Common Health Issues

Solving Diabetes Hypoglycemia Problems

• By Rich Health Editorial Team
• November 01, 2021

Hypoglycemia occurs when there is too little glucose in the blood. This is more likely to happen when something happens to make the insulin act more rapidly, when you don’t eat enough food or don’t eat at the right time, if your exercise or activity burns up too much glucose, or if you use alcohol or other drugs.

 

In people with diabetes, the body stops releasing insulin before glucose levels fall too low. In addition, other hormones kick in that counteract insulin and cause glucose to be released into the bloodstream to prevent low blood glucose.

 

But if you have diabetes, especially if you use insulin or oral medications that lower blood glucose, such as sulfonylureas, you can’t put a stop to the insulin that has already been injected or released. And because the counter-regulatory hormones may not be acting as they should, your body can’t get blood glucose levels up to normal.

 

HYPOGLYCEMIA (LOW BLOOD GLUCOSE)

The level of glucose that produces symptoms of hypoglycemia varies from person to person and for the same person under different circumstances. Ask your doctor about your safe range of blood glucose values.

Mild and moderate reactions to hypoglycemia can be easily treated by eating extra carbohydrate, if recognized in time. But if left untreated, severe hypoglycemia puts patients at risk for injury and death. The best way to prevent a hypoglycemia reaction is to know what causes it, recognize when it is occurring and treat it promptly.

 

HYPOGLYCEMIA RISKS

If you experience only mild episodes of hypoglycemia and treat them promptly, you may notice only a minimum disruption to your daily life. However, frequent moderate or severe attacks can have more threatening consequences. Because moderate and severe hypoglycemia affects your brain’s ability to function, anything that requires you to think and concentrate can be affected. For example, hypoglycemia could make it difficult to concentrate while taking an exam in school or making a presentation to a new client.

 

If you drive a car, ride a bike, or operate any kind of heavy machinery, hypoglycemia could be extremely dangerous. 

 

If you have frequent moderate or severe episodes, your central nervous system could become damaged. This is especially true in young children.

 

Some patients develop a fear of hypoglycemia that could lead to chronic overeating, under-treatment with insulin or other medications or both. This is risky because it will increase the chance of hyperglycemia, which can also be life-threatening. It can also increase the risk of developing diabetes complications over time.

 

Other patients develop a lack of concern over hypoglycemia and maintain blood glucose levels that put them at risk of recurrent bouts of hypoglycemia.

 

If you have heart disease, hypoglycemia poses an additional risk. When your blood glucose level gets too low, your heart beats faster than normal. Talk to your doctor about this and discuss whether you need to modify your blood glucose goals to reduce the risk of hypoglycemia and the effect it may have on your heart condition.

 

Anyone with diabetes can develop hypoglycemia. People with type 1 diabetes are especially prone to this condition. On average, people with type 1 diabetes have one or two episodes of hypoglycemia each week. People with type 2 diabetes experience hypoglycemia less frequently. It is also common in the elderly, among people who drink alcohol, and among those who are managing their diabetes with intensive therapy.

 

Any situation that causes your body to use up glucose faster than you release it into the bloodstream can make hypoglycemia more likely. That is why you have to be especially careful about timing your diet, exercise and insulin injections to avoid hypoglycemia.

 

HYPOGLYCEMIA SYMPTOMS

When you don’t have enough glucose in your blood, you may experience the symptoms (what you feel) and signs (what others notice) of hypoglycemia. There are two kinds of signals that tell you a hypoglycemia reaction is occurring: those that are caused by the effect of low blood glucose on the autonomic nervous system (the nerves that work without you even realizing it) and those that are caused by the effect of low blood glucose on the brain.

 

Symptoms of hypoglycemia usually appear when blood glucose levels fall below 50-60mg/dl. However, some people may not feel any symptoms at this level, and others may feel symptoms at even higher glucose levels.

 

You may not feel all the symptoms of hypoglycemia but it is important that you learn to recognize the signs and symptoms you experience during hypoglycemia. The only sure way to know whether you have hypoglycemia is to test your blood glucose level. However, you may not always have the time or opportunity to test your blood glucose during a bout of hypoglycemia. 

 

If you already know you are prone to hypoglycemia, you may want to measure your blood glucose level when you suspect an episode, so you know how your own body reacts to low blood glucose, you can learn to identify the symptoms and treat early to prevent a mild episode from becoming a severe one.

 

SYMPTOMS OF MILD HYPOGLYCEMIA

During an episode of mild hypoglycemia, you may experience any of the following symptoms: shakiness, tremors, palpitations, nervousness, sweating, chills and clamminess, rapid heartbeat, anxiety, light-headedness, and excessive hunger. These are all due to effects of the autonomic nervous system. Mild hypoglycemia will probably not affect your brain, and you should be able to recognize the symptoms and treat yourself.

 

SYMPTOMS OF MODERATE HYPOGLYCEMIA

If you have a moderate hypoglycemic reaction, you will experience both autonomic and cognitive symptoms caused by effects on the brain. In addition to the symptoms listed above, you may also experience headache, mood changes, irritability, drowsiness, blurred vision, nightmares, nausea, tingling or numbness in the lips or tongue, confusion, and decreased attentiveness.

SYMPTOMS OF SEVERE HYPOGLYCEMIA

If the early warning signs of hypoglycemia go unnoticed or ignored, then severe hypoglycemia can occur. Severe hypoglycemia is an event requiring assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions. If your brain has too little glucose for too long, you may become unresponsive, have convulsions or low consciousness. This is an emergency situation that requires immediate attention

 

WHAT YOU SHOULD DO

If you suspect an episode of hypoglycemia, test your blood glucose level right away. Talk to your health care team about the level at which you should begin treatment. If you are unable to test, but recognize the symptoms, do not wait until you are able to test your blood. Instead, treat right away! Never wait until you get home, especially if you have to drive.

 

TREATMENT OF HYPOGLYCEMIA

Mild Hypoglycemia

In general, if your blood glucose level is less than 70mg/dl or if you are experiencing symptoms of hypoglycemia, you should eat 10-15 grams of carbohydrate:

• 2-5 glucose tablets
• 2 tablespoon raisins
• 4 ounces of regular soda
• 4 ounces of fruit juice
• 5-7 Lifesavers
• 6 jelly beans
• 10 gumdrops
• 2 teaspoons of sugar
• 2 teaspoons of honey
• 6-8 ounces of fat-free or 1% milk

The easiest carbohydrate to keep on hand is probably glucose, sold in tablet or gel form at most pharmacies. Two to five glucose tablets or one package of glucose gel will most likely relieve your symptoms if you are having a mild reaction of hypoglycemia.

 

After taking your pocket carbohydrate, wait 10 to 15 minutes and test again. If your blood glucose levels are still under 70mg/dl, you may need an additional dose of carbohydrate. Talk to your health care team about what blood glucose levels you should aim for after treatment.

 

Moderate Hypoglycemia

If your symptoms are more severe and longer lasting, you may be having a moderate episode of hypoglycemia. Because you may also experience some confusion or impaired judgement, you may require assistant in treating yourself. You may even become belligerent and refuse treatment.

 

Make sure those close to you know what to do if you have hypoglycemia. If you have taken one dose of carbohydrate (10-15 grams), test your blood glucose level again in 15 minute. If after 15 minutes your blood glucose is still too low for you, or If you are still experiencing hypoglycemic symptoms, then take another 10-15 grams of carbohydrates and retest your blood glucose 15 minutes later. If you are being uncooperative and refuse to eat any carbohydrate snacks, you may need to be injected with glucagon, a hormone that causes the liver to release glucose and shuts down insulin release

 

Severe Hypoglycemia

If you do not respond to the above treatment or you have waited too long to treat low blood glucose, you will probably require assistance. Make sure those people who spend a lot of time with you know what to do during a severe hypoglycemic episode. If you have severe hypoglycemia, you may refuse help, be unable to swallow, or be unconscious.

 

In this case, you may require intravenous glucose or a shot of glucagon. If these are not available, your helper may be advised to apply a glucose gel between your cheek and gum.

 

If you are having a severe episode of hypoglycemia and medical personnel are available, intravenous glucose will be given to you. Most likely, you will be given 10-25 grams of glucose in the form of a 50% dextrose solution (dextrose is the optically pure chemical form of glucose used by the body). This will be given over a 1-to 3-minute period.

 

After that, intravenous glucose will be given at a rate of 5-10 grams per hour until you have fully recovered and are ready to eat.

 

If you are unable to get emergency help right away, which is often the case, glucagon should be injected. If you are prone to hypoglycemia, always keep a supply of glucagon nearby. Make sure anyone you spend time with—your parents, spouse, older children, siblings, roommates, friends, coach, teammates or teachers—know how to mix, draw up and administer glucagon and how to recognize when glucagon treatment is necessary.

 

Talk to your doctor or diabetes educator about whether to buy a glucagon kit, which is available by prescription. Have your diabetes educator teach you and your helpers how to use it.

A glucagon kit contains syringe filled with a diluting solution and a bottle of powdered glucagon. Before injecting, the powder must be mixed with the diluting fluid. Instructions for mixing and injecting glucagon are included in the kit. Make sure you go over the directions ahead of time with someone who can inject glucagon if you need it. The directions are not difficult, but at the moment you need help, it might be hard for your loved ones to concentrate on learning how to do it. So practice beforehand!

 

Glucagon should be injected the same way as insulin. Choose a site with fatty tissue, such as the upper thigh, back of the arm, abdomen, or buttocks. Make sure your hands and the injection site are clean and dry. Gently pinch a fold of skin between thumb and forefinger and inject straight in. push the needle through the skin quickly. Push the plunger in to inject glucagon and pull the needle straight out. You may need to apply pressure with a piece of gauze or cotton ball to prevent bleeding.

The usual dose of glucagon to treat a child less than 5 years old is 0.25-0.5mg. For children 5 to 10 years old, 0.5-1.0mg is recommended, and for those over the age of 10, 1.0mg is recommended. Glucagon should be injected intramuscularly (into the muscle) or subcutaneously (under the skin) into the shoulder or thigh. Make sure you or your child’s helper has been shown how and where to inject glucagon.

 

After you have been given glucagon, you are likely to vomit, so your helper should keep your head elevated above your stomach. You should respond to glucagon within 5 to 20 minutes. Once you are awake enough to chew and swallow, drink a clear fluid, such as ginger ale or 7-Up. This should help settle your stomach. Then try to eat a substantial snack such as bread and peanut butter or a half a cheese sandwich. If you don’t respond to the glucagon within 20 minutes, your helper should give you another dose and call for emergency help right away.

 

HYPOGLYCEMIA PREVENTION

If you have frequent episodes of hypoglycemia, it is important to figure out what causes them and take steps to prevent them from happening in the first place. Even if you experience hypoglycemia only occasionally, make sure you know what to do to keep a mild episode from becoming life-threatening.

 

INSULIN IRREGULARITIES

Sometimes, errors in insulin use can lead to hypoglycemia. Check that you have not reversed your morning and evening doses. Make sure you have not mixed up your short- and intermediate-acting insulins. Also, make sure that your time your insulin injections with your meals. Don’t wait too long to eat after injecting insulin if you are prone to hypoglycemia. In addition, don’t give yourself extra insulin without talking to your doctor first about the circumstances for which this would be necessary.

Check your injection site. If you have a hypertrophied injection site (a lumpy area caused by an overgrowth of fat cells), your insulin absorption could be unpredictable. Also, if you inject into an exercising muscle, insulin will be absorbed more rapidly than you might expect and could be contributing to low blood glucose. If you are following an intensive insulin therapy program you are more prone to hypoglycemia and may need to monitor your blood glucose more frequently.

 

Check any other diabetes symptoms you may have and get solutions with this free diabetes symptoms checker tool

Sources and References

• The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

 

• Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society by Elizabeth Seaquist, John Anderson, Belinda Childs et al

 

• A Large Difference in Dose Timing of Basal Insulin Introduces Risk of Hypoglycemia and Overweight: A Cross-Sectional Study by Akiko Nishimura, Yu Wang, Nobuya Inagaki et al

 

• Glucagon Physiology by Iben Rix, Asger Lund et al