What is hypoglycemia?

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You first find out you have diabetes when your blood sugar (glucose) level is way too high (hyperglycemia). Once you start taking insulin, which allows glucose to enter your cells, you can suffer from low blood sugar (hypoglycemia) and its effects if insulin and blood sugar levels are not in balance.

Low blood sugar

Hypoglycemia means there is too much insulin and not enough glucose in your blood.

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Mild hypoglycemia happens when blood glucose drops below 75mg/dl. Some people do not feel its effects until their blood sugar level is below 60mg/dl. Normal blood glucose is 90 to 100 mg/dl.

Hypoglycemia can happen when you don't eat enough, when you have waited too long to eat or have skipped a meal, when you use glucose faster than usual, and when there is too much medication (e.g. aspirin and beta blockers) in your body. It can also occur after exercise because your cells open to glucose to provide energy and youtr glucose is used up.

If you take too big an injection of insulin, it causes hypoglycemia because it is more than required to take care of the carbohydrates in your meal.

Symptoms

There are distinct feelings and behavior caused by low blood sugar. These can vary from person to person.

Symptoms of hypoglycemia include:

• nervousness
• shaking
• sweating
• dizziness
• feeling
• light headed
• sleepiness
• confusion
• difficulty speaking
• difficulty concetrating
• feelings of hunger
• rapid heartbeat
• physical weakness.

Why it happens

When blood glucose drops too low, the body tries to protect itself by releasing adrenaline from the adrenal glands. This causes the blood sugar level to rise.

It's the adrenaline surge which makes you feel anxious, sweaty, irritable, hungry, and even numb in your lips, fingers, and toes. Plus, your heart beats faster.

The brain also suffers from not getting enough glucose, and that's what causes confusion, concetration difficulties, dizziness, tiredness, impaired vision, and slurred speech. (The brain receives its glucose not via insulin but passively when glucose in the blood is higher than glucose in the brain cells).

Severity levels

Hypoglycemia is classed as mild, moderate, or severe.

Mild hypoglycemia occurs at blood glucose of about 75mg/dl. It is easily treated by the sufferer herself (or parent if the patient is a child). It is often discovered after testing blood glucose.

Moderate hypoglycemia occurs at blood glucose of about 65mg/dl. It is treated by taking two to four glucose tablets, waiting 20 minutes, testing for normal blood glucose level 90 to 100 mg/dl., then taking more glucose if it is not normal. Moderate hypoglycemia is recognized by symptoms such as anxiety and rapid heartbeat.

Severe hypoglycemia occurs at blood glucose under 55mg/dl. Someone with severe hypoglycemia may be unconscious and need a shot of glucagon (a hormone that raises the blood sugar level).

Treatment

Mild hypoglycemia is best prevented by regularly monitoring blood sugar. If you have it, the condition is treated by consuming fast-acting sugar.

First, check your blood sugar level to find out how low it is.

You should eat or drink 10 to 15 grams of fast-acting sugar. This can be:

• 2-4 glucose tablets (each tablet contains 4-5g)
• Half cup of orange or apple juice (1 cup=30g)
• Three quarters of a cup of non-diet soda (1 cup=24g)
• 2 tablespoons of raisins (1 tablespoon=7.5g)
• 3-4 teaspoons of cake icing (1 teaspoon-4g)
• 10-15 Skittles (each Skittle is 1g)
• 3-4 teaspoons of table sugar (1 teaspoon=4g)
• 1-1.5 cups of low fat milk (1 cup=13g)

If blood glucose is not normal (90 to 100 mg/dl) within 15 to 20 minutes, eat another snack.

It helps to remain inactive for 15 to 30 minutes while your blood sugar level returns from low to normal.

Medical care

You should seek emergency care if blood glucose is not at a normal level after the second snack.

If you are unable to swallow, or you have passed out, someone should give you a glucagon shot.

If you don't wake up 10 to 15 minutes after the glucagon shot, someone must call 911 (or its equivalent in other countries, e.g. 999 in the UK.)

Prevention

The best way to prevent hypoglycemia is to be aware at all times of your blood glucose level. This is done using your blood glucose meter.

Routine and experience help a lot too. If you wake up about the same time, eat meals at about the same time, and exercise the same amounts each day, you will have a much better idea how much insulin to take.

Of course, this is not always possible when travel, family gatherings and parties with friends upset your schedule. This is where knowledge and exprience come into their own.

It helps enormously to have supportive friends and family.

Children are helped by having supportive teachers. Adults have a better time living with diabetes if their bosses and co-workers are understanding.

By David Hay Jones. Written using American Diabetes Association Complete Guide to Diabetes and An AARP Guide: Living with Diabetes: Everything You Need to Know to Safeguard Your Health and Take Control of Your Life , and interviews with my daughter Maja, a type 1 diabetic.

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