Hypoglycaemia
Hypoglycemia, or hypo as most people with diabetes say, occurs when the blood sugar falls to a level below 4 mmol/l and you start to experience symptoms. In this section, you can read about the symptoms of hypoglycemia and precautions you must take to avoid
What is hypoglycemia?
Hypoglycaemia literally means ‘low blood sugar’. In a person who is taking antidiabetic medication, blood sugar is considered low when it is below 4 mmol/l. Although Type 2 diabetes is normally associated with high blood sugar, some antidiabetic medications work by increasing the amount of insulin you produce.
The extra insulin removes sugar from the blood by helping it to enter the body’s cells. You might experience a variety of unpleasant symptoms, described below. Your doctor will tell you whether your diabetes treatment puts you at risk of hypoglycaemia, and, if so, what steps to take to avoid this. Some antidiabetic medications are less likely to cause hypoglycaemia than others.
The experience of hypoglycaemia
If you experience hypoglycaemia, you'll probably have some of the following symptoms: feelings of weakness, drowsiness, confusion, sweating, shaking, hunger, anxiety, irritability, and dizziness. You may lose your concentration, get a cold, clammy feeling and turn pale. In very severe cases, a person can lose consciousness and even lapse into a coma. You may not experience all of these symptoms, as low blood sugar feels different to different people. It's important that you learn to recognise your particular warning signs and understand how to take appropriate action promptly.
The experience may change
An important aspect of hypoglycaemia to be aware of is that if you have frequent episodes (‘hypos’), you may become less sensitive to the symptoms of hypos in future. Why this should be is not fully understood, but this phenomenon could put you or someone else in danger.
If you think you have low blood sugar
If you feel you have low blood sugar, you should eat or drink something that contains sugar right away. Your doctor may have recommended that you take between 10 and 20 grams of fast-acting sugar. This could be 3-4 glucose or boiled sweets or 100 ml of a regular soft drink. If your next meal is more than an hour away, you should also eat a sandwich or a biscuit. If you don't feel better in 15-30 minutes, test your blood sugar. If it is still low, take more fast-acting sugar, or your blood sugar could become so low that you are unable to help yourself.
Teach your friends
Your blood sugar may drop so low that you're too confused to help yourself. That's why it's important that you teach your friends how they can help you. Here's what to tell them! They should make you eat some sweets, drink some juice or soft drink, or take another form of fast-acting sugar if you are still awake. If your blood sugar becomes so low that you pass out, your friends - if instructed - should give you an injection of glucagon and/or quickly call an ambulance. When you wake up, you'll need some juice and a sandwich.
In what situations is hypoglycaemia a risk?
Hypoglycaemia is only a risk for people with Type 2 diabetes if they treat their condition with certain anti-diabetic medications or with insulin injections. Even then, hypoglycaemia can be avoided by following a meal plan that is tailored to the treatment. Recently, medicines have been developed which allow you to adjust your treatment to your life style and eating habits, and not vice versa. They can give you excellent blood sugar control whilst providing increased lifestyle flexibility. These newer drugs, such as repaglinide, are short-acting, and only work in the period during and immediately after a meal. They are less likely to cause hypoglycaemia because in the period between meals, the drug is no longer active.
However, with some treatments you may start to feel symptoms of low blood sugar if you miss or postpone a meal or simply don't eat enough. Exercising more than usual or taking too much anti-diabetic medication also put you at risk, as does drinking too much alcohol. In addition, some medicines that you take for conditions other than diabetes can interact with your anti-diabetic medicine, increasing the risk of hypoglycaemia. Tell your doctor or pharmacist about your anti-diabetic medicine when you need to take new medicines for other illnesses.
Walking the tightrope
Few people with diabetes can avoid episodes of low blood sugar completely. Hypoglycaemia is, to some extent, a result of trying to keep the blood sugar near to normal. Most people who strive for good blood sugar control experience hypoglycaemia more often than those who are less motivated.
Dealing with hypoglycaemia
Here's some general advice on how to deal with hypoglycaemia. Always remember to carry glucose or boiled sweets or drinks containing fast-acting sugar. Always keep your diabetes ID card with you. Tell those around you how they can help if your blood sugar is low. Test your blood sugar regularly, particularly if you suspect hypoglycaemia, and eat, exercise and diet accordingly.
Is hypoglycaemia dangerous?
If you recognize the symptoms of hypoglycaemia, you can usually deal with the situation easily by taking sugar. Although it is very rare in people with Type 2 diabetes who are not using insulin injections, it is still possible for hypoglycaemia to lead to loss of consciousness and even hospitalisation, so don’t ignore suspicious symptoms or comments about your behaviour made by your friends or relatives. If you think your blood sugar is low, you should not drive a car. Don't risk passing out at the wheel and hurting someone. Trying to avoid hypoglycaemia is in everybody’s best interests.
APP/KOL/AC 22/02/07