What to do when the sugars go down
Hypoglycemia -needs action on the fast track
Just last week, Mrs. Jyoti who is on insulin therapy for long-standing type -2 diabetes brought we her monitoring chart
Do you have sleepless nights ? or early morning headaches ? or dreams and nightmares? I asked her. She immediately responded that for the last month she had severe headaches in the mornings and she felt better after taking breakfast. Mrs. Jyoti had nocturnal hypoglycemia or low blood sugars at night.
Every cell of the body requires glucose as fuel. Normally our food intake supplies this on daily basis. Glucose is also produced in the liver especially at night when there is no calorie consumption. The brain utilizes 50% of the glucose in the circulation daily. when sugar goes down there are intensive hunger or hunger pangs which signal that food should be consumed and normal glucose homeostasis is maintained.
In a diabetic patient, not only there is insulin deficiency but the liver makes excess glucose which increases the fasting glucose. After meals, the rise of glucose is exaggerated causing postprandial hyperglycemia. These surges are controlled by tablets and insulin therapy. With tight control, sugars can go below normal. If < 70 mg/dl then we call that HYPOGLYCEMIA.
In otherwise well-controlled patient hyperglycemia is precipitated by
- Taking insulin or tablets and not having meals
- Vomiting diarrhea with inadequate food intake
- Use of long-acting oral medication
- Taking too much insulin at bedtime can cause nocturnal hypoglycemia.
- Failure to monitor and inadequate correction before meals.
- Extra physical activity – unaccustomed.
How do we recognize Hypoglycemia?
There will be symptoms which are common
|Caused by low blood glucose||Caused by glucose deprivation to the brain|
|Anxiety||Difficulty in thinking|
|Nervousness||Difficulty in speaking|
|Dry mouth||Imbalance /gait|
If hypoglycemia is recurrent then there may be no symptoms at all namely “ Hypoglycemia unawareness” which can push the patient directly into the unconscious state.
Can we manage this at home ? or do we have to rush to a Hospital?
It is important to recognize early signs so management can be done at home. Here causes the need for frequent glucose monitoring at home with a glucose monitor. When the sugars show below 100mg/dl one should be alerted.
However, the Rule of 15 is a helpful treatment
Take 15 grams of carbohydrate or 3 teaspoon sugar with water, 1/2 glass fruit juice or lime juice or carbonated beverage or soda. In way instead, take glucose or glucose tablets if handy. Repeat the test after 15 mins. This should raise blood glucose by 50mg in 15 mins. The glucogenic response of oral glucose is short, ingestion of a carbohydrate snack like a sandwich or 1 fruit is advisable, especially if the next meal is larger than one hour away.
Get the doses of therapy altered by your doctor to prevent recurrent hypoglycemia. Keep monitoring and see that blood glucose values are at target.
Patients on insulin therapy should learn to increase or decrease doses or correct as per the pre-meal values of blood glucose.
Dr. Benny Negalur
MD FICP FACP FACE (USA) PGDDM (UK)
Fellowship In Diabetes (India)
Senior Consultant, Diabetes & Thyroid Specialities Center