Hypo management
Hypoglycaemia - Managing a Low Blood sugar level (‘hypo’)
Although diabetes is generally associated with high blood sugar levels, occasionally it can cause lower than usual levels (usually) as a result of treatment for the disease at a level more than is presently required. This can happen outside of illness if you have been particularly energetic (eg during / after vigorous exercise) or if you have taken in less carbohydrate than usual with a meal, or if the weather is much hotter than usual, or some hours after drinking alcohol, or occasionally with stress.
During illness hypoglycaemia can result either from a dramatically reduced intake of food over a number of days, or from overly aggressive adjustments to treatment aimed at combating higher than usual sugar levels associated with the illness.
The principles of treating low blood sugar levels are quite simple but are sometimes necessary to modify during illness
a. symptoms
sweaty / shaky / palpitations / feel anxious / feel hungry / feel ‘dazed’ / blurred vision
b. signs
not concentrating well / pale & sweaty / confused
3. Actions to TakeNone of the symptoms described above is completely specific to a low blood sugar level (many may be produced by for instance a virus infection), so if it is suspected it is important to confirm the suspicion (if possible) by doing a blood sugar test while the symptoms are present.
If the sugar level is below 4mmol/L it is sensible to assume that some (or all) of the symptoms are due to low sugar levels.
Symptoms caused by low blood sugar levels disappear quickly once the sugar levels are increased to levels above 4mmol/L, so the key goal of action is to raise the sugar level quickly into a range between 5 and 10mmol/L, and then maintain it there.
Step 1 – Give 10 – 20grams of a rapid-acting carbohydrate (examples):
- 200mls orange juice
Step 2 - repeat after 5 mins if symptoms persist and glucose level remains <4mmol/L
Step 3 – aim to take in 20-30 grams of a longer-acting source of carbohydrate to sustain the glucose level (examples):
A sandwich
2-3 digestive biscuit
A cereal bar
During illness your appetite may be less good than usual and the foodstuffs described for longer-acting source of carbohydrate difficult to eat. If this is the case and sugar levels are still showing a tendency to fall you can use the fast acting carbohydrate in the form of drinks at a rate of about 10grams every 90mins or so.
If you are unable to hold down any of the step 1 rapid-acting carbohydrates you should give consideration to use of glucagon (if you have it) and emergency medical care assistance (A&E or on call medical services)