Hypoglycemia

Hypoglycemia is defined as low blood glucose ("sugar").  Symptoms of hypoglycemia include hunger, sweating, tremulousness and, if severe, confusion, disorientation or even loss of consciousness.

What, exactly, "low" blood glucose is, varies to an extent from person to person and indeed, from dictionary to dictionary, but is generally said to be a blood glucose below 4.0 mmol/l.  I don't want to be too specific because different people experience symptoms at somewhat different values and some perfectly healthy people can have technically low readings but be perfectly fine.  (I find it fascinating that some marathon runners have been found, mid-race to have blood sugars in the two's with NO symptoms; amazing, eh?).

If you are being treated with insulin or certain forms of blood-glucose-lowering oral medicines ("oral hypoglycemic agents") such as sulfonylureas (eg. glyburide) or meglitinides (eg. Gluconorm) you will be at risk of hypoglycemia.  Conversely, drugs such as acarbose, metformin, glitazones (such as Avandia or Actos), GLP-1 analogues and DPP-4 inhibitors do not put you at risk of hypoglycemia.

Here's another "by the way:"  Contrary to what many people think, hypoglycemia in someone who does NOT have diabetes, does not lead to or cause diabetes!

Most episodes of hypoglycemia are mild and easily treated.  The Canadian Diabetes Association Clinical Practice Guidelines recommend:

• For "mild to moderate" hypoglycemia, ingest 15 grams of carbohydrate (preferably as glucose or sucrose tablets rather than orange juice or glucose gel).  If, after 15 minutes your blood glucose is still less than 4.0 (mmol/l), take another 15 grams.
• For "more severe" hypoglycemia take 20 grams of carbohydrate, and if, 15 minutes later, your glucose level is still less than 4, take a further 15 grams.
• Once the hypoglycemia has been reversed, individuals should eat their usual meal or snack to prevent repeated hypoglycemia.

If an episode of hypoglycemia is so bad that it has made you pass out, you should be given an injection of a substance called glucagon.  What this means, however, is that whomever is helping you out would, of course, need to know how to do this.  What I recommend is that if you have diabetes and if you have a history of severe hypoglycemia (to the point of making you unable to look after yourself during an episode) you should be given a prescription for glucagon (a "glucagon kit;" pictured left) AND you should take your spouse (or capable child or parent or whomever it is that is likely to have to look after you should you lose consciousness) to the pharmacist and have the pharmacist explain to them how to give you the glucagon.  Even if you have been given glucagon, I would still recommend an ambulance be summoned in case you need further assistance.

If you are having repeated episodes of hypoglycemia, this can lead to a loss of warning of the symptoms of hypoglycemia.  This is called "hypoglycemia unawareness."  I discuss this further here.