DIABETES AND HYPOGLYCEMIA
Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. Glucose, an important source of energy for body and Brain comes from food. Carbohydrates are the main dietary source of glucose. Cereals, Milk, Fruits, Sweets, Sugar are all sources of carbohydrate rich foods.
SYMPTOMS OF HYPOGLYCEMIA
* DIZZINESS OR LIGHT HEADEDNESS
* DIFFICULTY SPEAKING
Hypoglycemia can also occur during sleep. Some signs of Hypoglycemia during sleep include
* Crying out or having nightmares
* Finding clothes or sheets damp from perspiration
* Feeling tired, irritable, or confused after waking up.
CAUSES OF HYPOGLYCEMIA IN PEOPLE WITH DIABETES
Hypoglycemia can occur as a side effect of some diabetes medications, including insulin and oral diabetes medications- pills that increase insulin.
In people on insulin or pills that increase insulin production , low blood glucose can be due to
* Meals or snacks that are too small, delayed or skipped
* Increased physical activity
* Alcoholic Beverages
At what level of blood glucose is a person considered hypoglycemic?
For people with diabetes, a blood glucose level below 70 mg/dL is considered hypoglycemia.
|Normal and Target Blood Glucose Ranges|
|Normal Blood Glucose Levels in People Who Do Not Have Diabetes|
|Upon waking—fasting||70 to 99 mg/dL|
|After meals||70 to 140 mg/dL|
|Target Blood Glucose Levels in People Who Have Diabetes|
|Before meals||70 to 130 mg/dL|
|1 to 2 hours after the start of a meal||below 180 mg/dL|
Diabetes treatment plans are designed to match the dose and timing of medication to a person’s usual schedule of meals and activities. Mismatches could result in hypoglycemia. For example, taking a dose of insulin—or other medication that increases insulin levels—but then skipping a meal could result in hypoglycemia.
To help prevent hypoglycemia, people with diabetes should always consider the following:
• Their diabetes medications. A health care provider can explain which diabetes medications can cause hypoglycemia and explain how and when to take medications. For good diabetes management, people with diabetes should take diabetes medications in the recommended doses at the recommended times. In some cases, health care providers may suggest that patients learn how to adjust medications to match changes in their schedule or routine.
• Their meal plan. A registered dietitian can help design a meal plan that fits one’s personal preferences and lifestyle. Following one’s meal plan is important for managing diabetes. People with diabetes should eat regular meals, have enough food at each meal, and try not to skip meals or snacks. Snacks are particularly important for some people before going to sleep or exercising. Some snacks may be more effective than others in preventing hypoglycemia overnight. The dietitian can make recommendations for snacks.
• Their daily activity. To help prevent hypoglycemia caused by physical activity, health care providers may advise
• Checking blood glucose before sports, exercise, or other physical activity and having a snack if the level is below 100 milligrams per deciliter (mg/dL)
•adjusting medication before physical activity.
•Checking blood glucose at regular intervals during extended periods of physical activity and having snacks as needed.
•Checking blood glucose periodically after physical activity.
Their use of alcoholic beverages. Drinking alcoholic beverages, especially on an empty stomach, can cause hypoglycemia, even a day or two later. Heavy drinking can be particularly dangerous for people taking insulin or medications that increase insulin production. Alcoholic beverages should always be consumed with a snack or meal at the same time. A health care provider can suggest how to safely include alcohol in a meal plan.
• Their diabetes management plan. Intensive diabetes management—keeping blood glucose as close to the normal range as possible to prevent long-term complications—can increase the risk of hypoglycemia. Those whose goal is tight control should talk with a health care provider about ways to prevent hypoglycemia and how best to treat it if it occurs.
When people think their blood glucose is too low, they should check the blood glucose level of a blood sample using a meter. If the level is below 70 mg/dL, one of these quick-fix foods should be consumed right away to raise blood glucose:
Prompt Treatment for Hypoglycemia : “The Rule of 15”
The rule of 15 is a helpful way to remember the treatment regimen for mild-to-moderate hypoglycemia. For example,
► 15 gms of quickly absorbed carbohydrate such as 1 tablespoon of sugar or honey,
1/2 cup, or 4 ounces, of any fruit juice
1/2 cup, or 4 ounces, of a regular (not diet) soft drink
1 cup, or 8 ounces, of milk
5 or 6 pieces of hard candy
► Wait 15 minutes.
► If not better, or blood glucose is not above 60 mg/dl, treat with another 15 gms of quickly absorbed carbohydrate.
► As this quickly absorbed carbohydrate will not last long in the body, it is important that the person is given something to eat within a short time.
► If the next meal is more than 1 hour away, the person should be given some food rich in carbohydrate and protein, such as sandwich with sprouts, a fruit with milk or a small chapatti (Indian bread) with dal (lentils) or a fistful of murmura (puffed rice) and roasted chana (whole Bengal gram). This will ensure that the blood sugar will not drop again before the next meal.
• 3 or 4 glucose tablets
• 2 tbsp of sugar—the amount equal to 15 grams of carbohydrate
• 1/2 cup, or 4 ounces, of any fruit juice
• 1/2 cup, or 4 ounces, of a regular—not diet—soft drink
• 1 cup, or 8 ounces, of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey
Recommended amounts may be less for small children. The child’s doctor can advise about the right amount to give a child.
The next step is to recheck blood glucose in 15 minutes to make sure it is 70 mg/dL or above. If it’s still too low, another serving of a quick-fix food should be eaten. These steps should be repeated until the blood glucose level is 70 mg/dL or above. If the next meal is an hour or more away, a snack should be eaten once the quick-fix foods have raised the blood glucose level to 70 mg/dL or above.