Hypoglycemia Treatment and Prevention

If you have any type of diabetes, at some point you are likely to experience hypoglycemia.  Hypoglycemia is sometimes called an insulin reaction, and it is a complication of low blood sugar. It can happen quickly, with little warning and anywhere, whether you are at home, work, in a restaurant, at the gym or traveling. You need to be prepared to act immediately to treat the condition should it occur.

Treatment of Hypoglycemic Incidents

A diabetic always has a chance of experiencing at least one incidence of hypoglycemia during their lifetime, but it will probably happen periodically depending on your lifestyle. If this happens, the appropriate response will depend upon the severity of the attack. No matter what you are doing, whether at home, traveling across town or across the country, or playing tennis at the local park, it’s important to carry the items that can help you correct hypoglycemia

The general rule of thumb is to eat approximately 15 grams of carbohydrates that can act quickly. If you don’t have that many carbohydrates on hand then consume what you have and try to get access to more quickly. After consuming the carbs, wait about 15 minutes and test your blood sugar level.

A better approach, of course, is to confirm that your blood sugar is dropping before hypoglycemia occurs by taking a glucose reading with a meter. Each person is different as to the blood sugar low that prompts this complication, but you learn to recognize an odd feeling over time that is giving you warning. If you use your glucose meter frequently throughout the day or after strenuous exercise, it’s very possible to prevent these occurrences.

Following are some suggestions for ways you can be prepared for a hypoglycemic episode. For mild or moderate hypoglycemia, always have on hand some of the following items in case of a hypoglycemic incident:[1]

  • Glucose tablets. You can purchase these over-the-counter (OTC). They consist of 4 gm of glucose. The best amount to take initially is between 2 to 4 tablets.
  • Honey: A single teaspoon is equivalent to 5 gm of glucose
  • Piece of fruit: If you have prepared ahead of time then you know the amount of carbohydrates the fruit you have on hand contains.
  • Raisins: 40-50 or one of the small snack boxes sold in grocery stores
    • Juice boxes: Cartons of orange or other sweetened juices equivalent to a half glass or half cup
  • A soft drink (non-diet): Drink 4 oz or approximately 1/2 can
  • Lifesavers or hard candy
  • Sugar packets or cubes: These will do in a pinch. Consume 4 tsp or 6 ½-inch cubes
  • Saltine crackers: eat 6
  • Graham crackers: eat 3
  • Small tube of decorative cake frosting: eat the whole tube

As mentioned, after 15 to 20 minutes, you should check blood sugar or have someone help you check it. Administer more glucose if the test level is below 100 mg/dl. You can eat another 15 carbohydrate grams.

  • Severe hypoglycemia: In the case of severe hypoglycemia, it is likely someone else may have to administer a treatment.  If you are conscious and able to swallow, a friend or family member can help you access the carbohydrates and make sure you don’t pass out or choke. If you lost consciousness, someone will need to inject you with glucagon, which comes in kit form.  If no one knows how to inject you or glucagon is not available ,then 911 should be notified immediately.

The Glucagon Kit

Glucagon is currently the best means of quickly increasing the levels of sugar in the blood. When an emergency strikes, such as hypoglycemia, it is extremely handy to have glucagon readily available.[2] It will promote the release of stored glucose from the liver so that blood glucose levels in the bloodstream can return to normal.

A glucagon kit is simple and consists of the following 2 items:

  • A vial of 1 mg of powdered glucagon
  • A syringe or needle pre-filled with the fluid to dissolve the glucagon.

All of the liquid solution is injected into the vial. You then need to shake the vial to combine the powder and liquid together completely. Next, you will need to draw the mixture back into the syringe. The solution is injected into the muscle, if possible, of the thigh, buttocks or arm. For a child, you will need to adjust the dose, reducing it to half of the recommended dose. [3]

Check the contents of the kit carefully. Not only is it necessary that it be ready and operative but you need to make sure that the glucose is not past the “best used before” or expiration date.

Once the patient regains consciousness, give him or her oral glucose. If there is no response to the injection, call 911 immediately.

Once you understand how quickly hypoglycemia can strike, it’s easy to see why diabetics are told to always make sure at least one person around them knows what to do in the event of a diabetic emergency.

Prevention of Hypoglycemia

There are ways to prevent hypoglycemia. If you had an episode, the first thing to do after treatment is review the circumstances as to why the most recent episode took place and if there were early warning signs. Identifying triggers leading to the event can help you prevent a repeat episode. Did you forget to do something? Were you exercising vigorously? Did you get light headed or feel odd? Whenever possible pin down the suspected cause of the incident and the way you felt right before it happened.

If you determine the hypoglycemic attack happened right before a meal or in the mid-morning, middle of the afternoon or late at night, it’s possible the insulin type needs to be changed, you need to adjust your insulin schedule or you need to add snacks to your diet. Remember that there are certain types of insulin for this very reason.

For the first two hours after eating a meal, you require insulin that is effective and fast acting. For the remainder of the day, you can use the long acting insulin. Modern technology can provide assistance. It’s possible to download from a recognized and reliable website a glucose meter reading log so you can track your blood sugar level. Software programs will assist you in recognizing your personal patterns of high and low blood glucose levels.

Other measures to take include the following:

  • Be aware of the signs and symptoms of hypoglycemia.
  • Don’t guess what your blood sugar levels are – use your glucose meter regularly.
  • Learn how to adjust your insulin appropriately to your carbohydrate intake.
  • Recognize behaviors and activities that will put you at risk of hypoglycemia. For example, drinking alcohol can lead to hypoglycemia.
  • If you have frequent hypoglycemic episodes, consider using a continuous monitoring system to act as a warning when your glucose levels dip below your specific target point.[4]
  • Timing: Time your meals, insulin injections, and other aspects of your life in a regular and orderly fashion. This may seem tedious, but it will help you avoid hypoglycemia episodes.

If your primary worry concerns hypoglycemia occurring at night, you may be able to avoid it by having an evening snack. The food you eat though should promote the slow release of glucose, like foods with protein that slow the release of carbohydrates. The snack quantity should be based on your weight and the information gleaned from your glucose meter log. A nutritionist, dietician or your doctor can help.

Conclusion

When talking about hypoglycemia, there are two aspects to be considered: treatment and prevention. You need to be prepared at all times to treat hypoglycemia incidents.  Diabetics should always carry snacks around that will act to boost glucose levels. You can purchase a glucose kit and show all those who are likely to be around you, should a hypoglycemic incidence occur, how to use it in case of an emergency. It’s just as important to take the time to evaluate ways you can prevent hypoglycemia attacks from ever happening.

References

[1] American Diabetes Association (2009). Type 2 Diabetes. Your Healthy Living Guide. Alexandria, VA: ADA.

[2] Warshaw, HS; and Pape, J (2009). Real-Life Guide To Diabetes. Alexandria, VA: ADA.

[3]Masharani, U (2008). Diabetes DeMYSTiFieD. New York: McGraw Hill.

[4] Meltzer, SJ; and Belton, AB (2009). Diabetes in Adults. Toronto: Key Porter Books.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.