How to identify and manage hypoglycaemia?

Hypoglycaemia is a condition in which the blood glucose levels fall far below the normal level (< 70mg/dL). It is one of the most common and deadly complication of diabetes, especially in type 1 diabetic patients. Around 2-4 % of deaths in type 1 diabetes is due to hypoglycaemia. The usual culprit for this problem is the diabetes medications. Hypoglycaemia, if not identified and treated on time, can lead to coma and death.

Hypoglycaemia in diabetics

Glucose serves as a fuel for all cells. The carbohydrates from the food is broken into glucose in the stomach. This glucose is absorbed by the blood and transported to the cells where it gets converted to energy.

The hormone insulin, released by the pancreas, helps the body cells to utilise glucose. The extra glucose circulating in the blood is stored as glycogen and fat. Certain organs, such as the brain, cannot store glucose for a long time and therefore need a constant supply for functioning. Thus, a certain blood glucose level must be maintained to achieve optimal functioning of all cells in the body.

When the blood glucose levels fall below normal, another hormone called glucagon (also released by the pancreas) breaks down glycogen and releases glucose. In some diabetics, response to hormone glucagon is impaired. This leads to low blood sugar levels or hypoglycaemia.

How to identify hypoglycaemia?

Though these signs may be due to hypoglycaemia, it can be only confirmed by checking the blood glucose levels.

Causes of hypoglycaemia

Antidiabetic medications and hypoglycaemia

Antidiabetic medications which stimulate insulin, may cause hypoglycaemia. These include sulphonylureas such as glimepiride, glipizide, glibenclamide. Hypoglycemia is common in people taking insulin.
Ask your doctor, whether your medications may cause hypoglycaemia. If you seem to have symptoms, inform your doctor, your medication dose may be adjusted accordingly.

Did you know?
Non-diabetic medications such as aspirin, probenecid, allopurinol or warfarin when taken with your typical diabetes meds, may also increase the risk of hypoglycaemia.

Food and hypoglycaemia

When you eat very less food, or you skip a meal but take your insulin, you may develop hypoglycaemia.

Exercise and hypoglycaemia

When you perform heavy exercises, the risk of hypoglycaemia increases as your body cells utilise more sugar from the blood and so, discuss your exercise plan with your doctor, he will guide about what exercises are apt for you.

Insulin injections and hypoglycaemia

When you repeatedly administer insulin at one site, it leads to lipodystrophy (check the booklet- All you want to know about insulin). This may delay the absorption of insulin. Thus, if you take insulin before a meal, it will show its effect long after you have eaten, when your blood glucose is already low, leading to hypoglycaemia.

Gastroparesis and hypoglycaemia

Normally, the intestinal muscles contract in a coordinated manner to propel food through the digestive tract. In diabetes, if the nerve that controls the movement of the intestinal muscles (the vagus nerve) gets damaged, it leads to a condition where motility of the intestinal muscles is decreased, called as gastroparesis.

Gastroparesis slows down digestion and increases the time for blood sugar to spike up. If you take insulin before meals and you have gastroparesis, the insulin would show its effect, but the blood sugar levels would not have increased yet. This causes hypoglycaemia.

Kidney disease and hypoglycaemia

Kidneys play an important role in removing insulin from the body. So, if you are on insulin and your kidneys are damaged, the insulin stays in your body for a longer time and increases your risk of having hypoglycaemia.

Prevention of hypoglycaemia

Your medications: Clarify all your doubts about your medications. Ask your doctor the following

When to take the medicines?
How much medicine should you take?
How to take the medication? (Orally/ injections)
Do you need to make any adjustments in the dose during exercise or after skipping a meal?
Does your medications have the potential to cause hypoglycaemia?
When is the medication at its peak levels of action?

Always follow your doctor’s instructions while taking your meds.

Your food: Irregular and unhealthy food habits can also cause hypoglycaemia. Follow these measures to prevent hypoglycaemia:

Your exercise regime: In order to prevent exercise induced hypoglycaemia, follow these tips:

Your alcohol consumption: It is best to limit alcohol consumption as much as possible. However, if you have an occasional drink, do not take it on an empty stomach. Have it with a snack or have it after meals.

Management of hypoglycaemia

The first and the most important step is to identify the signs of hypoglycaemia. Keep in mind all the signs of hypoglycaemia and act fast if you seem toexperience any. If your child is diabetic and on insulin, educate his/her school
teacher about the signs of hypoglycaemia and also about how to manage it.

If you seem to have symptoms of hypoglycaemia, check the blood sugar levels - if it is lower than 70mg/dL, follow the 15/15 rule.

If your blood sugar level is low again, have another 15 mg of carbohydrate. Continue these steps until your blood sugar level is above 70mg/dL.

Common foods that have
15 gm of simple carbohydrate:

5-6 pieces of candies
3 tablets of glucose
2 tablespoons of raisins
Half a cup of juice
1 tablespoon of honey or sugar
Skimmed milk 1 cup

Glucagon and hypoglycaemia

If you have severe hypoglycaemia, you would need somebody to give you glucagon injections. Glucagon is a hormone that helps in increasing blood sugar levels. Let your friends and family know how to administer this medication.

Driving and hypoglycaemia

Having an episode of hypoglycaemia while driving, may have dire consequences. Always carry your blood sugar monitor and simple carb snacks with you. If you seem to have any symptoms, get off the road and stop your vehicle. Check your blood sugar levels and follow the 15/15 rule.

Hypoglycemia during sleep

Nocturnal hypoglycaemia is pretty common in patients who are on insulin. When you sleep, your body needs less energy, therefore less glucose is required. In normal people, less insulin is released at night time. This balance is difficult to achieve in diabetics who are on insulin.

What causes night-time hypoglycaemia?

There can be many causes:

How to prevent night time hypoglycaemia

Eat a night time snack.
Check your blood sugar early in the morning (3AM).
If you have a habit of eating late, inform your doctor. He would replace your regular insulin with rapid acting insulin. This acts within 5 minutes of administration and stops controlling glucose levels in 2-4 hours.

Night time hypoglycaemia is characterised by the following symptoms:

Hypoglycaemia unawareness

This is a condition where diabetics do not experience any symptoms of hypoglycaemia despite having low blood sugar levels. This occurs when a body frequently has hypoglycemic episodes and stops responding to low glucose levels.

How to prevent this?

Following preventive measures for hypoglycaemia can help the person to understand the hypoglycaemia symptoms. In people who cannot identify hypoglycaemia symptoms, doctors aim for higher than usual blood sugar targets for short term till the person is aware of the condition.

A person, who is on diabetes medications, needs to be alert and listen to what the body says. Hypoglycaemia, if not managed on time, can have dire consequences. If you are able to identify the signs and symptoms of hypoglycaemia, managing it is not difficult.