Hypoglycemia (Low Blood Glucose)

What is Hypoglycemia?
Hypoglycemia means low blood sugar. When the amount of blood glucose falls below the acceptable normal level (< 70 mg/dL), it is called Hypoglycemia

What are the symptoms of Hypoglycemia?

Hypoglycemia produces a number of symptoms. You should learn to recognize these symptoms at the earliest. The common symptoms are:

  • Hunger pains
  • Excessive sweating and anxiousness
  • Weakness
  • Palpitations (Rapid beating of the heart)
  • Trembling (Shaking of body)
  • Headache
  • Blurring of vision
  • Irritability/Confusion
  • Sleepiness
  • Fainting/Loss of consciousness (coma)

Can Hypoglycemia occur without symptoms?

Hypoglycemia is generally accompanied by warning symptoms described above. In some diabetics, especially those with long standing poorly controlled disease and in diabetics taking beta blocker drugs (e.g. Atenolol which is used to control the increased blood pressure ), severe hypoglycemia may occur without warning symptoms. Occasionally hypoglycemia occurring during sleep may not produce symptoms other than sweating and bad dreams. Your doctor will advise you about it.

How does Hypoglycemia occur?

The body has the capability of correcting low blood sugar by generating glucose. Lowering of blood sugars to levels that produce symptoms of hypoglycemia occurs only when correcting influences cannot work. This may be due to excess insulin or oral hypoglycemic agent. At times, hypoglycemia may occur even with normal doses of insulin or oral drugs, if the patient exercises inappropriately or reduces his food intake considerably.

The factors that increase the chances of hypoglycemia
  • Too little food, skipping meals or snacks
  • Taking alcohol (alcohol reduces glucose production by the liver).
  • Doing extra exercise without taking extra food
  • Taking too much insulin or oral hypoglycemic agents – as a result of taking excess dose or missing a dose.

What happens when Hypoglycemia is not treated?

The consequences of untreated hypoglycemia depend on how severe it is. Mild hypoglycemia, irrespective of the cause, is self-limiting and is corrected by the body's natural mechanisms. If not treated properly, severe hypoglycemia, especially that caused by excess insulin or oral anti diabetic drugs, may result in unconsciousness. Here, the body's compensatory mechanisms are unable to counter the effect of too much insulin or oral hypoglycemic agents.

How to treat hypoglycemia?

When the patient is conscious and hypoglycemia is suspected, he/she should be given something sweet to eat or drink e.g.20 to 25 gms of sugar, sweets, glucose, lemonade or tea etc. and this should be followed by a carbohydrate meal.

In hypoglycaemia follow the "15-15" rule

It’s easy to remember how to treat hypoglycemia with the 15-15 rule. Eat 15 grams of carbohydrates, wait 15 minutes, and then test your blood glucose again to see if you are on your way up to a normal level. If not, take a second dose of 15 grams and test again. You want to get safely up to 100 mg/dL. Fifteen grams of carbohydrates should bring up your glucose by about 50 mg/dL. It is often recommended that people use hard candies or glucose tablets, or drink some fruit juice. Fifteen grams of carbohydrates looks like this:

  • 5-6 hard candies
  • 3-4 glucose tablets
  • ½ cup juice

Don’t forget: One candy or tablet will raise your glucose by only 10 mg/dL or so. You are likely to need several!

Precautions:

  • After you feel better, you might need a snack to carry you over until the next meal, if that meal is more than an hour away. You don’t want to slip back toward a low glucose situation.
  • If you are on medication that could cause low blood glucose, be sure to always carry a source of carbs with you. Place glucose tablets, a juice box or candy in your glove compartment, purse, desk drawer, working bag or briefcase. It never hurts to be prepared.
  • If you treat your diabetes by injecting insulin, hypoglycemia must be treated quickly because it can get worse fast and you could lose consciousness.

What is Glucagon?

Glucagon is a hormone. Like insulin it is produced in the body. It is released when the blood sugar falls below the accepted normal levels. It has an effect which is opposite to the effect of insulin. It increases blood sugar by stimulating natural body mechanisms.

How to use Glucagon?

Glucagon is available in vials in a powder form, has a shelf life of two years and has to be reconstituted with a diluting fluid which is provided with the vial. Before reconstitution it can be stored at normal temperature.

Take a sterile 2 ml syringe and withdraw the diluting fluid from its vial into the syringe. Inject this fluid into the vial containing glucagon powder. Remove the syringe and needle and shake the glucagon vial well till the powder is completely dissolved. Using the same syringe, withdraw glucagon solution; raise a fold of skin by pinching and insert the needle quickly and inject the contents by pressing the plunger.

In case of adults above 25 kg body weight, inject the entire contents. In children below 25 kg body weight, inject only half the quantity.

Glucagon is safe. No serious side effects have been reported in diabetics who have used the dose suggested or even higher quantities accidentally during emergencies.

Measures To Be Carried Out By The Diabetic

  • Always carry some sweet (20-25 gm sugar) with you.
  • Carry an identity card mentioning that you are diabetic.
  • Avoid skipping meals