by Ann S.
Williams, MSN RN CDE
This column focuses on providing information to help people make their diabetes care fit their needs and their lives.
Hypoglycemia, or low blood glucose (sugar), is one of the most unpleasant, and at times frightening, experiences that diabetes can bring to the people who live with it. Most people who use insulin have had hypoglycemia. Many people who use oral medications have also experienced it. A few people who use no diabetes medications have encountered it.
In general, hypoglycemia is the result of having an imbalance between the factors that lower blood glucose (insulin and exercise) and those that raise it (food and release of stored sugar). Before the late 1990s, most diabetes professionals believed some hypoglycemia was an unavoidable consequence of trying to keep blood glucose close to normal by using insulin or oral diabetes medications. However, we now have medications that allow us to fine-tune diabetes control, and we also have improved techniques for preventing hypoglycemia.
If you are having a problem with frequent hypoglycemia, you should know that with modern medications and tools, most people can either eliminate or greatly reduce this distressing experience. It usually takes some effort to do this. You will probably need to do frequent blood glucose checking, and careful analysis of the results. In consultation with your doctor or diabetes educator, you might need to change your medication, eating habits, or your activity patterns. Since hypoglycemia is very individual, what works for you may not work for someone else. But there are some common causes of hypoglycemia, and general patterns to look for that can give you clues about what you can do to prevent it from occurring.
This article will explain what hypoglycemia is, how to treat it, and (next issue) some ideas about what you can do to prevent it.
What Is Hypoglycemia?
By definition, hypoglycemia is a condition in which the blood sugar (glucose)
is lower than normal. Most diabetes professionals believe that any blood sugar
below 70 MG/Dl should be considered too low. There are, at times, reasons to
think that a blood sugar around 80 or 90, or even 100, is too low for a particular
person.
The symptoms of hypoglycemia can be very different for different people. They can even be different for the same person at different times. Generally, in the early stages of hypoglycemia, most people notice feeling one or more of the following symptoms:
feeling shaky, nervous, or anxious.
feeling sweaty, and either hot or cold.
having a fast pulse or a pounding heart.
having tingling in the feet or hands.
These are just like the feelings you would have with intense fear. There is a good reason for this. When your blood sugar drops too low, your body reacts in exactly the same way as when confronted with a frightening emergency. Your body gets ready for action, goes into the "fight or flight" response, and sends a lot of adrenaline all around the body. It is the adrenaline that causes the symptoms mentioned above.
If the hypoglycemia is more severe, you might notice one or more of these symptoms: feeling lightheaded, having trouble concentrating, or having slow thinking, or being fatigued, having extreme emotions, such as getting very angry or crying over small problems, having blurred vision, being uncoordinated, or walking like a drunk person. These symptoms are due to the brain not having enough glucose (sugar) to function properly. Since the brain can use only glucose for fuel, it cannot work properly when the blood glucose is too low.
Other possible symptoms of hypoglycemia can include: headache, weakness, hunger, nausea, or muscle cramps. When you have low blood sugar, you might feel any or all of the above symptoms. You might even have unusual hypoglycemia symptoms that no one else seems to have. For example, one of my patients told me when her blood sugar is low, her nose feels cold!
Usually, people know something is really wrong when they have hypoglycemia. They feel several symptoms at once, and feel them quite strongly. It's important to pay attention to these feelings, and treat hypoglycemia in the early stages. If hypoglycemia is not treated in the early stages, it can become more severe, and can cause you to become very disoriented, pass out, have seizures, and even die. Having a "hypo" while driving a car can be lethal.
Sometimes, when people have had diabetes for many years, they do not feel any hypoglycemia symptoms in the early stages. This is known as hypoglycemia unawareness. If you have hypoglycemia unawareness, it is important to check the blood sugar frequently, and to keep it from going too low.
How To Treat Hypoglycemia
If you think you might be having hypoglycemia, if at all possible you should
check your blood glucose to be sure. This is important because the feelings
of hypoglycemia can be easily confused with several other common conditions
for
example, fatigue, panic attacks, menopausal "hot flashes," emotional stress,
illness, and even hyperglycemia (high blood sugar; both conditions can make
you feel terrible). If your blood glucose is below 70, you know for certain
you really
have hypoglycemia and should treat it. Many people need to treat all readings
below 80, or 90, as hypoglycemia, because at those levels it's too easy to
drop even further.
To treat hypoglycemia, you should follow the "Rule of 15:"
1. Eat or drink something that contains 15 grams of carbohydrate.
2. Wait 15 minutes.
3. Re-check your blood glucose. If it is not rising, eat or drink 15 more grams of carbohydrate.
It's best if what you eat or drink is made of simple sugars, so your body can absorb it quickly. Some good choices are:
1. Three or four glucose tablets (available without a prescription in most pharmacies).
2. One tube of glucose gel (available without a prescription in most pharmacies).
3. 1/2 cup of most fruit juices (orange, apple, pear, etc.) or mixture of juices.
4. One tablespoon honey, jelly, syrup, or table sugar.
5. Five or six Lifesavers, other hard candies, or jellybeans
6. 1/2 cup of any REGULAR soft drink, NOT sugar-free!
7. 12 ounces low-fat or skim milk.
8. If simple sugars are not available, any available carbohydrate can be used; for example, one slice of bread, 1/3 cup of rice, 1/2 cup of potatoes, or six saltines. These will work, although they may take a bit longer.
Chocolate candy is not the best choice for treating hypoglycemia, because the fat in the chocolate slows down the absorption of the sugar. But if that's all you have available, you're better off eating the chocolate than nothing at all
When treating hypoglycemia, you need to be very careful not to over-treat it. Most people feel really awful while they are having hypoglycemia. It can be very hard to restrain yourself and avoid overeating in response. It's even harder than usual, because restraining yourself is a brain function, and your brain is not operating well -- because it doesn't have enough glucose! Unfortunately, if you do overeat at this time, within the next 1/2 to 1 hour, you'll have high blood glucose, maybe very high. And of course you'll feel really awful again. So it's a good idea to have something appropriate, in the right amount, ready for hypoglycemia treatment. And it's best if you carry this with you, so it's handy at all times.
If you don't treat hypoglycemia early enough, and you pass out, you will need someone else to help you recover. If no one around you knows how to help you, they will probably call an ambulance, and you will get the help you need from the paramedics.
But it would be better to be prepared. If you use insulin, especially if you have already passed out from hypoglycemia, you should have a Glucagon Emergency Kit. Your doctor can prescribe this for you. It is an injection that will raise your blood glucose quickly. Since a glucagon injection should be used only on an unconscious person, you are not the person who will use it. You need to make sure the people who are around you a lot, such as family members, close friends, perhaps at least one co-worker, know how to use it. The instructions are very simple to follow. However, anyone who might have to use it should look at the literature and instructions with you, while you are well. After all, if you are unconscious or having a seizure from hypoglycemia, the people who care about you will themselves be upset. It will not be a good time for them to learn something new
Another important precaution to take, if you have ever had hypoglycemia, is to wear or carry identification that says you have diabetes. This is especially important if you have ever passed out from hypoglycemia--or think you might. If you are wearing diabetic identification, and you need help in an emergency, you'll get the help you need a lot faster
Next issue, I will discuss ways to prevent hypoglycemia.