Healthy Living Newsletter
Hypoglycemia
Quick Response Needed
Eileen was in her 70s and living alone when she developed diabetes. Even though she was generally conscientious about monitoring her blood sugar and giving herself injections, she was sometimes forgetful about eating meals and snacks on schedule.
As a result, she suffered a series of hypoglycemic attacks that sent her to the emergency room...and eventually to a nursing home.
Most of the educational material regarding diabetes focuses on the life threatening and disabling complications caused by high blood sugar. More directly, diabetes can be life threatening as a result of episodes when blood sugar goes too low, sometimes resulting in loss of consciousness.
Hypoglycemia means low blood sugar, and the condition occurs primarily as a result of diabetic treatment. Some diabetics never experience hypoglycemia, but the incidence has increased significantly since the advent of intensive control of blood sugar, now recognized as the best way of avoiding or delaying long-term complications.
In the Diabetes Control and Complications Trial (DCCT), 65 percent of patients getting intensive treatment (compared to 35 percent of those receiving conventional treatment) had at least one episode of severe hypoglycemia over a six and a half-year period.
The Need for Glucose
The body and particularly the brain are highly dependent on energy obtained from glucose or sugar in the blood. This comes not only from sweet foods but from the breakdown of complex carbohydrates such as fruits, vegetables, rice and potatoes. Insulin, a hormone secreted by the pancreas, is the key that allows cells to take in glucose, use it for energy and store what is left in the liver and muscles for future use.
In a person with diabetes, blood sugar becomes elevated because the pancreas is unable to produce enough insulin or because cells are unable to use it effectively.
Because of a lack of insulin, excess glucose lingers in the blood, eventually damaging nerves and small and large blood vessels and leading to the common complications of diabetes. But a certain amount is needed, particularly by the brain, to carry on routine activities, and the goal of diabetes treatment is to provide the right amount of insulin to balance the patient’s diet and physical activity.
Too much insulin coupled with too much physical activity or too little food can cause blood sugar to drop fairly dramatically. For a person with diabetes, hypoglycemia, or low blood sugar, can also occur because the liver doesn’t react as it should to the signals of low blood sugar.
Mild symptoms of hypoglycemia include intense hunger, nervousness, sweating, weakness, trembling and rapid heart beat. A person without diabetes might experience similar symptoms as a result of high circulating insulin levels and prolonged fasting, but this can be managed simply by eating a snack or meal. For a diabetic, the need to raise blood sugar is truly urgent and requires quick consumption of a simple sugar that can be easily absorbed.
The general rule for mild hypoglycemia is to take 10 to 15 grams of glucose; that is the equivalent of 10 hard candies, three teaspoons of sugar or half a can of regular soda or juice. Desserts such as cookies or brownies are not recommended because the simple sugars are combined with complex carbohydrates, fat and protein and, as a result, take longer to be absorbed.
After the immediate symptoms resolve, a longer acting carbohydrate snack–such as half a sandwich is usually recommended to stabilize blood sugar.
If there’s no improvement of symptoms after 15 minutes, the patient should take another 10 to 15 grams and repeat the process no more than three times before calling an ambulance.
Without prompt attention, a diabetic’s blood sugar will continue to drop and symptoms will become more severe: confusion, slurred speech, blurred vision, difficulty concentrating, behavioral changes, seizures and eventually loss of consciousness.
For Eileen, hypoglycemic attacks came on so quickly that she often was at the point of passing out by the time she thought about pressing her emergency call button.
Diabetics who are at risk of frequent hypoglycemic attacks should check their blood sugar. A reading of 70 mg/dL is considered mild hypoglycemia, requiring action even though it might not produce symptoms. A reading of 50 mg/dL or below is severe and requires urgent attention.
Who Is At Risk?
Mild hypoglycemic attacks now occur fairly frequently among type 1 diabetics on intensive therapy and sometimes among type 2 diabetics.
Elderly patients are particularly at risk because they may have other medical conditions or be taking medications that effect blood sugar. They may also be prone to memory lapses or have difficulty measuring their insulin doses because of failing vision.
Smoking and excess alcohol intake (particularly on an empty stomach) also increases the risk of hypoglycemia.
To prevent hypoglycemia, athletes are advised to plan workouts at times when insulin effects are low and blood glucose is on the rise, such as shortly after a meal. It’s important to check blood sugar not only before exercise but 15 minutes after exercise and sometimes even during a workout if it lasts more than 30 minutes. Carbohydrate snacks should be kept readily available.
Awareness must be high at all times since hypoglycemic attacks can occur several hours after exercise–or even the next day. It’s important for patients to learn to recognize the signs of a mild attack and carry with them glucose tablets or food for quick treatment. Signs may vary from person to person but are usually fairly consistent within the same person.
Good education is essential so that fear of hypoglycemia does not lead a patient to over-eat in anticipation of an attack or neglect efforts to keep blood sugar under tight control. To find out more about diabetes self-management, talk to your doctor or call the Mercy Diabetes Center at (810) 985-1840.
The long-term complications that develop because of uncontrolled blood sugar are at least as life threatening as a severe hypoglycemia attack. Both must be avoided.
|
