Hypoglycaemia
What is a hypoglycaemia episode (‘a hypo’)?
Hypoglycaemia or a ‘hypo’ means a low blood sugar of 4.0mmol/l or below. When your blood sugars are at this level or below, you will start to feel ‘hypo’ and you need to take action. Episodes of hypoglycaemia are usually classed as mild, moderate or severe episodes. It is important to avoid hypos as best you can. It is not recommended that you have too many sugars below 4.0mmol/l. Remember ‘Four is the Floor’!
What causes a hypo to occur?
Hypos occur for lots of reasons:
- Too much insulin
- Too little carbohydrate, missed or late meals /snacks
- Alcohol
- More exercise than usual – see Physical Activity
- Hot weather - Travelling
- A change of injection sites – from an area of ‘lumpy skin’ to ‘normal skin’
- Stress
What are the symptoms of a hypo?
Most people who have experienced a hypo can feel the signs and warnings that a hypo is going to happen. You will soon recognise your own signs of when a hypo is going to occur. However occasionally you may have a hypo without any signs. This is why it is important that family members / work colleagues / friends all know how to recognize and help you treat a hypoglycaemic episode if it should occur.
Symptoms of a mild hypo include:
- Blurred vision
- Dizziness
- Hunger
- Sweating
- Headache
- Palpitations
If you experience any of the above symptoms, it is important to check your blood sugar immediately.
Symptoms of a moderate hypo include:
- Mood change – rudeness / hysterical laughter
- Irritability and aggression
- Confusion
- You may appear to be ‘drunk’
Make family and friends aware of these symptoms, as they may need to help you treat this sort of hypo. You may refuse to take their help and treatment but highlight the importance to them, of not taking any notice of your refusals, as you may not recognise your own symptoms. Always carry / wear some form of identification letting people know you have diabetes.
If a moderate hypo is not treated effectively and quickly you can develop a severe hypo. In this situation you become increasingly drowsy and you can go unconscious. Again explain to friends / family / work colleagues what to do if they find you in this state.
How do I avoid hypos?
Avoiding hypos is better that having to deal with them. Here are a few tips to avoid hypos:
- Being familiar with the warning symptoms of hypoglycaemia is the most important defence against hypos. If you are unsure always test your sugar levels bearing in mind that conventional finger prick glucometers are not very accurate at low level of blood glucose.
- Always carry some form of fast-acting sugar with you - glucose tablets or a sweet drink will do. With mild symptoms it is not necessary to take a large amount of sugar. Eating a meal or having a snack will do.
- Ensure regular meals. Avoid missing meals at all costs. Take snacks between meals if you find your levels tend to drop before your next meal.
- Avoid binge drinking. If you plan to drink alcohol, make sure you eat a meal beforehand. When you return home at night, take a snack before going to bed.
- If you are going to exercise, measure your levels before and after. Very strenuous exercise may require you lowering the preceding dose of insulin.
How to I treat a hypo?
It is important to treat a hypoglycaemic episode quickly. Treatment of a hypo involves taking some quick acting carbohydrate and following this up with a snack of a slower acting carbohydrate. When feeling the symptoms of a hypo, check your blood sugars and if below 4mmol/l, treat with one of the following:
- One glass of a fizzy drink (not diet)
- ½ a glass of lucozade
- 4-6 dextrose tablets
This will raise your blood sugar level quickly. Then take some slow acting carbohydrate to maintain your sugar level - any of the following:
- A sandwich
- A couple of biscuits
- Banana and toast
- A glass of milk
- Or eat your next meal if it is due
This will prevent your sugar level falling again.
With a more severe hypo you may need a relative or friend to help you. This is because your blood sugar level goes so low that you may not behave rationally or even recognise that you are having a hypo. Treatment includes:
- ½ glass of lucozade
- 1 glass of a fizzy drink (not diet)
- If you refuse to take a drink, Glucogel® can be used as it does not need to be swallowed. It is squeezed directly into the mouth and around the gums and will raise your blood sugars quickly. Glucogel® should never be used on somebody who is unconscious. Glucogel® can be used for people who are semi-conscious.
- When you start feeling better remember to follow up with a slow acting carbohydrate.
- Occasionally, you may not have any warning signs and become unconscious or become semi-conscious. Again, it is important friends/ relatives know exactly what to do, if they find you semi-conscious or unconscious.
- If this does not work an injection of glucagon may be needed. If your relative or friend knows how to give a glucagon injection this should be used.
- Sometimes if things are bad and your hypo is very severe your family or friends will need to dial 999 and call an ambulance.
Glucagon is a hormone that occurs naturally in our bodies and has the opposite effect to insulin. In other words, it raises blood sugar by releasing stored glucose from your liver. Injecting glucagon helps raise your blood sugar level when you are hypo. It should be used as a last resort. It takes about 10-15 minutes to work and may cause some vomiting. It does not last long and should always be followed up with a carbohydrate snack.
A Glucagen kit should be kept in your fridge for use in an emergency. If kept in a fridge it can be stored for up to 3 years. Remember to check the expiry date - if the expiry date is past disregard immediately and replace with a new kit.
Here are the instructions to use Glucagen:
- Remove the cap of the Glucagen bottle and push the needle of the syringe through the plastic seal.
- Inject all the fluid from the syringe into the Glucagen bottle and leaving the syringe in the bottle, gently shake until all the powder has dissolved and the fluid is clear.
- Using the plunger in the syringe draw up all of the fluid from the Glucagen bottle into the syringe.
- Give the injection into muscle. The best sites for injection are the large muscles over the buttocks or thigh. Make sure there is no air in the syringe before giving the injection.
- When the person is able to drink give them a sugary drink and follow up with a carbohydrate snack.