DO NOT provide food or fluids. DO NOT put hands in your mouth. DO inject glucagon. DO call for emergency help.
Continue Learning about Hypoglycemia Complications What are the complications of hypoglycemia? Jeanne Morrison, PhD. Untreated, hypoglycemia may become severe. Severe hypoglycemia occurs when blood sugar is dangerousl If you think you have hypoglycemia unawareness, speak with your health care provider. This helps your body re-learn how to react to low blood sugar levels. This may mean increasing your target blood sugar level a new target that needs to be worked out with your diabetes care team.
It may even result in a higher A1C level, but regaining the ability to feel symptoms of lows is worth the temporary rise in blood sugar levels. This can happen when your blood sugar levels are very high and start to go down quickly. If this is happening, discuss treatment with your diabetes care team.
Your best bet is to practice good diabetes management and learn to detect hypoglycemia so you can treat it early—before it gets worse. Monitoring blood sugar, with either a meter or a CGM, is the tried and true method for preventing hypoglycemia. Studies consistently show that the more a person checks blood sugar, the lower his or her risk of hypoglycemia. This is because you can see when blood sugar levels are dropping and can treat it before it gets too low.
If you can, check often! Together, you can review all your data to figure out the cause of the lows. The more information you can give your health care provider, the better they can work with you to understand what's causing the lows.
Your provider may be able to help prevent low blood sugar by adjusting the timing of insulin dosing, exercise and meals or snacks. Changing insulin doses or the types of food you eat may also do the trick. If you're new to type 2 diabetes, join our free Living With Type 2 Diabetes program to get help and support during your first year. Log in menu Manage Account Search. Donate now. Hypoglycemia Low Blood Glucose. Blood Sugar Testing and Control.
Hypoglycemia Low Blood sugar. Signs and symptoms of low blood sugar happen quickly Each person's reaction to low blood sugar is different. Treatment—The " Rule" The rule—have 15 grams of carbohydrate to raise your blood sugar and check it after 15 minutes. Note: Young children usually need less than 15 grams of carbs to fix a low blood sugar level: Infants may need 6 grams, toddlers may need 8 grams, and small children may need 10 grams. This needs to be individualized for the patient, so discuss the amount needed with your diabetes team.
When treating a low, the choice of carbohydrate source is important. Complex carbohydrates, or foods that contain fats along with carbs like chocolate can slow the absorption of glucose and should not be used to treat an emergency low.
If you have diabetes, you might not make enough insulin type 1 diabetes or you might be less responsive to it type 2 diabetes. As a result, glucose tends to build up in the bloodstream and can reach dangerously high levels. To correct this problem, you might take insulin or other drugs to lower blood sugar levels. But too much insulin or other diabetes medications may cause your blood sugar level to drop too low, causing hypoglycemia. Hypoglycemia can also occur if you eat less than usual after taking diabetes medication, or if you exercise more than you normally do.
Some critical illnesses. Severe liver illnesses such as severe hepatitis or cirrhosis can cause hypoglycemia. Kidney disorders, which can keep your body from properly excreting medications, can affect glucose levels due to a buildup of those medications. Long-term starvation, as can occur in the eating disorder anorexia nervosa, can result in too little of substances your body needs to create glucose. Hypoglycemia usually occurs when you haven't eaten, but not always.
Sometimes hypoglycemia symptoms occur after certain meals high in sugar because your body produces more insulin than you need. This type of hypoglycemia, called reactive hypoglycemia or postprandial hypoglycemia, can occur in people who have had stomach bypass surgery. It can also occur in people who haven't had this surgery. Over time, repeated episodes of hypoglycemia can lead to hypoglycemia unawareness.
The body and brain no longer produce signs and symptoms that warn of a low blood sugar, such as shakiness or irregular heartbeats. When this happens, the risk of severe, life-threatening hypoglycemia increases.
If you have diabetes, recurring episodes of hypoglycemia and hypoglycemia unawareness, your doctor might modify your treatment, raise your blood sugar level goals and recommend blood glucose awareness training. If you have diabetes, episodes of low blood sugar are uncomfortable and can be frightening. Fear of hypoglycemia can cause you to take less insulin to ensure that your blood sugar level doesn't go too low.
Glucagon kits are now available which comprise a vial of glucagon powder, a syringe prefilled with solvent and supportive text and graphic instructions for reconstitution and use in an emergency situation.
They should also be advised on the importance of avoiding any delay in treating the patient experiencing hypoglycemia and measures to be taken to restore normal blood glucose levels should be considered. A conscious patient with hypoglycemia should be treated with oral administration of grams of carbohydrate 4 teaspoons of sugar or glucose. This should be followed by a SMBG 15 minutes later and the treatment should be repeated if hypoglycemia is persisting.
The patient should be advised to eat a regular meal or have a snack to prevent recurrence of hypoglycemia. If a patient is unconscious and unable to accept food orally, immediate administration of intravenous glucose is necessary; alternatively glucagon may be administered intramuscularly at home by a family member.
Treatment should be modified in the event of hypoglycemia occurring repeatedly at a particular time of the day or in the event of hypoglycemia unawareness. Hypoglycemia, an often neglected complication of diabetes therapy, has far-reaching clinical, economical, and social impacts. Mild hypoglycemia reduces QoL, while severe hypoglycemia is life-threatening and can precipitate major cardiovascular and cerebrovascular events.
Careful attention should be paid while deciding upon a treatment regimen for the management of diabetes such that adequate glycemic control measures can be implemented against the life-threatening complication of hypoglycemia.
To improve diabetes-related outcomes, including reducing the risk and consequences of hypoglycemia, effective patient education is essential. Physician-patient collaboration is vital to develop and modify a treatment plan that is acceptable to the patient.
The use of newer antidiabetic medications with little or no risk of hypoglycemia will reduce the future risk of hypoglycemia. Empowering patients with the tools to monitor hypoglycemia, making them aware of the risks of hypoglycemia and the available preventive strategies, together with an individualized plan of treatment, can decrease the frequency and severity of hypoglycemia. The authors thank Jeevan Scientific Technology Limited, Hyderabad, for providing writing assistance in the development of this manuscript.
Conflict of Interest: None declared. National Center for Biotechnology Information , U. Indian J Endocrinol Metab. Ganapathi Bantwal 3 Department of Endocrinology, St. Ambady Ramachandran 7 Dr. Author information Copyright and License information Disclaimer.
John's Medical College, Bangalore, India. Corresponding Author: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.
Abstract Hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes mellitus. Keywords: Diabetes mellitus, glucagon, hypoglycemia, hypoglycemia unawareness, insulin, management, physiologic impact, quality of life.
Open in a separate window. Figure 1. Table 1 Causes of hypoglycemia[ 25 ]. Table 2 Signs and symptoms of hypoglycemia.
Table 3 Risk factors for hypoglycemia in the elderly patients[ 42 ]. Table 4 Risk factors for hypoglycemia. Hypoglycemia and the brain Glucose is the metabolic fuel for the brain. Hypoglycemia and the heart Patients with T2DM are associated with increased risk of cardiovascular disease. Figure 2. Sleep and hypoglycemia Hypoglycemia occurring during sleep is a major area of concern, where episodes may be asymptomatic as a result of impaired counter regulatory-hormonal response,[ 92 ] coupled with lower intensity of hypoglycemic symptom scores.
Employment and hypoglycemia Hypoglycemia at work place can be awkward, embarrassing and frightening. Exercise, recreational activities and hypoglycemia A number of factors have been identified that influence the risk of exercise-related hypoglycemia. Travel and hypoglycemia Rapid travel across time zones can disrupt normal glycemic control and increase the risk of hypoglycemia because of irregular meal times and unpalatable meals, which may contain insufficient amount of carbohydrate.
Patient and physician perceptions towards hypoglycemia Patient perception of hypoglycemia can differ from clinical definitions. Hypoglycemia unawareness Repeated hypoglycemia blunts symptomatic and hormonal responses to subsequent episodes leading to hypoglycemia unawareness, which is an acquired syndrome associated with insulin treatment. Agents with a higher risk of causing hypoglycemia Insulin Despite high risk of hypoglycemia, several international guidelines on diabetes emphasize intensive insulin treatment designed to reduce the risk of long-term diabetic complications.
Sulphonylureas Sulphonylureas, commonly used as second-line therapy in patients with T2DM, promote insulin release independent of prevailing glucose value and as a result, hypoglycemia is an expected side effect. Meglitinides They trigger insulin secretion with a faster onset and shorter duration of action anticipating a lower risk of hypoglycemia.
Prevention of hypoglycemia To prevent or reduce the risk of hypoglycemia, it is important that the patient understands and agrees to adhere to all aspects of the treatment plan in terms of both medication and lifestyle modification. Patient education Achieving adequate glycemic control without causing troublesome hypoglycemia is the key to providing optimum care to individuals with diabetes. Blood glucose monitoring Regular measurement of blood glucose is one of the most effective ways of demonstrating blood glucose trends and identifying asymptomatic hypoglycemia.
Insulin therapy An ideal insulin therapy for patients with diabetes should include long-acting basal insulin, to mimic the hour endogenous insulin secretion by the pancreas and a bolus or short-acting insulin to mimic normal physiological insulin response to ingestion of a meal.
Basal insulin Currently available basal insulins include NPH or isophane insulin, insulin glargine and insulin detemir. Premixed insulin They contain a combination of a short-acting and intermediate-acting insulin in standard proportions supplementing both basal and bolus insulin within a single injection thus facilitating fewer daily injections. Glucagon Glucagon is a counter-regulatory hormone to insulin, secreted by the pancreas to maintain glucose production in the liver.
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