypoglycemia, immediately check your blood glucose level and consume 15-20 grams of fast-acting carbohydrates if it's below 70 mg/dL. This is based on the recommendations from the American Diabetes Association, as outlined in the 2018 standards of medical care in diabetes 1. The treatment for hypoglycemia involves consuming glucose (15–20 g) for the conscious individual with blood glucose below 70 mg/dL, and repeating the treatment if symptoms persist after 15 minutes.
Key Points to Consider
- Hypoglycemia is a major limiting factor in the glycemic management of type 1 and type 2 diabetes, and its symptoms include shakiness, irritability, confusion, tachycardia, and hunger 1.
- A hypoglycemia alert value of below 70 mg/dL can be important for therapeutic dose adjustment of glucose-lowering drugs in clinical care and is often related to symptomatic hypoglycemia 1.
- Severe hypoglycemia is defined as severe cognitive impairment requiring assistance from another person for recovery, and individuals at risk should have glucagon prescribed and readily available 1.
- Tingling sensations during hypoglycemia occur because low blood glucose affects nerve function, disrupting normal signal transmission, and the brain and nervous system rely heavily on glucose for energy 1.
Recommendations for Management
- If you experience frequent hypoglycemia with tingling, consult your healthcare provider to adjust your medication, meal plan, or to investigate other potential causes.
- Individuals at risk for hypoglycemia should be asked about symptomatic and asymptomatic hypoglycemia at each encounter, and caregivers or family members should know how to administer glucagon if needed 1.
- Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if low cognition or declining cognition is found 1.
From the FDA Drug Label
Symptoms of mild to moderate hypoglycemia may occur suddenly and can include: ... tingling in the hands, feet, lips, or tongue ...
Hypoglycemia (too little glucose in the blood) is one of the most frequent adverse events experienced by insulin users.
Hypoglycemia and Tingling: Tingling in the hands, feet, lips, or tongue is a symptom of mild to moderate hypoglycemia, which is a common adverse event experienced by insulin users 2.
- Key Points:
- Hypoglycemia can be caused by missing or delaying meals, taking too much insulin, exercising or working more than usual, and other factors.
- Symptoms of hypoglycemia can include tingling, sweating, drowsiness, dizziness, and others.
- If you experience symptoms of hypoglycemia, you should monitor your blood glucose frequently and consider eating or drinking sugar-containing foods to treat your hypoglycemia.
- Severe hypoglycemia can lead to disorientation, seizures, unconsciousness, and death, so it is crucial to obtain medical assistance immediately if you experience severe symptoms 2.
From the Research
Hypoglycemia and Tingling
- Hypoglycemia is a common side effect of certain diabetes medications, including sulfonylureas 3, 4, 5
- Sulfonylureas can cause hypoglycemia due to their mechanism of action, which stimulates insulin release from the pancreas 3, 5
- The risk of hypoglycemia associated with sulfonylureas can be minimized by using safer drugs, possibly in lower doses 3
- Tingling is a symptom that can be associated with hypoglycemia, although it is not explicitly mentioned in the provided studies 5, 6
- Severe hypoglycemia, which can cause symptoms such as tingling, is a significant risk associated with sulfonylurea use, particularly in elderly patients 5, 6
Risk of Hypoglycemia with Sulfonylureas
- The risk of severe hypoglycemia associated with sulfonylureas is elevated compared to metformin, with a hazard ratio of 4.53 (95% CI, 2.76-7.45) 5
- Elderly patients with type 2 diabetes who use sulfonylureas are at a higher risk of severe hypoglycemia, with a 10-year risk increase of 7.7-8.6% compared to non-exposed subjects 6
- The use of sulfonylureas and insulin is a more significant predictor of severe hypoglycemia and death than glucose levels in elderly patients with type 2 diabetes 6
Management of Hypoglycemia
- Clinicians should consider alternative hypoglycemic agents when metformin is not tolerated or contraindicated, due to the risk of severe hypoglycemia associated with sulfonylureas 5
- Patients with type 2 diabetes should be closely monitored for symptoms of hypoglycemia, including tingling, and treated promptly to prevent severe hypoglycemia 5, 6