Hypoglycaemia means having too little glucose (sugar) in the blood. Having a hypoglycaemic attack (or ‘hypo’) is one of the most common complications of diabetes. People taking insulin are most at risk of hypos but some diabetes tablets can also precipitate these. Hypos are usually caused by excessive insulin or other diabetes medications, eating too little (especially carbohydrate), physical activity or drinking alcohol. Sometimes there may be no obvious cause. Hypos are not generally harmful themselves, in fact the vast majority are easily treated and have no long-term consequences. Severe hypos can cause drowsiness, confusion or unconsciousness, and this may result in accidents, particularly while driving. Such episodes may also lead to a loss of confidence in one’s ability to manage daily life. Very severe hypos can damage the brain, but this is very rare.
Symptoms of hypoglycaemia may start to appear when the blood glucose falls below 4 mmol/l. Signs of a hypoglycaemic attack include feeling hungry, sweaty, shaky, anxious, irritable, angry or confused. Tingling of the hands, feet, lips or tongue, palpitations, headaches and blurred vision may occur. If practical, it is useful to check the blood sugar level to confirm a hypo. It is important to treat a hypo since, if left untreated, then the blood glucose may fall to a lower level, resulting in worsening confusion and eventually in unconsciousness.
Most people learn to recognise the symptoms of a hypo and can take action to treat this themselves. Hypos need to be treated as quickly as possible with some form of sugar. Patients on insulin or susceptible to hypos should always carry some sugar-containing material with them.
A good initial treatment for a hypo is to take one of the following:
- 6 glucose tablets such as Dextro Energy, shown below
- 100-120ml (half a medium-sized glass) of Lucozade
- 4-5 Jelly Babies
- 200ml (one medium-sized glass) of fruit juice or full-sugar cola
- Tea or coffee with 2 teaspoons of sugar
Drinks will generally raise the blood glucose quicker than tablets or sweets.
You should then wait for 10 minutes. If the hypo does not improve, repeat the treatment above.
To prevent the blood sugar falling again you should follow-up this initial glucose with a longer acting carbohydrate such as:
- a piece of fruit (e.g. apple, banana)
- a sandwich
- two biscuits
- a bowl of cereal
- or merely take your next meal if this is due
If someone is having a severe hypo they may become drowsy or lose consciousness, and so will need help from someone else. In these circumstances, the assistant should follow these guidelines:
- Try to smear GlucoGel (a glucose containing gel) on the inside of the cheeks and gently massage the outside of the cheek so that the glucose is absorbed into the blood stream. An alternative is to use treacle, jam or honey
- If the person is unconscious then Glucagon can be injected by someone trained to do this
- If neither of the above measures can be carried out then someone should call an ambulance immediately
- If the person with hypoglycaemia is unconscious and cannot swallow, DO NOT give anything into the mouth. Patients who are unconscious should be place in the recovery position, on their side with the head tilted slightly backwards
If a person with diabetes is experiencing frequent hypos, it is important to review the person’s treatment and other factors such as diet, exercise or alcohol consumption that may be contributing to the problem. This should be discussed with a diabetes healthcare professional at the first reasonable opportunity.
People with type 1 diabetes who are having problems with hypos can sometime gain benefit from using an insulin pump. This is a device that is worn on the body and which provides a continuous feed of insulin into the subcutaneous tissues and allows for sophisticated adjustments to the rate of insulin delivery. Click on the link or the feature on the right.