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Hypoglycaemia

Hypoglycaemia, or hypo, is the medical term for low blood glucose levels – that is a blood glucose level of less than 4 mmol/l. This is too low to provide enough energy for your body’s activities.

What causes a hypo?

A hypo can be caused by the following:

• too much insulin (e.g. miscalculating a dose or giving a dose twice by mistake)
• delayed or missed meal or snack
• not enough carbohydrate
• exercise or unplanned activity
• alcohol, especially in large quantities and/or with little or no food
• injecting into an overused site.
• Sometimes there is no obvious cause

Signs of a mild hypo

Most people have some warning signs when their blood glucose level starts to go low. These include:

• feeling hungry
• trembling or shakiness
• sweating
• anxiety or irritability
• going pale
• fast pulse or palpitations
• tingling of the lips
• blurred vision.

Signs of a more severe hypo

• difficulty in concentrating
• vagueness or confusion
• irrational behaviour.

Immediate treatment

Once you notice your hypo warnings, take action quickly or it could possibly become more severe.

Immediately treat with short-acting carbohydrate such as:

• Lucozade, Coke or lemonade
• glucose tablets
• sweets such as jelly babies or jelly beans

The following table gives examples of food and fluid which will raise your blood sugar by approximately 5 mmol/l (e.g. from 2 to 7mmol/l)

 

Type of food or fluid	Weight/volume providing 20g Carbohydrate	Measure providing 20g carbohydrate
Apple juice	200ml	200ml carton
Bassets jelly babies	25g	4 jelly babies
Bassets liquorice allsorts	27.5g	5 sweets
Coca cola	185ml	1/3 550ml bottle
Dextrosol glucose tablets	23.1g	7 tablets
Fanta	150ml	½  330ml can
Jelly beans	22g	15-20 beans
Lucozade original	115ml	1/3 380ml bottle
Lucozade sport	310ml	3/5 500mll bottle
Mars bar	29g	½ 62.5g bar
Maynards wine gums	26g	6 wine gums
Orange juice	200ml	200ml carton
Pineapple juice	167ml	¾ 200ml carton
Ribena	144ml	½ 288ml carton
Vita Energy glucose tablets	24g	10 tablets

Reference Baldwin and Feher “Sweets, fluids and foods in the treatment of mild hypoglycaemia” Practical Diabetes 2006 vol 23 no5 218-220

If your hypo is more severe and you cannot treat it yourself, someone else can help you by:

• applying GlucoGel (or treacle, jam or honey) on the inside of your cheeks and gently massaging the outside of your cheeks.

A severe hypo can lead to unconsciousness or a fit

If you are unconscious, Glucagon can be injected if the person you are with has been trained to use it. Otherwise the people you are with should call 999 for an ambulance immediately.

Important: If you are unable to swallow or unconscious, you should not be given anything by mouth (including GlucoGel, treacle, jam or honey). Make sure your family and friends are aware of this. If you are unconscious, you should be placed in the recovery position (on your side with your head tilted back) so that your tongue does not block your throat.

Follow-on treatment

To prevent your blood glucose levels dropping again, you should follow your sugary foods with a longer-acting carbohydrate such as:

• a sandwich
• fruit
• a bowl of cereal
• biscuits and milk
• the next meal if due.

Hypos at night

If you have a hypo while sleeping, it is unlikely that you will come to any harm. The hypo may wake you but, if it does not, you may wake up feeling very tired, with a headache or hangover sensation. If you are concerned about night-time hypos, check your blood glucose between 2am and 3am when hypos are most likely to happen. Keep something sugary by your bed just in case.

Alternatively have a snack before bed-time such as biscuits and milk, half a sandwich, fruit or yoghurt.

Hypos and physical activity

Physical activity lowers your blood glucose level so it is important to eat some form of carbohydrate (e.g. small amounts of Lucozade) before, possibly during and after your activity especially if it is strenuous or lasts a long time. Hypos can happen up to 36 hours after strenuous or prolonged physical activity so you might need to adjust your medication or carbohydrate intake to compensate. If you do regular sport you will need to work out a system of insulin doses and short acting carbohydrate that suits you. If you speak to the specialist diabetes team we can help

Hypos and driving

Always test your blood glucose levels before driving. You should only drive if your blood sugar is above 5 mmol/l. If you feel you may be hypo when driving, pull over, stop the car as soon as it is safe to do so and remove the keys from the ignition. Leave the driving seat and treat your hypo in the usual way. Do not attempt to start driving again until you are sure your blood glucose levels have risen again.

You can look at the information from the DVLA http://www.dft.gov.uk/dvla/medical/ataglance.aspx

Hypos and alcohol

Hypos associated with alcohol can often be more severe and serious. Drinking a lot of alcohol or drinking on an empty stomach makes a hypo more likely to occur often several hours after you have finished drinking. In addition, you may not recognise that you are having a hypo when you are drunk.  The outwards signs of a hypo can be very similar to those of being drunk so people with you may not realise that you are having a hypo.  Always have something to eat if you are drinking alcohol. This could be a meal but also some chips or a kebab on the way home. It is a good idea to tell the people you are with about your diabetes and what to do if you need help treating a hypo.

Important points to remember:

• Always carry something sugary with you to treat a hypo.
• Wear some medical I.D.
• Tell your friends what signs you have when you go hypo and how to treat it, as you may not be able to think clearly when your blood glucose goes low.
• If you do become unconscious through a hypo, your body will eventually release its stores of glucose into the blood and you will recover. However alcohol can delay this process
• Hypo warning signs may change or decrease over time, so be prepared to check your blood glucose level if you experience any unusual symptoms. If you think this may be happening you can discuss this with the specialist diabetes team.