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Hypoglycemia happens when blood glucose drops below 70mg/dl. Most people recognize low blood glucose symptoms, and get relief of these symptoms after eating a fast-acting carbohydrate. Individuals taking insulin or some type 2 diabetes medications are at risk of hypoglycemia.
Severe hypoglycemia occurs when blood glucose falls to a level that requires someone else to help with treatment because of altered mental status.
Usually when hypoglycemia occurs, there are a variety of recognizable symptoms such as shakiness, sweating, anxiety, heart palpitations, irritability, and dizziness. With hypoglycemia unawareness, blood glucose drops without these typical warning symptoms. This condition is caused by a failure of glucose counter regulation.
Frequent episodes of hypoglycemia can cause increasingly lower levels of glucose to produce symptoms. In some cases, these warning symptoms are not present at all.
Hypoglycemia unawareness is more common with type 1 diabetes because of the dependence on insulin. The longer the duration of diabetes, the greater the risk of hypoglycemia unawareness.
The absence of hypoglycemia symptoms presents a danger for the person with diabetes. This can be especially concerning if it happens during sleep, or when one is driving. It is also a difficult management issue for the health care provider.
Treatment for hypoglycemia unawareness is avoiding low blood glucose. Start with identifying the blood glucose level that triggers hypoglycemic symptoms. Work with your health-care provider to modify glucose and A1C targets to prevent hypoglycemia. The longer hypoglycemia is avoided the better. It can help restore the blood glucose response.
Technology can play an important safety role. Wearing a continuous glucose monitor that alarms as glucose levels drop too low will alert you to the developing hypoglycemia. Some devices can send alerts to loved ones as an additional safety measure. This safety measure provides another level of comfort for parents of children with type 1 diabetes. Some insulin pumps will suspend insulin delivery when glucose drops too low.
Diabetes and Food
Keeping a daily record of physical activity, food intake, and insulin administration can help pinpoint causes of hypoglycemia. A careful review of carbohydrate intake may identify areas of your meal plan that need to be updated. Diabetes is a progressive disease requiring periodic review of your meal plan and medication. Share your record keeping with your health-care provider and registered dietitian to fine-tune carbohydrate counting and/or carb-to-insulin ratios.
Tips for preventing hypoglycemia:
- Work with your health-care team to set or update target blood glucose ranges.
- Understand when your insulin or other medication peaks.
- Check blood glucose as instructed by your health-care provider.
- Never go to sleep without a snack if your blood glucose is below your individual target level.
- Check blood glucose before exercising or driving and treat as appropriate.
- Eat regularly scheduled meals and snacks.
- Keep fast-acting carbohydrate handy.
Remember the 15/15 rule to treat hypoglycemia. If blood glucose is below 70 mg/dl eat or drink 15 grams of fast-acting carbohydrate. Wait 15 minutes and recheck blood glucose. It takes about 15 minutes to feel better despite the amount of carbohydrate consumed. If still low, treat with an additional 15 grams of fast-acting carbohydrate. If no meal or snack is planned follow-up with a glucose check one hour after treatment.
Seek medical advice if unable to effectively treat and maintain a safe blood glucose level.
Sources of fast-acting carbohydrates:
- 4 ounces of juice
- 4 ounces of regular soda
- 5-6 Lifesavers
- 3-4 Glucose tablets
- 15 gram tube of glucose gel or liquid
Hypoglycemia unawareness can be a challenging and dangerous condition. Careful monitoring and prevention of low blood glucose can help restore your ability to recognize and treat the symptoms.