Hypoglycemia

Hypoglycemia (or hypo) is a low blood glucose level of 4.0 mmol/L or less. People at risk of hypoglycemia are those with or certain diabetes medications. Being able to pick up early symptoms of hypoglycemia and treat the low blood glucose straight away helps reduce the chance of having severe hypoglycemia.

Understanding the activities and situations that trigger hypoglycemia helps those at risk to plan ahead and work out ways to reduce the possibility of this happening. It is important to work together with your health care professional (doctor, diabetes specialist or diabetes educator). This includes:

• developing a personal plan for preventing hypoglycemia
• looking at ways to manage this if it occurs

The information provided in this fact sheet is basic and is not a replacement for education by your health care professional about hypoglycemia and its management. You need to have a hypoglycemia management plan in place that has been developed by you and your health care professional. Regular follow-up with your health care professional for blood glucose and medication review is important.

What is hypoglycemia? Hypoglycemia means low blood glucose or not having enough glucose in the blood. A low blood glucose level is usually 4.0 mmol/L or less. In frail older people a low blood glucose level may be under 6.0 mmol/L (according to the McKellar guidelines).

Hypoglycemia is sometimes referred to as ‘a hypo'.

Hypoglycemia can be classified as mild or severe#

Who is at risk of hypoglycemia? People with diabetes who inject insulin or who take certain diabetes tablets (sulphonylureas) are at risk of low blood glucose. There are other medical conditions that may cause a person to produce too much insulin and people can experience symptoms of low blood glucose levels even when they do not take insulin or certain diabetes medications.

If so it is important to have this investigated by your doctor#

Various activities or actions can cause blood glucose levels to go too low in people with diabetes. The most common reasons are the person has: lost weight and no longer needs the same insulin or medication dose. The most common early warning signs of hypoglycemia are: Don’t ignore hypoglycemia symptoms.

Treat symptoms immediately so your blood glucose level does not continue to drop. In cases of mild hypoglycemia the person can treat themselves (young children or people being cared for by others may need assistance).

If the person’s blood glucose level is 4.0 mmol/L or less and they are conscious and able to swallow, the following steps apply.

Take 15–20 grams of glucose such as:

• 3 teaspoons of sugar or honey. Recheck your blood glucose in 15 minutes. If your blood glucose level is still 4.0 mmol/L or less
• repeat step 1
• recheck your blood glucose in 15 minutes

Once your blood glucose is above 4.0 mmol/L: if your next meal is more than an hour away, have a snack containing carbohydrate such as a piece of fruit, a slice of bread, dry biscuits, a glass of milk or a small tub of low-fat yogurt if it is time for a meal, make sure that it contains some carbohydrate.

This will help maintain your blood glucose level#

After you have treated your low blood glucose (hypo), you need to check your blood glucose more often. (When someone has had a hypo they are more likely to have another one). Checking your blood glucose level more often will help you know if your blood glucose level is dropping again.

Severe hypoglycemia occurs when the brain is not getting enough glucose to function properly.

Symptoms of severe hypoglycemia include: becoming unconscious#

In cases of severe hypoglycemia the person cannot treat themselves, and needs the help of someone else. Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance immediately.

If the person can’t swallow or follow instructions do not give them any treatment by mouth.

If you are trained in how to prepare and inject glucagon (or how to use it yourself) and feel comfortable injecting it, then this can be administered. Ambulance paramedics have the resources to manage severe hypoglycemia. Sometimes a person living with diabetes who is at high risk for hypoglycemia may have a GlucaGen Hypokit on hand.

Glucagon is given as an injection and helps release glucose that has been stored in the liver back into the blood.

This helps to increase blood glucose levels#

A GlucaGen Hypokit is used when a person has a severe or unconscious hypo. They cannot have treatment by mouth as they are at risk of choking if they are unable to swallow properly. A support person needs to be trained in how to prepare and inject glucagon.

Ambulance officers are able to treat this type of hypoglycemia and it is best to call them for assistance.

After a severe hypo, once the person is conscious and able to swallow, it is important to replace their used-up energy stores. They will need both quick acting glucose (such as fruit juice or soft drink) and longer acting carbohydrate (such as a sandwich or yogurt or glass of milk).

Don’t exercise for the rest of the day after a severe hypoglycemic episode.

After a severe hypo your blood glucose needs to be checked more often#

(When someone has had a hypo they are more likely to have another one.) Checking your blood glucose level more often will help you know if your blood glucose level is dropping again.

Try and work out why you had the low blood glucose. Did you do more exercise or more intense exercise than usual? Did you forget that you had taken insulin or diabetes tablets, and take another dose? Did you inject into a new area or an area that warmed up with exercise and absorbed more quickly? Was there not enough carbohydrate in your last meal? Is there a particular time of day that hypoglycemia occurs for you? Tell your doctor and diabetes educator that you have had hypoglycemia, especially if it was severe or is happening more often.

Your insulin or diabetes medication may need to be adjusted.

Wear or carry some form of identification, such as a MedicAlert medical ID, to indicate that you have diabetes and are taking insulin or sulphonylureas.

What if I don’t get any signs that I have hypoglycemia? Sometimes people are unable to recognize symptoms of hypoglycemia and find it difficult to tell if their blood glucose might be low.

This may be because a person has: ignored early warning signs of hypoglycemia.

The only way to know if blood glucose has gone too low is to check blood glucose levels more often. Sometimes people use a continuous glucose monitor to help them know where their glucose is trending. It is possible to regain the ability to recognize symptoms of hypoglycemia.

Talk with your diabetes specialist or diabetes educator for advice and support. Elderly people may not get the usual warning signs of hypoglycemia and it may be difficult to detect if they have low blood glucose. They may feel disorientated, irritable, have slurred speech and may not be able to express how they are feeling.

They may need to rely on others checking whether their blood glucose could be low.

Always check your blood glucose level before driving#

It is recommended that you have a blood glucose level of above 5.0 mmol/L to drive. If your blood glucose becomes low while you are driving, pull over straight away, and put the hazard lights on.

Turn the car off and remove the keys from the ignition#

Check your blood glucose level if possible and treat your hypoglycemia.

If your blood glucose level is above 4.0 mmol/L but under 5.0 mmol/L and you are at risk of hypoglycemia, have a snack. diabetes who are on insulin Management of hypoglycemia regular review of your blood glucose levels adjustment of insulin or other diabetes medications as necessary Causes of hypoglycemia taken too much insulin or medication done more exercise or more intense exercise than usual missed a meal or not had enough carbohydrate Symptoms of mild hypoglycemia sweating feeling shaky fast heart beat sudden hunger headache Treatment for mild hypoglycemia Step 1 6 or 7 regular size jelly beans, or 100–120 ml (½ standard cup) Lucozade energy drink (not Sport), or 150 – 200 ml soft drink or fruit juice (1 standard cup), or 15 grams of glucose gel, or Step 2 Step 3 Symptoms of severe hypoglycemia unable to think clearly unable to follow instructions confusion slurred speech appearing drunk fitting (having a seizure) Treatment for severe (or unconscious) hypoglycemia Glucagon for hypoglycemia Further tips after a hypoglycemic episode had diabetes for a long time had too many recent episodes of hypoglycemia not treated their hypoglycemia correctly Elderly people Driving and diabetes Vic Roads has more information about driving and diabetes

Where to get help#

Key Points#

• People at risk of hypoglycemia are those with or certain diabetes medications
• important to work together with your health care professional (doctor, diabetes specialist or diabetes educator)
• This includes: developing a personal plan for preventing hypoglycemia and looking at ways to manage this if it occurs
• Regular follow-up with your health care professional for blood glucose and medication review is important
• If so it is important to have this investigated by your doctor