Hypoglycemia In Diabetics

India, today leads the world with the largest number of people with diabetes in any given country.

The International Diabetes Federation (IDF) reports that in 2007 there were 46.5 million people in India with diabetes and that this number is expected to go to 80.3 million by 2025. (IDF, 2006).

Diabetes is mainly characterized by elevated blood glucose levels. But, hypoglycemia (low blood glucose) is one of the most feared complications of diabetes treatment. Hence, it is very necessary for a diabetic patient to understand all the facts and treatment for hypoglycemia. 

Following is what a diabetic patient should know or be educated about hypoglycemia:

         What is hypoglycemia?

Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. Glucose, an important source of energy for the body, comes from food. Carbohydrates are the main dietary source of glucose.

Hypoglycemia is a common side-effect of well-managed diabetes. As people improve their management to achieve target blood glucose levels, the risk of hypoglycemia increases. Because hypoglycemia is such an uncomfortable feeling, people often over treat it, resulting in high blood glucose levels. 

At what level of blood glucose is a person considered hypoglycemic?

For people with diabetes, a blood glucose level below 70 mg/dL is considered hypoglycemia.

Normal and Target Blood Glucose Ranges
Normal Blood Glucose Levels in People Who Do Not Have Diabetes
Upon waking—fasting	70 to 99 mg/dL
After meals	70 to 140 mg/dL
Target Blood Glucose Levels in People Who Have Diabetes
Before meals	70 to 130 mg/dL
1 to 2 hours after the start of a meal	below 180 mg/dL

Source: American Diabetes Association. Standards of Medical Care in Diabetes—2008. Diabetes Care. 2008; 31:S12–S54.

What are the symptoms of hypoglycemia?   

Hypoglycemia causes symptoms such as:

• Hunger
• Shakiness
• Nervousness
• Sweating
• Dizziness or light-headedness
• Sleepiness
• Confusion
• Difficulty speaking
• Anxiety
• Weakness

Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include:

• Crying out or having nightmares
• Finding pajamas or sheets damp from perspiration 
• Feeling tired, irritable, or confused after waking up.

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What causes hypoglycemia in people with diabetes?

Hypoglycemia occurs due to a relative excess of insulin in the blood, which in turn lowers the blood glucose to below normal levels. This relative excess of insulin can be due to:

► Too much medication causing higher than needed insulin levels.     

► The prolonged action of certain medications.

► Not eating enough food to match the insulin level in the bloodstream.  

► Not eating at the proper time (skipping or delaying meals).

► Unplanned or excessive exercise, leading to lower blood glucose.

How can hypoglycemia be prevented?

Diabetes treatment plans are designed to match the dose and timing of medication to a person’s usual schedule of meals and activities. Mismatches could result in hypoglycemia. For example, taking a dose of insulin or other medication that increases insulin levels but then skipping a meal could result in hypoglycemia.

To help prevent hypoglycemia, people with diabetes should always consider the following:

Their diabetes medications

A health care provider can explain which diabetes medications can cause hypoglycemia and explain how and when to take medications. For good diabetes management, people with diabetes should take diabetes medications in the recommended doses at the recommended times. In some cases, health care providers may suggest that patients learn how to adjust medications to match changes in their schedule or routine.

Their meal plan

 

A registered dietitian can help design a meal plan that fits one’s personal preferences and lifestyle. Following one’s meal plan is important for managing diabetes. People with diabetes should eat regular meals, have enough food at each meal, and try not to skip meals or snacks. Snacks are particularly important for some people before going to sleep or exercising. Some snacks may be more effective than others in preventing hypoglycemia overnight. The dietitian can make recommendations for snacks.

Their daily activity

To help prevent hypoglycemia caused by physical activity, health care providers may advise -

►Checking blood glucose before sports, exercise, or other physical activity and having a snack if the level is below 100 milligrams per deciliter (mg/dL)

►Adjusting medication before physical activity

 

►Checking blood glucose at regular intervals during extended periods of physical activity and having snacks as needed

►Checking blood glucose periodically after physical activity

Their use of alcoholic beverages

 

Drinking alcoholic beverages, especially on an empty stomach, can cause hypoglycemia, even a day or two later. Heavy drinking can be particularly dangerous for people taking insulin or medications that increase insulin production. Alcoholic beverages should always be consumed with a snack or meal at the same time. A health care provider can suggest how to safely include alcohol in a meal plan.

Their diabetes management plan

Intensive diabetes management helps keeping blood glucose as close to the normal range as possible to prevent long-term complications that can increase the risk of hypoglycemia. Those whose goal is tight control should talk with a health care provider about ways to prevent hypoglycemia and how best to treat it if it occurs.

Prompt Treatment for Hypoglycemia : “The Rule of 15” 

The rule of 15 is a helpful way to remember the treatment regimen for mild-to-moderate hypoglycemia. For example,

► 15 gms of quickly absorbed carbohydrate such as 1 tablespoon of sugar or honey,

     1/2 cup, or 4 ounces, of any fruit juice

      1/2 cup, or 4 ounces, of a regular (not diet) soft drink

      1 cup, or 8 ounces, of milk

      5 or 6 pieces of hard candy

► Wait 15 minutes.

► If not better, or blood glucose is not above 60 mg/dl, treat with another 15 gms of quickly absorbed   carbohydrate.

► As this quickly absorbed carbohydrate will not last long in the body, it is important that the person is given something to eat within a short time.

► If the next meal is more than 1 hour away, the person should be given some food rich in carbohydrate and protein, such as sandwich with sprouts, a fruit with milk or a small chapatti (Indian bread) with dal (lentils) or a fistful of murmura (puffed rice) and roasted chana (whole Bengal gram). This will ensure that the blood sugar will not drop again before the next meal.

Hypoglycemia When Driving

Hypoglycemia is particularly dangerous if it happens to someone who is driving. People with hypoglycemia may have trouble concentrating or seeing clearly behind the wheel and may not be able to react quickly to road hazards or to the actions of other drivers. To prevent problems, people at risk for hypoglycemia should check their blood glucose level before driving. During longer trips, they should check their blood glucose level frequently and eat snacks as needed to keep the level at 70 mg/dL or above. If necessary, they should stop for treatment and then make sure their blood glucose level is 70 mg/dL or above before starting to drive again.

    Thus, in conclusion, important points a diabetic has to remember are :

•  Hypoglycemia can occur from time to time to everyone who has diabetes;
• Check blood glucose levels to determine when your level is low; 
• Learn to identify the symptoms of hypoglycemia so you can treat it quickly;
• Treat hypoglycemia by raising your blood glucose level with some form of sugar;
• If misdiagnosed or untreated, hypoglycemia can be fatal;   

References

1. Briscoe VJ & Davis SN (2006).Hypoglycemia in Type 1 and Type 2 diabetes: physiology,   pathophysiology and management. Clinical Diabetes. 24(3):115-121

2. http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/) retrieved on 21/11/09