Living with Diabetes

• Hypoglycemia happens from time to time to everyone who has diabetes.
• Check blood glucose levels to determine when your level is low.
• Learn to identify the symptoms of hypoglycemia so you can treat it quickly.
• Treat hypoglycemia by raising your blood glucose level with some form of sugar.

Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to manage your diabetes. So, although many times you can't prevent it from happening, hypoglycemia can be treated before it gets worse. For this reason, it's important to know what hypoglycemia is, what symptoms of hypoglycemia are, and how to treat hypoglycemia. You may also be interested in our book, 487 Really Cool Tips for Kids with Diabetes.

How do I know when my blood glucose is low?

Part of managing diabetes is checking blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. The results from checking your blood will tell you when your blood glucose is low and that you need to treat it.

You should check your blood glucose level according to the schedule you work out with your doctor. More importantly though, you should check your blood whenever you feel low blood glucose coming on. After you check and see that your blood glucose level is low, you should treat hypoglycemia quickly.

If you feel a reaction coming on but cannot check, remember this simple rule: When in doubt, treat.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia include the following:

• Shakiness
• Dizziness
• Sweating
• Hunger
• Headache
• Pale skin color
• Sudden moodiness or behavior changes, such as crying for no apparent reason
• Clumsy or jerky movements
• Seizure
• Difficulty paying attention, or confusion
• Tingling sensations around the mouth

How do I treat hypoglycemia?

The quickest way to raise your blood glucose and treat hypoglycemia is with some form of sugar.  Many people with diabetes like to carry glucose tablets. You gan get glucose tablets at any drugstore and at many other stores as well.

Other sources of sugar or simple carbohydrates also work well to treat hypoglycemia, such as fruit juice, hard candies, or pretzels or crackers.  The important thing is to get at least 15-20 grams of sugars or carbohydrates. A food's nutrition label can tell you how much you need to eat of that food to get enough to treat an episode of hypoglycemia.  To treat hypoglycemia you should stick with something that is mostly sugar or carbohydrates. Foods that have a lot of fat as well as sugars and carbohydrates, such as chocolate or cookies, do not work as quickly to raise blood glucose levels.

Foods with 15 grams carbohydrates:

• 4 oz (1/2 cup) of juice or regular soda
• 2 tablespoons of raisins
• 4 or 5 saltine crackers
• 4 teaspoons of sugar
• 1 tablespoon of honey or corn syrup

Ask your health care professional or dietitian to list foods that you can use to treat low blood glucose. Then be sure you always have at least one type of sugar with you.

Once you've checked your blood glucose and treated your hypoglycemia, wait 15 or 20 minutes and check your blood again. If you blood glucose level is still low, eat or drink another 15-20 g carbohydrate. Symptoms often linger after your blood glucose level is up to a safe level. You don’t want to overtreat and have your blood glucose go too high. Go by your meter result to decide if you need to eat more.  After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood glucose level up.

What if it goes untreated?

It's important to treat hypoglycemia quickly because hypoglycemia can get worse and you could pass out. If you pass out, you will need immediate treatment, such as an injection of glucagon or emergency treatment in a hospital.

Glucagon raises blood glucose. It is injected like insulin. Ask your doctor to prescribe it for you and tell you how to use it. You need to tell people around you (such as family members and co-workers) how and when to inject glucagon should you ever need it. For more information about glucagon, view this training video.

If glucagon is not available, you should be taken to the nearest emergency room for treatment for low blood glucose. If you need immediate medical assistance or an ambulance, someone should call the emergency number in your area (such as 911) for help. It's a good idea to post emergency numbers by the telephone.

If you pass out from hypoglycemia, here are some DOs and DON'Ts for friends, families and co-workers:

What is hypoglycemia unawareness?

Hypoglycemia unawareness is a state in which a person does not feel or recognize the symptoms of hypoglycemia. This can cause a person to not recognize when blood glucose levels are dropping below a safe level, and so they don't know to take action to bring glucose levels back up. Hypoglycemia unawareness seems to occur more frequently in people who have had a lot of low blood glucose episodes or who have had diabetes for a long time, but it doesn't happen to everyone. It is also more common in pregnant women and people who intensively manage their diabetes. Tell your healthcare team if you don't feel any symptoms when your blood glucose drops in the 60s (mg/dl) or below. Your health care provider may adjust/raise your blood glucose targets to avoid further hypoglycemia and risk of future episodes.

Someone with hypoglycemia unawareness may not respond immediately to treatment, and the hypoglycemia may last longer. People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night, and they have less defenses against hypoglycemia during exercise.  

This is a dangerous condition, and if you think you have hypoglycemia unawareness, you should consult with your health care team. Sometimes, just avoiding mild hypoglycemia can help restore a person’s awareness of the symptoms of hypoglycemia. 

Some Safety Nets for Hypoglycemia Unawareness

• Increase the number of times you check every day or check at different times
• Always check before driving. If levels are under 100 mg/dl, eat and test again. If glucose levels are higher than that but falling, eat and test again before driving
• Discuss your hypoglycemic episodes with your health care team so you can look for patterns to use as warning cues
• Educate the people you’re with everyday about hypoglycemia and how to help you
• Wear an ID bracelet that identifies you as a person with diabetes
• Ask for prescription glucagon, and be sure those around you know how to use it. (Find out more about glucagon later in this chapter.)
• Attend a class on blood glucose awareness training offered at a specialty diabetes clinic.

Medical IDs 

Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.

In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person’s health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can’t speak for themselves.

Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person’s full medical record for use in an emergency.

How can I prevent low blood glucose?

Your best bet is to practice good diabetes management and learn to detect hypoglycemia so you can treat it early—before it gets worse.