Hypoglycemia

Hypoglycemia occurs when blood glucose (sugar in your blood) levels drop below normal levels. The term hypoglycemia usually refers to a reading on the glucose meter (device that measures blood glucose) that is less than 4 mmol/L. Glucose is an essential sugar that our body requires and an important source of energy. Having low blood glucose can therefore interfere with the proper functioning of the body and can cause severe symptoms.

Causes

Hypoglycemia can occur at any time in healthy individuals, regardless of age. The condition however, is more common in those with diabetes, a disease characterized by blood glucose levels that are too high. Diabetics take medication to bring down their blood glucose levels, which helps them achieve normal levels. Some situations however, lead to a greater than expected drop, resulting in hypoglycemia.

Hypoglycemic episodes can occur for several reasons:

  • Vigorous physical exercise or being more active than normal
  • Significant physical or mental stress
  • The use of certain medications
  • Not having eaten, having waited too long to eat or not having eaten enough
  • Drinking alcohol without eating
  • In diabetics, taking a higher dose of antidiabetic medication (example: insulin)

Symptoms

Hypoglycemic episodes can develop slowly, but can also appear suddenly and progress quickly. Symptoms vary from person to person and are even non-existent in some, especially those who have had diabetes for a long time or if blood sugar drops slowly. Symptoms increase and become more severe as blood sugar drops.

Low blood sugar
You may experience:
Very low blood sugar
You may also experience:
Mood change
Confusion
Difficulty speaking
Difficulty concentrating
Dizziness
Weakness
Hunger
Increased heart rate
Headache
Nausea
Nervousness

Pallor
Tingling feeling on the tongue and lips
Drowsiness
Sweating
Tremor
Blurred vision
At night:
  • Nightmares
  • Headache upon waking
  • Perturbed or difficult sleep

Confusion and disorientation
Loss of consciousness
Seizures

Prevention

The following recommendations may help prevent hypoglycemia

  • Stick to a regular meal and snack schedule and eat healthy foods.
  • If you are diabetic, take your insulin or other medications as prescribed.
  • Check your blood glucose regularly and adjust your diet or medication accordingly.
  • Know the symptoms of hypoglycemia in order to treat them promptly.
  • Adjust what you eat based on your level of physical activity.

Any person with diabetes or prone to hypoglycemia should carry a source of fast-acting glucose and snacks on their person at all times. Friends and loved ones should be instructed on how to treat hypoglycemia. If you are hypoglycemic, it is important for you to notify your pharmacist or physician since hypoglycemia may be the result of improper management of antidiabetic medication, something that can be resolved with a simple medication adjustment.

What if symptoms develop?

As soon as the first signs of hypoglycemia appear:

  • Check blood glucose with a blood glucose meter as soon as possible.
  • If blood glucose is lower than 4 mmol/L (or if you cannot check), take action:
    • Immediately ingest one dose of fast-acting glucose (see table below).
    • Wait 15 minutes, then check blood glucose a second time, if possible.
    • If blood glucose is still less than 4 mmol/L, take a second dose of fast-acting glucose.
    • If a meal is not scheduled within the next hour, eat a snack that contains both carbohydrates (15 g of glucose) and protein (e.g., 4 crackers with cheese or peanut butter).
    • In an effort to prevent future episodes from occurring, try to identify the cause.
    • Wait until you have fully recovered before engaging in any activity that requires you to be vigilant.
  • If blood glucose is less than 2.8 mmol/L, a higher dose of fast-acting glucose (20 g) is recommended (see table below). You may require help and your doctor should be notified.
  • In severe cases, glucagon, a hormone that increases blood sugar, can be injected. If such is the case, call 911. For more information, speak to your health provider.

Sources of fast-acting glucose (15 g)
(blood sugar below 4 mmol/L)
Higher sources of
fast-acting glucose (20 g)

(blood sugar below 2.8 mmol/L)
Glucose tablets:
  • 3 tablets of Gluco 5g
  • 4 tablets of Dex4

1 bottle (59 mL) of liquid Dex4

¾ cups (175 mL) of fruit juice or regular soft drink (not a diet soft drink)

15 mL (1 tablespoon) of honey or maple syrup or corn syrup

4 packets of white sugar (or 15 mL) diluted in water (never use artificial sweeteners such as Splenda®)

5 LifeSavers candies

Glucose tablets :
  • 4 tablets of Gluco 5g
  • 5 tablets of Dex4

1 cup (250 mL) of fruit juice or regular soft drink (not a diet soft drink)

20 mL (4 teaspoons) of honey or maple syrup or corn syrup

5 packets of white sugar (or 20 mL) diluted in water (never use artificial sweeteners such as Splenda®)

7 LifeSavers candies

Note :
Chocolate, pastries and whole fruits are not the best choices when treating hypoglycemia. These sugars are considered too slow-acting.

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