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Subject: {Recipes_for_Health} Diabetes - Understanding Hypoglycemia
Understanding Hypoglycemia
Source: everydayhealth.com, from Harvard Health Publications Special
Health Report, Diabetes: A Plan for Living.
Anyone who takes insulin or other glucose-lowering medications,
either alone or in combination with other antidiabetic drugs, is
prone to hypoglycemia. Hypoglycemia, or low blood sugar, is less
common among people with type 2 diabetes than among those with type
1, but it can be serious when it occurs. Blood sugar may fall
abnormally low from too much insulin, too much exercise, too little
food or carbohydrates, a missed or delayed meal, or a combination of
these factors. As you pursue near-normal blood sugar control more
aggressively, your risk for hypoglycemia increases.
It's important that people with diabetes, and those who live and work
with them, learn to recognize and understand hypoglycemia so it can
be prevented and treated before it becomes a life-threatening crisis
(see Severe Hypoglycemia).
Symptoms of Hypoglycemia
nervousness
weakness
hunger
lightheadedness or dizziness
trembling
sweating
rapid heartbeat
feeling cold and clammy
irritability
confusion
drowsiness
slurred speech
double vision
in severe cases, loss of consciousness, seizures, and even coma
Spotting the Signs of Hypoglycemia
Many experts associate hypoglycemic reactions with blood sugar levels
below 60 mg/dL, but it's difficult to pinpoint the level at which
hypoglycemia symptoms occur because each person responds differently.
For instance, your blood sugar might fall below 40 mg/dL without
causing any symptoms, while someone else might feel symptoms coming
on when his or her blood glucose falls below 70 mg/dL.
Over time, the symptoms often become subtler, especially among people
with type 1 diabetes. Eventually, for example, you may not experience
the palpitations, sweating, and anxiety that once characterized the
condition. Instead, your first symptom may be fuzzy thinking. Some
people develop a condition, termed hypoglycemia unawareness, in which
they experience no warning symptoms even when their blood sugar
levels are very low.
Low blood sugar usually sets off alarms in many organ systems. The
brain, which relies on glucose to function, is especially sensitive
to sugar deprivation. The first signs of hypoglycemia resemble those
of an anxiety attack because a decline in blood sugar affects the
autonomic nervous system. Epinephrine (also known as adrenaline) is
secreted, causing sweating, nervousness, trembling, palpitations,
lightheadedness, and often hunger. The release of adrenaline is a
corrective response to hypoglycemia because it stimulates your liver
to make more sugar.
More profound levels of hypoglycemia affect brain function and result
in fatigue, weakness, blurred vision, dizziness, slurred speech, and
confusion and other behavior that resembles inebriation, such as
belligerence or silliness. A further drop in blood sugar levels or
failure to promptly treat the condition may result in loss of
consciousness, seizures, and even death (see Severe Hypoglycemia).
Rarely, an episode of hypoglycemia while driving may cause a serious
car accident.
Not everyone experiences all these symptoms, and it can be hard to
tell the difference between hypoglycemia and anxiety over a problem
at work or an argument with your spouse. In addition, beta blockers
(used to treat high blood pressure and heart disease) and alcohol can
exacerbate hypoglycemia by masking early symptoms. Therefore, they
must be used cautiously.
If hypoglycemia occurs during sleep, the only clues may be damp
pajamas (from sweating), vivid nightmares, or a nagging headache on
awakening. It's important to be attuned to these early signs and to
know what blood sugar levels set off hypoglycemia.
Preventing Hypoglycemia
Preventing hypoglycemia is preferable to treating it. On the other
hand, current intensive therapy for type 1 diabetes isn't an exact
science. Your blood glucose levels may be pushed close to the
hypoglycemic range, especially during pregnancy, when very tight
control is desirable. The art of diabetes care is to balance the long-
term need for near-normal control against the short-term risks and
discomfort of hypoglycemia.
Preventing hypoglycemia is preferable to treating it. On the other
hand, current intensive therapy for type 1 diabetes isn't an exact
science. Your blood glucose levels may be pushed close to the
hypoglycemic range, especially during pregnancy, when very tight
control is desirable. The art of diabetes care is to balance the long-
term need for near-normal control against the short-term risks and
discomfort of hypoglycemia.
Whenever you change your meal schedules, activity levels, and
medications, step up your monitoring of blood sugar levels, and be
ready to adjust your insulin or other blood sugar-lowering
medications. Remember to discuss these changes with your health care
team. If you're a person with type 1 diabetes following intensive
treatment, check your 3 a.m. glucose level periodically to detect
hypoglycemia during sleep, and make adjustments to prevent its
reoccurrence. Experts also strongly recommend that people with type 1
diabetes check their blood sugar before driving a car or engaging in
other potentially dangerous activities.
If you're taking insulin, it's likely that despite your best efforts,
you'll experience hypoglycemia at some time, although the risk is
higher for people with type 1 diabetes than for those with type 2
diabetes being treated with insulin and sulfonylureas. For the
latter, low blood sugar usually occurs only with a change in eating
patterns, such as missing a meal. But if you binge-drink alcohol,
have irregular eating patterns, or have liver or kidney disease, you
are at particular risk.
For people with type 1 diabetes, mild hypoglycemic episodes
(involving hunger, slight shakiness, and an exaggerated realization
that mealtime is at hand) may occur as often as once a day. More
severe reactions, which require another person's help, occur on
average once every 18 months in people treated with intensive
therapy, compared with once every five years in those treated less
intensively. The most severe cases, including seizure or coma, occur
on average no more than every 5–6 years with intensive therapy and
once every 20 years with conventional therapy.
Keep in mind that these are average estimates from the Diabetes
Control and Complications Trial. Not everyone experiences such severe
hypoglycemia. However, if you start having major episodes, they're
likely to recur if you don't seek guidance from your doctor and
follow through on his or her advice.
Treating Low Blood Sugar
While it's a good idea to test your blood glucose level if you
suspect you're having a hypoglycemic reaction, often there just isn't
time. Once you start to feel strange, don't put off treatment. You
need to eat or drink some sugar that will reach your bloodstream
quickly. If you can't check your blood sugar at the time symptoms
begin, don't wait to treat. Treat first and check later.
About 10–15 grams of carbohydrate should suffice. That can be 4–6
ounces of fruit juice, half a can of regular soda, 2 tablespoons of
raisins, or some candy (usually five to seven LifeSavers or six
jellybeans will be enough). A glass of milk also works well, as do
fast-acting glucose tablets, which are sold at pharmacies. You can
expect relief 10–15 minutes after eating the sugar. But test your
blood glucose level at that time, and if it's still low, you may need
another snack.
Doctors strongly suggest that people taking insulin carry some hard
candy, sugar lumps, or even a tube of cake icing so they're ready to
treat themselves at the first signs of hypoglycemia. However,
hypoglycemic reaction shouldn't be seen as a justification for
pigging out on sweets. It's crucial to get enough glucose to correct
the problem, but it's not wise to overload, which will only cause
your blood sugar levels to surge later.
From the Harvard Health Publications Special Health Report, Diabetes:
A Plan for Living. Copyright 2004 by the President and Fellows of
Harvard College. Illustrations by Susan Avishai and Marcia Williams.
All rights reserved. Written permission is required to reproduce, in
any manner, in whole or in part, the material contained herein. To
make a reprint request, contact Harvard Health Publications. Used
with permission of StayWell.
Harvard authorizes you to view or download a single copy of the
Harvard Content on Everyday Health solely for your personal,
noncommercial use if you include (i) the following copyright
notice: "Copyright, President and Fellows of Harvard College. All
rights reserved."; (ii) the following notice regarding permission for
use: "Used with permission of StayWell."; and (iii) all other
copyright and proprietary rights notices which were contained in the
Harvard Content.
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