Diabetic Hypoglycemia

Low blood sugar, or hypoglycemia, is common in diabetics with type 1 diabetes and occurs occasionally in people with type 2 diabetes who are taking oral hypoglycemic drugs. Hypoglycemia is the result of a mistake in insulin dose, exercise, and available carbohydrates usually because of a missed meal.

The symptoms of hypoglycemia result from a compensatory autonomic nervous system response and from impaired cerebral function due to a decrease in glucose available for use by the brain. The onset of hypoglycemia in diabetics is sudden with blood glucose levels of less then 45 to 60 mg/dL. In severe cases death can occur.

For the diabetic there are two forms of hypoglycemia that they can experience; mild and severe.

For mild hypoglycemia immediate treatment is necessary. Diabetics experiencing hypoglycemia should take about 15g of a rapid-acting sugar. This amount of sugar is found, for example, in three glucose tablets, ½ cup of fruit juice or regular soda, 8 oz of skim milk, five Life Savers candies, three large marshmallows, or 3 tsp of sugar or honey. Sugar should not be added to fruit juice. Adding sugar to the fruit sugar already in the juice could cause a rapid rise in blood glucose, causing persistent hyperglycemia.

If the symptoms of hypoglycemia continue the 15/15 rule should be followed. Wait for 15 minutes, check blood glucose levels, and if it is still low eat another 15 grams of carbohydrate. This procedure can be repeated until blood glucose levels return to normal. Diabetics should have a source of carbohydrate readily available all the time so that they can quickly deal with hypoglycemic symptoms. If the hypoglycemia continues to happen more than two or three times a weeks an adjustment of the diabetes management plan may be in order.

Diabetics who experience severe hypoglycemia often need to be hospitalized to get their symptoms under control. The criteria for hospitalization are one or more of the following.

• Blood glucose is less than 50 mg/dL, and the prompt treatment of hypoglycemia has not resulted in recovery of symptoms.

• The diabetic has coma, seizures, or altered behavior.

• The hypoglycemia has been treated, but a responsible adult cannot be with the client for the following 12 hours.

• The hypoglycemia was caused by a sulfonylurea drug.

If the diabetic is conscious and alert they should be given 10 to 15 g of an oral carbohydrate. If they are semi-conscious glucose or glucagon will be given by injection or IV which is the fastest way to increase blood glucose levels. Glucagon is used in severe cases of insulin induced hypoglycemia to rapidly raise glucose levels. It acts fast but does not last long so it is important that some form of carbohydrate be administered after its use to prevent a recurrence of hypoglycemia. In cases of unconsciousness glucagon may cause vomiting when he diabetic regains consciousness.

Diabetic hypoglycemia is not a condition to be taken lightly. At the first signs of its effects it is important to start taking action to counter its effects.