Understanding Hypoglycemia: Risks, Prevention and Treatment

Hypoglycemia, or low blood sugar, is often considered the limiting factor in reaching glycemic goals. Hypoglycemia and the fear of hypoglycemia can negativity impact quality of life for people with diabetes. Recurrent hypoglycemia increases the risk of having a severe hypoglycemic episode and may also result in hypoglycemia unawareness. This article will easily explain if you are at risk for hypoglycemia and how to properly treat a hypoglycemic episode.

What blood sugar number is considered low?

  • The American Diabetes Association classifies a low blood sugar as less than 70 mg/dL. It should be noted that some people might feel symptoms of a low blood sugar at a higher or lower reading.

There is a risk of hypoglycemia with any of the following medications:

  • Insulin
    • Lantus, Levemir, NPH, Regular, Novolog, Humalog, Apidra
  • Sulfonylureas  (stimulates the pancreas to release more insulin)
    • Diabeta, Micronase, Glucotrol, Glucotrol XL, Amaryl, Glynase
  • Meglitinides (stimulates the pancreas to release more insulin)
    • Prandin, Starlix

Common causes of hypoglycemia:

  • Dose of insulin or oral medication (listed above) is too high

(Discuss with your doctor if you are concerned that your diabetes medication needs adjustment)

  • Delayed or missed meal
  • Exercise (exercise burns sugar stored in muscle and makes you more sensitive to insulin)
  • Giving an insulin injection into a muscle
  • Taking a hot bath or shower soon after taking an insulin shot
  • Alcohol (avoid drinking alcohol on an empty stomach)

Common signs and symptoms of hypoglycemia:

  • Shaking
  • Sweating
  • Hunger
  • Headache
  • Confusion
  • Behavioral changes
  • Double vision
  • Face may become red or pale

** If symptoms are ignored or not recognized, a severe hypoglycemia episode may occur which can lead to a seizure and/or unconsciousness.

Proper treatment for hypoglycemia:

  • Step 1: use the Rule of 15
  • Step 2: check blood sugar with a blood glucose meter
  • Step 3: If blood sugar is less than70 mg/dL consume 15 grams of quick acting carbohydrates (See list below). Avoid over treating which can cause large blood sugar spikes.
  • Step 4: Recheck blood sugar in 15 minutes. Repeat treatment if blood sugar is still below 70 mg/dL after 15 minutes
  • Step 5: Once blood sugar is above 70 mg/dL eat another 15 grams of carbohydrate with some protein (such as half a peanut butter sandwich) if no meal or snack will be consumed in the next 1-2 hours.

* Special note on blood glucose test strips (for blood glucose meters) coverage for Medicare: if you are using insulin you may be able to get 300 test strips every 3 months. If you do not use insulin you may be able to get 100 test strips every 3 months.  Additional test strips may be approved if your doctor writes a letter of medical necessity.

Quick acting carbohydrates:

  • 4 oz fruit juice
  • 3-4 glucose tablets
  • 1 tube glucose gel
  • 4 oz Regular pop
  • 15 Skittles
  • 4 Lifesavers hard candy
  • 1 tablespoon honey

*Foods with fat and protein  (cookies, cake, candy bars, milk, etc.) should not be used for the treatment of hypoglycemia. Fat and protein slow down the absorption of carbohydrates. As a result, it will take longer for the blood sugar to rise if such foods are used as treatment.

Preventing Hypoglycemia:

  • Avoid skipping meals
  • Accurate carbohydrate counting (this is important if you dose insulin based on the amount of carbohydrates eaten at a meal)
  • Carry quick acting carbohydrates with you at all times
  • Monitor blood sugar regularly
  • If you exercise more or longer than usual, have a carbohydrate snack (such as a small granola bar or ½ sandwich)
  • Avoid consuming alcohol on an empty stomach
  • Avoid taking a hot shower right after an insulin injection

* Preventing recurrent hypoglycemia will reduce the risk of developing hypoglycemia unawareness. Hypoglycemia unawareness is when symptoms typical of a low blood sugar do not occur.  This puts a person at greater risk for having a severe low blood sugar.

What is Glucagon?

  • Glucagon is an emergency injection used to treat a severe low blood sugar episode when a person is unconscious or having a seizure.
  • Glucagon is a hormone that tells the liver to release stored sugar (glycogen)
  • People who treat their diabetes with insulin should keep glucagon on hand. A prescription is needed for glucagon.

Medical Identification:

  • If your diabetes treatment carries a risk of hypoglycemia wearing diabetes identification is especially important.
  • To learn more about medical identification options check out the following website: medicalert.org

Bottom Line: Don’t let the fear of hypoglycemia prevent you from reaching your glycemic goals. The first step is learning if your medication puts you at risk for hypoglycemia. A little extra planning can help prevent a low blood sugar from occurring and also help prepare should you experience a low blood sugar.

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