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Hypoglycemia
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Hypoglycemia is defined as low blood sugar.
Hypoglycemia manifests as hunger, sweating, tremulousness and, if severe,
with confusion, disorientation and, on occasion, loss of consciousness.
What,
exactly, "low" blood sugar is, varies to an extent from person to person and indeed,
from dictionary to dictionary, but is generally said to be a blood sugar
below 3.6 to 3.8 mmol/l. I don't want to be too specific about the
precise number because different people experience symptoms at somewhat
different values and some perfectly healthy people can have technically
low readings but be perfectly fine. (I find it fascinating that some
marathon runners have been found, mid-race to have blood sugars in the
two's with NO symptoms; amazing, eh?). In any event, most people with diabetes who are
on therapy with pills ("oral hypoglycemic agents") or insulin are at risk
for hypoglycemia.
By the way, not all "diabetes pills" lead to
low blood sugar. Sulfonylurea drugs (such as
glyburide) or
meglitinides (such as
Gluconorm) can, whereas
acarbose,
metformin,
glitazones (such as
Avandia or
Actos), GLP-1 analogues and
DPP-4 inhibitors do not.
Here's another "by the way:" contrary to what many
people think, hypoglycemia in someone who does NOT have
diabetes, does NOT lead to or cause diabetes! Note that I
both bolded and capitalized the word "not" so I must really, really, mean
this.
Most episodes of hypoglycemia are mild and easily treated. The
Canadian Diabetes Association
guidelines recommend:
 | For "mild to moderate" hypoglycemia, ingest 15 grams of carbohydrate
(preferably as glucose or sucrose tablets rather than orange juice or
glucose gel). If, after 15 minutes your blood glucose is still
less than 4.0 (mmol/l), take another 15 grams. |
 | For "more severe" hypoglycemia take 20 grams of carbohydrate, and
if, 15 minutes later, your glucose level is still less than 4, take a
further 15 grams. |
 | Once the hypoglycemia has been reversed,
individuals should eat their usual meal or snack to prevent repeated
hypoglycemia. |
If an episode of hypoglycemia is so bad that it has made you pass out,
you should be given an injection of a substance called
glucagon. What this means,
however, is that whomever is helping you out would, of course, need to
know how to do this. What I recommend is that if you have diabetes
and if you have a history of severe hypoglycemia (to the point of making
you unable to look after yourself during an episode) you should be given a
prescription for glucagon (a "glucagon kit;" pictured left) AND you should take your spouse (or capable
child or parent or whomever it is that is likely to have to look after you
should you lose consciousness) to the pharmacist and have the pharmacist
explain to them how to give you the glucagon. Even if you have been
given glucagon, I would still recommend an ambulance be summoned in case
you need further assistance.
If you are having repeated episodes of hypoglycemia, this can lead to a
loss of warning of the symptoms of hypoglycemia. This is called
"hypoglycemia unawareness." I discuss this further
here. |
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