Preventing Hypoglycemia

Hypoglycemia, or low blood sugar, is a known complication of diabetes, and it is defined as a blood sugar value below the "normal" range, i.e. less than 80 mg/dl.

As you know, hypoglycemia presents with nausea, dizziness, sweating, cool pale skin, and anxiety. If left untreated, low blood sugar can result in coma and injury to key organs including the brain.

Here are some tips to prevent hypoglycemia:

1) Make sure that meal times are
regular, especially if they are
timed around your insulin peaks.
2) Do not skip meals when on glucose
lowering medication - it is
important to eat a regular times to
keep your sugar on an even keel.
3) Plan ahead for exercise and have a
snack before vigorous exercise.
4) Plan for when you are not going to
be able to eat a regular meal, and
keep a meal substitute handy, so
that you can stay on your eating
routine.
5) Avoid quantities of simple sugars.
These cause sudden increases in your
sugars, followed by sudden decreases
(hypoglycemia).
6) Talk to your doctor about any diet,
activity or medication changes, so
that he can guide you and monitor
your status, to avoid fluctuating
sugar levels.
7) Keep a diabetic diary - track blood
sugars, exercise, symptoms and food
intake, so that you can anticipate
when your sugar may become low, and
be prepared to treat it.
8) Be prepared and treat at the first
sign of low blood sugar, to avoid a
more serious drop in your glucose.

When all is said and done, knowing your own body and following your diabetes care plan are the best ways to prevent complications such as hypoglycemia.

Basics of Hypoglycemia

In general, hypoglycemia has been defined as a blood sugar level less than 80, though some medical centers define it as a value that is less than 60. There may or may not be accompanying symptoms.

Generally, hypoglycemia can be caused by too little food intake when compared to insulin, too much insulin when compared to food intake, exercise beyond normal, medication side effect or non-diabetes-related illness.

Symptoms include: sweating, nausea, confusion, dizziness, hunger and weakness.

Treatment is relatively simple: provide a complex carb with a protein to bring the blood sugar level up. Combining a carb and a protein provides for a fairly rapid upswing in blood sugar (from the carb) and a level of stability of blood sugar (from the protein). This decreases the risk for rebound hypoglycemia, which is often seen in those who utilize simple carbs, alone, to treat low blood sugar.

If hypoglycemia occurs 2 days in a row, or at least 3 times within 1 week, see your doctor, to help trouble-shoot your medication, activity and diet regime.

Symptoms of Hypoglycemia

It is important to be able to recognize the symptoms of hypoglycemia, in order to treat it quickly. Glucose feeds all of the organs in the body, including the brain. Low blood sugar, for prolonged periods can result in injury to your organs.

"Mild" hypoglycemia is characterized as hypoglycemia that occurs when the person is still able to self-treat. This is in contrast to a "severe" hypoglycemic reaction, in which the person cannot self-treat and needs outside help.

The symptoms of hypoglycemia include:

1) Feeling shaky or nervous
2) Fatigue
3) Blurred vision, or visual changes,
such as sparks or auras
4) Difficulty concentrating or in doing
tasks which are normally easy for you
5) Sweating
6) Pale, clammy skin
7) Slurred speech
8) Rapid pulse

If you experience these symptoms, or just "don´t feel right," the best course of action is to suspect hypoglycemia, check your blood sugar, and then treat it. This is especially true if you are on medication that can lower blood sugar levels.

Keep track of your blood sugars and notify your doctor if you have low blood sugars two days in a row, or three times during one week. They can help you adjust your diet, exercise or medications to stabilize your sugars.

Symptoms of Hyperglycemia

It is important for the person with diabetes to be able to recognize the signs of hyperglycemia, or high blood sugars.

Consistently high blood sugars can increase the risk for complications including vascular and heart disease, stroke, kidney disease, nerve damage and blindness.

Symptoms can include:

1) Increased thirst (polydipsia)
2) Increased urination (polyuria)
3) Tiredness/drowsiness
4) Headache
5) Blurred vision
6) Dry mouth and/or skin
7) Itching (urticaria)
8) Hunger (polyphagia)

Long-term elevated blood sugars can cause:
1) Infections: yeast, thrush, urinary
tract infection, skin infection
2) Weight loss

It is normal for there to be a blood sugar spike after eating carbohydrates, however, if these symptoms occur frequently or persist, you should contact your health care provider for evaluation and treatment.

Defining Hyperglycemia

Hyperglycemia, for the diabetic person, is defined as a blood sugar level that is higher than the normal accepted range of 80-120 mg/dl. For the person who is not diabetic, a normal fasting (no food 12 hours before the test) glucose level is less than 126 mg/dl.

Do not be swayed by the term "normal," however, since "normal" is truly an individual thing. If your "normal" fasting blood sugar is 150 mg/dl, and you do not have any symptoms of hyperglycemia, it is up to you and your doctor to determine if any action needs to be taken.

For those with long-term diabetes, who may have not had good control in the past, 150 mg/dl may be a perfectly acceptable fasting value.

Talk to your doctor about what is "normal" for you, and work together to reach that goal.

Hyperglycemia - Causes and Treatment

There are many causes of hyperglycemia (high blood sugar), including, but not limited to:

1) infection
2) medication effect, i.e. prednisone
or Sulfa
3) dehydration
4) improper eating
5) incorrect insulin or antidiabetic
agent dosing

The keys to the treatment of hyperglycemia involve:

1) Determining what caused it and
correcting the cause
2) treating the high blood sugar
3) prevention complications

If your glucoses are high, repeatedly, over the course of several days, and you have no idea why, you should see your health care provider as soon as possible for recommendations -- you may need insulin or antidiabetic medication adjustments, alter your diet plan, or change another medication that may be contributing to the elevated blood sugar level.

For a one or two time glucose that is elevated, you may want to:

1) Monitor more frequently -- become
aware of your blood sugar patterns
during the day. Are they higher at a
certain time of day?
2) Drink plenty of water to prevent or
treat dehydration
3) Problem-solve the cause: Did you
overeat? Skip exercise? Are you
under unusual stress? Are you
starting to get sick?

Sometimes reviewing your day can provide clues to the cause of periodic elevated blood sugars, and you can take steps to prevent a recurrence. However, if the elevations are more than periodic, see your physician.

Treatment of Hypoglycemia

When you first feel the symptoms of low blood sugar (hypoglycemia) you should treat it. You know your body better than anyone.

In general, treat a hypoglycemic reaction immediately with 15 grams of a fast-acting carbohydrate source. This source should not contain fat, since that delays absorption.

What is "15 grams of carbohydrate"? Easy to find sources are 1/2 cup orange juice or regular soda, 1 cup skim milk, or 1 TBSP of honey. 15 grams of carbs can also be found in glucose tablets, available at your local pharmacy.

Follow this with a protein, to provide for blood sugar stability, and to decrease the risk of a sudden drop 20 minutes after treatment.

Key tips:

1) Know the symptoms
2) Understand the treatment
3) Have a plan

Remember to notify your physician if you have low blood sugar two days in a row, or three times during one week. They can help you adjust your diet, activity or medications to reduce this potentially harmful effect.

Causes of Hypoglycemia

Being a diabetic, you are risk for both high and low blood sugars - hypoglycemia. Since hypoglycemia can result accident and injury to your body, it is important to understand the causes, to help you prevent them.

Here are some of the most common causes:

1) Forgetting to eat or changing your
eating schedule without adjusting
your medication
2) Irregular meal times - set up
regular times to eat to keep blood
sugars stable
3) Taking too much medication/insulin -
follow your doctor's instructions
for using your medications and
report any change in your activity
or diet, so that the medication can
be adjusted
4) Extra exercise for a long period, or
extra strenuous activity - add a
snack to supplement your blood sugar
when you anticipate extra or more
strenuous exercise
5) Alcohol - this is a simple carb,
which gets broken down easily and
can cause spikes followed by drops
in blood sugar

Know the symptoms and the causes, and be prepared to treat hypoglycemia, to avoid the negative outcomes that can follow.