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Hypoglycaemia - How to Treat and Prevent Low Blood SugarHypoglycemia prevention and management -
If blood glucose stays low for too long, starving the brain of glucose, it may lead to seizures, coma, and very rarely death. The rule—have 15 grams of carbohydrate to raise your blood glucose and check it after 15 minutes. Make a note about any episodes of low blood glucose and talk with your health care team about why it happened.
They can suggest ways to avoid low blood glucose in the future. Many people tend to want to eat as much as they can until they feel better. This can cause blood glucose levels to shoot way up. Using the step-wise approach of the " Rule" can help you avoid this, preventing high blood glucose levels.
Glucagon is a hormone produced in the pancreas that stimulates your liver to release stored glucose into your bloodstream when your blood glucose levels are too low. Glucagon is used to treat someone with diabetes when their blood glucose is too low to treat using the rule.
Glucagon is available by prescription and is either injected or administered or puffed into the nostril. For those who are familiar with injectable glucagon, there are now two injectable glucagon products on the market—one that comes in a kit and one that is pre-mixed and ready to use.
Speak with your doctor about whether you should buy a glucagon product, and how and when to use it. The people you are in frequent contact with for example, friends, family members, and coworkers should be instructed on how to give you glucagon to treat severe hypoglycemia.
If you have needed glucagon, let your doctor know so you can discuss ways to prevent severe hypoglycemia in the future. If someone is unconscious and glucagon is not available or someone does not know how to use it, call immediately.
Low blood glucose is common for people with type 1 diabetes and can occur in people with type 2 diabetes taking insulin or certain medications.
If you add in lows without symptoms and the ones that happen overnight, the number would likely be higher. Too much insulin is a definite cause of low blood glucose. Insulin pumps may also reduce the risk for low blood glucose. Accidentally injecting the wrong insulin type, too much insulin, or injecting directly into the muscle instead of just under the skin , can cause low blood glucose.
Exercise has many benefits. The tricky thing for people with type 1 diabetes is that it can lower blood glucose in both the short and long-term. Nearly half of children in a type 1 diabetes study who exercised an hour during the day experienced a low blood glucose reaction overnight.
The intensity, duration, and timing of exercise can all affect the risk for going low. Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times. In the event of a severe hypoglycemic episode, a car accident or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc.
Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves. Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency.
As unpleasant as they may be, the symptoms of low blood glucose are useful. These symptoms tell you that you your blood glucose is low and you need to take action to bring it back into a safe range. But, many people have blood glucose readings below this level and feel no symptoms. This is called hypoglycemia unawareness.
Hypoglycemia unawareness puts the person at increased risk for severe low blood glucose reactions when they need someone to help them recover. People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night. People with hypoglycemia unawareness need to take extra care to check blood glucose frequently.
This is especially important prior to and during critical tasks such as driving. A continuous glucose monitor CGM can sound an alarm when blood glucose levels are low or start to fall. This can be a big help for people with hypoglycemia unawareness.
If you think you have hypoglycemia unawareness, speak with your health care provider. This helps your body re-learn how to react to low blood glucose levels.
This may mean increasing your target blood glucose level a new target that needs to be worked out with your diabetes care team. It may even result in a higher A1C level, but regaining the ability to feel symptoms of lows is worth the temporary rise in blood glucose levels. This can happen when your blood glucose levels are very high and start to go down quickly.
If this is happening, discuss treatment with your diabetes care team. Your best bet is to practice good diabetes management and learn to detect hypoglycemia so you can treat it early—before it gets worse.
Monitoring blood glucose, with either a meter or a CGM, is the tried and true method for preventing hypoglycemia. Studies consistently show that the more a person checks blood glucose, the lower his or her risk of hypoglycemia.
This is because you can see when blood glucose levels are dropping and can treat it before it gets too low.
A drop in blood glucose can make reading comprehension nearly impossible. In addition, low blood glucose may cause blurred vision, which may cause disorientation. This entire process makes rational thought, work, school, and activities such as driving extremely difficult. The signs and symptoms of hypoglycemia may be different for each person see sidebar.
Medication Mix-Ups According to Francine Kaufman, MD, chief medical officer and vice president of global medical, clinical, and health affairs at Medtronic, one of the world's largest medical technology, services, and solutions companies, and former president of the American Diabetes Association, there are several factors that may lead to diabetes-related hypoglycemia: errors in insulin or medication doses, mistakes in calculating the amount of insulin required to cover a meal or snack, mixing up insulin ie, taking morning insulin at night or vice versa , or drinking alcohol on an empty stomach.
Adjust Target Blood Glucose Range According to Henry Anhalt, DO, a pediatric endocrinologist and chief medical officer for T1D Exchange, a Boston-based nonprofit organization dedicated to accelerating research and improving type 1 diabetes outcomes, surveillance data often are inadequate and unreliable for capturing the real problem of hypoglycemia.
Young children and the elderly are at significant risk of adverse outcomes due to hypoglycemia, Anhalt says. He also points out the complication of significant cardiovascular disease in people who experience hypoglycemia. Physicians should refer our patients with diabetes to registered dietitians to assist with meal planning and snack adjustments to help combat the issue of hypoglycemia.
Avoid Fixed Insulin Ratios Gary Scheiner, MS, CDE, owner of Integrated Diabetes Services, and the American Association of Diabetes Educators diabetes educator of the year, has lived with type 1 diabetes for 32 years. Scheiner suggests matching a patient's insulin program to actual needs or individual requirements.
Also, at mealtimes, it's better to use a rapid-acting insulin analog eg, aspart, glulisine, or lispro than regular insulin because the rapid analogs finish working earlier and are less likely to cause premeal lows. Immediate treatment with carbohydrates is essential for low blood glucose. Recheck blood sugar in 15 minutes.
Scheiner says carbohydrate grams should be based on body weight, rather than using 15 g carbohydrate as a standard for children and adults. This is due to the fact that bigger people have more blood volume into which the glucose will dissolve.
Every gram of carb will raise a small child's blood glucose much more than that of a fully grown adult," Scheiner says. Don't Depend on Protein Often, patients are advised to add protein to the carbohydrate to prevent late onset hypoglycemia. Marion J. Protein does not contribute to sustained glucose elevations, slow the absorption of carbohydrate, or help in the treatment of hypoglycemia.
She says she keeps a variety of snacks on hand to always be prepared for the expected or unexpected. I will carry sustaining snacks like nutrition bars and nuts for in between meals," Smithson says. Consider Continuous Glucose Monitoring It's important to speak with patients about the significance of frequent blood glucose monitoring.
These vital data can be used to individualize meal plans, exercise programs, insulin regimes, and medications. Discuss available technology, including sensors, meters, and continuous glucose monitors CGMs to help achieve positive outcomes.
CGMs have built-in alerts, which can show lowering blood glucose trends. Keep Glucagon on Hand When glucose levels are severely low, the person may not be able to swallow carbohydrate-containing food, and intramuscular glucagon will be required. Glucagon 1 mg should be administered intramuscularly or subcutaneously.
It's essential for parents, caregivers, spouses, family members, or roommates to learn how to properly use glucagon. Glucagon kits include prefilled syringes, as well as diluting fluid.
After glucagon administration, normal plasma glucose levels may return in approximately 10 to 15 minutes. The patient may experience nausea or vomiting as a side effect from the glucagon.
Unfortunately, glucagon may not be effective if the patient consumed a large amount of alcohol. Always call if the individual is experiencing severely low blood glucose, although you still may have to administer glucagon.
Wear Medical Alert Identification Moreover, it's vitally important to educate patients about the importance of wearing a medical alert bracelet or other form of identification if they have diabetes. If they become hypoglycemic, confused, or disoriented, they may not be able to properly treat their low blood glucose.
A medical alert bracelet is the first thing medical professionals look for when they suspect hypoglycemia or are trying to differentiate low blood glucose from intoxication, because the signs at first glance may appear to be similar. Fine-Tune Mealtime and Timing of Meals If patients are taking intermediate or long-acting insulin, they can better manage blood glucose levels by eating on a consistent schedule.
If meals are significantly delayed eg, late service when dining out or a traffic jam coming home from work , hypoglycemia can result. Dietitians should advise their patients to carry a carbohydrate-containing snack with them, in case their usual meal is delayed, to prevent an unwanted drop in blood glucose.
Although foods high in fiber are healthful and should be included in meal planning, they shouldn't be used to raise plummeting blood glucose levels. Educate Family, Friends, and Coworkers Advise patients to educate those around them about diabetes and hypoglycemia symptoms.
Knowing the symptoms and treatment for hypoglycemia can alert friends, family, and coworkers to take immediate action. Remind patients to keep glucose tablets or another source of carbohydrate on hand to treat low blood glucose levels.
Dietitians and diabetes educators always should keep glucose tablets in the office, and encourage blood glucose monitoring during sessions. This allows for an open discussion about managing daily diabetes care and preparedness for emergency situations.
Hypoglycemia Unawareness In some circumstances, there are patients who are unaware that they're having a hypoglycemic episode. While normally a person may feel low blood glucose symptoms, lack of the stress response hormones causes an absence of physical symptoms such as shaking and sweating.
It's increasingly likely that the more serious issues, such as confusion, may not occur until blood glucose has dipped to a dangerously low level. Anthony McCall, MD, PhD, an endocrinologist at the University of Virginia, says, "People with hypoglycemia unawareness often state that they're OK because they don't feel so bad.
In fact, that's when things become very dangerous. People suffering from hypoglycemia unawareness may experience very strange behavior, including extreme anger or irritability, explosive emotions such as inappropriate laughter, or irrational thought. The problem of hypoglycemia unawareness may be caused by frequent low blood glucose, a rapid drop in blood glucose, having diabetes for many years due to the lack of stress hormone production , excessive alcohol consumption, or use of medications such as beta-blockers prescribed for high blood pressure or heart disease.
If too much alcohol is consumed, the liver is blocked from producing the glucose needed to raise blood glucose. In addition, free fatty acid release is blocked, so fuel for energy is limited.
As previously discussed, glucagon administration may be needed. Nocturnal hypoglycemia unawareness also is a major concern, as episodes may be connected to impaired counter regulatory-hormonal responses, and symptoms may go undetected.
CGMs can help identify hypoglycemia unawareness during sleep and alert the person with diabetes to a dip in blood glucose during the overnight hours. The best advice for reversing hypoglycemia unawareness is to avoid frequent low blood glucose levels.
This can be best accomplished by checking blood glucose levels often and consider wearing a CGM. Glucose meters should be easily accessible at home, work, or school.
Contributor Hypoylycemia. Please read the Disclaimer at Manqgement end of this managemeng. Hypoglycemia is the medical term for low blood glucose blood sugar. People with Hypoglycemia prevention and management 1 diabetes who take insulin to manage their blood glucose levels are at risk for getting hypoglycemia. The frequency of hypoglycemia among people with longstanding type 2 diabetes increases over time, as the body eventually stops making enough insulin. The symptoms of low blood glucose vary from person to person and can change over time. What is Hypoglycemia? Hypoglycemiaor Hypoglycemia prevention and management blood glucose Functional fitness exercises, happens when pgevention glucose preventjon drop Hypoglycwmia low. Hypoglycemia can be caused Nutrient timing for athletic success skipping a meal or a snack, eating less than usual, taking too much diabetes medication, or more exercise than usual. Symptoms of low blood sugar include:. How to treat a low blood sugar :. Step 1: Check your glucose. Good sources of 15 grams fast acting carbohydrate are:.
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