What is Hypoglycemia

Hypoglycemia is a condition in which your blood sugar (glucose) level is lower than normal. Glucose is your body’s main energy source. Hypoglycemia is often related to diabetes treatment. But other drugs and a variety of conditions — many rare — can cause low blood sugar in people who don’t have diabetes

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Preventing and Treating Hypoglycemia

Hypoglycemia means low blood sugar. It’s extremely common in patients with diabetes, especially those taking insulin. It’s associated with typical signs and symptoms and it’s really a barrier to the appropriate management of diabetes. Studies around the world have shown that hypoglycemia is incredibly common amongst insulin treated patients with diabetes. Roughly 87% of type I diabetics will have at least one episode of hypoglycemia, and about 43% of type II diabetes patients on insulin.

So you can see, as far as type I diabetes is concerned, it essentially affects everybody and at least half of the insulin treated type II diabetics. Hypoglycemia is not just incredibly common, it’s a barrier to appropriate control of blood sugar in our patients with diabetes. We know that after an episode of hypoglycemia, our patients with diabetes will change behaviour because of fear of hypoglycemia, which will lead to elevated blood sugars.

And these include things like stopping exercise, snacking excessively, missing insulin doses or inappropriately reducing insulin. Patients with insulin treated diabetes need to be counseled about the signs and symptoms of hypoglycemia.

We need to ensure that they take the proper amount of insulin, given the circumstances related to their food intake and exercise. It’s appropriate to keep a log of hypoglycemic episodes and review this with the physician so that they can adjust therapy appropriately. And perhaps most importantly, patients need to be on a brand of insulin that minimizes the risk of hypoglycemia. Hypoglycemia is often unrecognized and under reported by patients suffering from hypoglycemia.

So it’s very important that physicians take a detailed history to discover if the patient is having episodes of hypoglycemia.

In fact, many patients aren’t aware of the signs and symptoms of hypoglycemia and will not deliberately report it to the physician unless asked appropriate questions. So we need to dig deeper into the story of hypoglycemia and then you’ll realize how under reported this condition is. Insulin brands that minimize the risk of hypoglycemia should be chosen in patients at risk of hypoglycemia.

And any patients with episodes of hypoglycemia need to discuss this with their healthcare provider and they should be counseled by members of the diabetes care team including pharmacists, dieticians, diabetes nurse educators or endocrinologists. Diabetes Now Hypoglycemia Patient Communication System

Presenter: Dr. Ronald Goldenberg, Endocrinologist, Thornhill, ON

Local Practitioners: Endocrinologist

Quiz: Do You Understand Hypoglycemia?

Test your knowledge by answering the following questions:

Questions
True
False
1

Exercising more than usual isn't a cause of hypoglycemia.

Explanation:
You may develop hypoglycemia from taking too much diabetes medication or insulin, exercising more than usual or skipping a meal. You can determine if you have low blood sugar by using a blood glucose meter.
2

Hunger is an early symptom of hypoglycemia.

Explanation:
Early symptoms of diabetic hypoglycemia include: dizziness, hunger, headache, sweating and anxiety.
3

Blurry vision is a symptom of more severe hypoglycemia.

Explanation:
If left untreated, diabetic hypoglycemia can lead to seizures and loss of consciousness. Watch for more severe symptoms such as muscle weakness, jerky movements, blurry vision, slurred speech and confusion.
4

Short-term hypoglycemia treatment involves eating sodium-rich foods such as potato chips.

Explanation:
Short-term hypoglycemia treatment involves drinking fruit juice or soda, eating hard candy or taking glucose tablets to raise your blood sugar to a normal range.
5

Not skipping meals is a way to prevent diabetic hypoglycemia.

Explanation:
To prevent diabetic hypoglycemia don't skip meals, monitor your blood sugar, take your insulin and diabetes medication as prescribed and record your low glucose reactions to help identify patterns.
(Answer all questions to activate)

How To Avoid Hypoglycemia in Type 1 and 2 Diabetes

So hypoglycemia is when there’s not enough sugar or glucose in the blood And glucose is a source of energy for many of our organs, the muscles, the heart, but particularly the brain. So it causes a series of symptoms when people have hypoglycemia and therefore we try to avoid that.

When people are treated with insulin, particularly patients with type I diabetes, it’s almost everybody that has had at least some episodes of hypoglycemia, certainly well over 80%. When patients are treated, with type II diabetes, are treated with medications that do not cause hypoglycemia, and there are many, then usually they don’t get it. They will get it if there treated with certain pills that do cause that, for example, glyburide or glipizide or with insulin.

And overall, when we take patients with type II diabetes treated that way, it’s about 40% that had at least one episode of hypoglycemia. So when people get hypoglycemia, something that’s very scary and therefore people do a series of things to try to avoid getting them again. Some of these things are good, some are not as good.

So people, for example, will talk to their physicians, that’s good. They will try to change insulin dosages appropriately, that’s fine. Things that are not as good are, for example, skipping insulin injections, eating a lot more, avoiding doing physical activity, that’s not good approaches. So the point is to test more often, people often do that, and talk to the health professional.

A lot of things can be done to reduce the risk of hypoglycemia. First, we can try to use medications that cause less hypoglycemia. We know, for example, that with the insulins, some of the insulin preparations cause less hypoglycemia than others. Within all the medications, some medications cause less hypoglycemia than insulin. So all of this should be considered.

Once we continue with a medication, such as insulin that causes hypoglycemia, the important thing is to monitor frequently so we know what happens to adjust the dosages correctly not only by themselves but also in relation to food intake and physical activity.

So there’s no doubt we can reduce the number of hypoglycemic episodes. The most important is to ask patients if they had hypoglycemia. When we asked them they tell us, but if we don’t, often they won’t.

The other thing is that a large proportion of patients actually do not know what are the symptoms of hypoglycemia. It’s important to teach them, but also when we ask them to ask questions such as did you have nightmares during the night, do you have episodes where you sweat and you’re nervous, rather than just ask if they had low blood sugars.

So it’s important to go after to get the information we need. So if you think you have a problem with hypoglycemia, it’s important to realize that something can be done. And it’s important to go and get the help. The help you can talk about it to your pharmacist, to a nurse educator, to your family physician or to an endocrinologist. But the important thing, go and get some help because something can be done. Diabetes Now Hypoglycemia Patient Communication System

Presenter: Dr. Jean-François Yale, Endocrinologist, Montreal, QC

Local Practitioners: Endocrinologist

Dr. Ronald Goldenberg, MD, FRCPC, FACE, Endocrinologist, discusses Preventing and Treating Hypoglycemia.

Dr. Jean-Francois Yale, MD, CSPQ, FRCPC, Endocrinologist, discusses the symptoms of Hypoglycemia.

Lori Berard, RN, CDE, Diabetes Educator, discusses treatment for hypoglycemia.

Definition of Hypoglycemia

Hypoglycemia or low blood sugar is defined by most associations as a glucose level of less than or equal to 3.9 millimoles per liter or 70 milligrams per deciliter.

So basically what we understand is that for people who are treated with insulin or an insulin secretagogue drugs – drugs that ask your pancreas to make more insulin – these are drugs that can put you at risk of hypoglycemia.

It’s important that you understand what hypoglycemia is, how you feel and what causes it. So symptoms of hypoglycemia in the early stage would be things like trembling, shaky, weakness, but when you move on to having a moderate event you might feel confusion, agitation, inability to concentrate.

The treatment of hypoglycemia is 15 grams of carbohydrate, wait 15 minutes, retest your blood glucose. If it isn’t above 3.9 or 70  you need to retreat your blood sugar and test again in 15 minutes.

What is also very important about hypoglycemia episodes or low blood sugars is that after you’ve had one and you’ve treated it, it’s very imp that you follow it up with either a sizable snack or the next meal if it’s not too far away.

And the last thing that I think is very important to understand about hypoglycemia events is what causes it, and typically that’s pretty easy. It’s either too much medication, not enough food, or unplanned or increased activity.

So thinking about what might have caused that hypoglycemia event that you’ve had will help you to prevent it from happening in the future. So we like to remind people being 5 or 90 to drive is appropriate.

Testing before you operate a motor vehicle, making sure that your blood sugar is in that level, you’re safe to go. Always carry the treatment of hypoglycemia with you in the car. You would also want to make sure that you have your blood glucose meter with you, and again this is if you’re at risk of having hypoglycemia.

The other thing that’s very important to understand is that if you’re a professional driver, what the legislation in your area is around that. For example in certain places if you’re a professional driver your blood sugar needs to be over 6, or 108, to be able to operate a professional vehicle such as a school bus or an ambulance or a fire truck.

Understanding hypoglycemia or low blood sugar is for your benefit. We want to keep you safe and those around you safe. When hypoglycemia progresses from mild to moderate you can experience confusion, and that can put you at risk.

What’s really important is to understand why hypoglycemia occurs, how to treat it and most importantly how to prevent it from happening. Diabetes Now Hypoglycemia Patient Communication System
Presenter: Lori Berard, Nurse, Winnipeg, MB

Local Practitioners: Nurse

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