Diabetes Management

How To Treat a Hypo

Diabetes mellitus, more commonly referred to as just diabetes, is a disease that is increasing in prevalence.

Diabetes affects an organ called the pancreas and its ability to produce the hormone insulin.

When the insulin-producing cells of the pancreas are destroyed, or when the body doesn’t respond to insulin as well as it should, blood glucose (sugar) levels rise, and diabetes develops. 

When the pancreas is healthy and functioning, blood sugar levels tend to be regulated very well without any intervention. The pancreas releases enough insulin to keep blood sugar levels from rising too high and usually doesn’t release too much insulin as to make blood sugar levels dangerously low. 

When the pancreas’ insulin-producing abilities are impacted, such as with diabetes, blood sugar levels become more difficult to keep balanced. As a result, both high and low blood sugars can result.

A high or low blood sugar level is potentially dangerous and require medical management. The ultimate goal of managing diabetes is keeping blood sugars in a healthy range between 70-140 mg/dL (milligrams per deciliter). 

Knowing which blood sugar levels are dangerous is important for people with type 1 and type 2 diabetes in order to stay healthy and prevent complications. It’s also beneficial for the knowledge of family and friends of those diagnosed with diabetes to be aware of the signs and symptoms of abnormal blood sugar in order to help keep them safe and avoid complications. 

What is a hypo?

Low blood sugar is referred to as hypoglycemia, which is often referred to as a “hypo.” 

“Hypo” means low, and “glycemia” refers to blood sugar. On the other hand, “hyper” means high, so hyperglycemia is the opposite of hypoglycemia.

Hypoglycemia occurs when blood glucose level falls below 70 mg/dL. When blood sugar is low, it causes harmful and disruptive symptoms. Prolonged periods of severe hypoglycemia can cause insulin shock. Insulin shock can be life-threatening and lead to coma and death if it’s not treated promptly.

There are different levels of hypoglycemia, which correlate with the severity of the hypo. 

  • Level 1 (mild) hypoglycemia: Blood glucose is less than 70 mg/dL but is 54 mg/dL or higher.

  • Level 2 (moderate) hypoglycemia: Blood glucose is less than 54 mg/dL.

  • Level 3 (severe) hypoglycemia: A person is unable to function because of mental or physical changes. They need help from another person. In this case, blood glucose is often below 40 mg/dL.

What are the symptoms of a hypo?

There are many warning signs of hypoglycemia. People experience different low blood sugar symptoms, so it’s important to know that someone experiencing low blood sugar won’t necessarily have all of the common symptoms.

The most common symptoms of hypoglycemia include:

  • Feeling shaky and/or dizzy

  • Sweating

  • Hunger

  • Feeling irritable or moody

  • Feeling anxious or nervous

  • Headache

Some people experience nocturnal hypoglycemia, which means it occurs overnight while sleeping. Signs of nocturnal hypoglycemia include:

  • Damp sheets or nightclothes, due to perspiration during sleep

  • Nightmares

  • Feeling tired, irritable, or confused after waking

If hypoglycemia isn’t treated, severe hypoglycemia can occur. Signs and symptoms of severe hypoglycemia include:

  • Clumsiness or jerky movements

  • Muscle weakness

  • Slurred speech or difficulty speaking

  • Blurry or double vision

  • Drowsiness

  • Confusion

  • Convulsions or seizures

  • Unconsciousness/fainting

  • Coma

  • Death

What causes a hypo?

There are different causes of hypoglycemia. Most of them are related to diabetes, but some people without diabetes can also develop a hypo. 

  • Too much insulin: Injecting insulin lowers blood sugar more quickly than any other diabetes medication. The risk of low blood sugar is highest with short- and rapid-acting insulins. Fast-acting insulin is usually taken around meals because eating raises blood sugar, so it works quickly to counteract the rise in blood sugar. Taking short- and rapid-acting insulins without eating may result in a hypo.

    Long-acting or basal insulin works the slowest out of all of the types of insulin. It is usually injected once or twice a day. Long-acting insulin mimics the body’s natural ability to constantly release a small amount of insulin throughout the day and night.

    Intermediate-acting insulin works more slowly than fast-acting but is faster than basal insulin. They are often injected twice per day.

    Insulin doses can overlap, which increases the risk of hypoglycemia. For example, taking a morning dose of intermediate-acting insulin as well as a dose of rapid-acting insulin before lunch can cause a “stacking up” of insulin levels in the body and increase the risk of a hypo.

  • Too much of another kind of diabetes medication: Other diabetes medications that aren’t insulin can also cause hypoglycemia. These medications include:
    -Sulfonylureas, such as glipizide, glyburide, and glimepiride. 
    -Meglitinides, such as Prandin and Starlix.
    -Exenatide (Byetta) can cause hypoglycemia if it’s also taken with a sulfonylurea; it usually doesn’t cause hypoglycemia on its own, though.

  • Hypoglycemia unawareness.  People who have had diabetes for a long time may not be aware of hypoglycemia symptoms. This can occur as a result of autonomic neuropathy, which is a complication of long-term high blood sugar. This makes a hypo much more dangerous because the symptoms might not be felt until the hypo turns severe.

  • Not enough food, especially carbohydrates.  Foods that contain carbohydrates, such as bread, milk, fruit, and starchy vegetables, turn into sugar when digested. If someone isn’t eating very many carbohydrates, especially if they’re also taking insulin or other diabetes medications, hypoglycemia can occur.

  • Exercise and weight loss.  Physical activity stimulates the body to take up more glucose for energy, causing low blood sugar if food or drink containing carbohydrates aren’t taken in regular amounts while exercising for long periods of time.  

    The liver stores sugar in the form of glycogen. Glycogen helps provide our bodies with sugar when we are fasting and during exercise, which reduces hypoglycemia risk. 

    During prolonged periods of exercise or fasting, glycogen stores can become used up. Severe weight loss can also use up glycogen stores due to being in a fasting state. Without adequate glycogen stores, hypoglycemia can occur.

  • Reactive hypoglycemia. People with and without diabetes can produce too much insulin to eat, especially simple sugars like candy and juice. This is called reactive hypoglycemia, and it usually occurs within minutes to hours after eating.

  • Gastroparesis. Gastroparesis is the slowing of stomach emptying, which can occur as a complication of diabetes. When food isn’t emptied from the stomach very quickly, it isn’t available to be digested and converted into sugar in the bloodstream. Hypoglycemia risk increases in people with gastroparesis who also take insulin. 

  • Too much alcohol. Alcohol can cause an increase in insulin secretion and interfere with the liver’s ability to create sugar, which can result in hypoglycemia.

  • Other causes not related to diabetes. Pancreatic tumors, adrenal or pituitary problems, kidney problems, liver problems, and certain non-diabetic medications can all cause hypoglycemia.

How can you prevent a hypo?

  • Eat consistently.  Eating a variety of foods, including protein, fat, and carbohydrates, every few hours can help keep blood sugar levels stable. Some people find that eating protein helps promote steady blood sugars. For example, eating cheese and crackers instead of just crackers can help slow the carbs’ breakdown into blood sugar.

    Eating a very low carbohydrate diet, such as a ketogenic diet, may not be the best choice for chronic hypoglycemia. These diets consist of fewer than 50 grams of carbohydrates per day. For comparison, the US Dietary Guidelines suggest eating between 225-335 grams of carbohydrates per day, but individual requirements and preferences vary greatly.

    For people with reactive hypoglycemia, avoiding simple sugars may help prevent hypoglycemia. Simple sugars such as soda and sweets stimulate the pancreas to release insulin more quickly than foods like fruit and bread and mixed meals with protein and fat. A rapid increase in insulin levels can cause low blood sugar from reactive hypoglycemia.

  • Take insulin and medications as prescribed.  While very useful, insulin is a potentially dangerous medication because of its immediate effectiveness in reducing blood sugar. Insulin should only be used under the guidance of a healthcare provider and only as prescribed. If someone’s blood sugar levels are high, they should discuss it with their healthcare provider and never change insulin doses independently.

    The timing of insulin is also very important. A rapid-acting insulin is designed to be taken a few minutes before starting a meal. If someone forgets to take their rapid-acting insulin, it can often be safer to skip that dose instead of taking it several hours after the meal.

  • Use snacks as a tool. For someone prone to hypoglycemia, snacks can be a very useful tool in preventing low blood sugar. Having a snack before exercising or before taking a bedtime dose of insulin can help offset the blood sugar lowering effect.

  • Don’t drink alcohol on an empty stomach. Drinking alcohol, while taking certain diabetes medications can increase hypoglycemia risk. If someone taking diabetes medications chooses to drink, they should be sure to eat something first, as drinking alcohol on an empty stomach can worsen hypoglycemia.  

Treating a hypo

If blood sugar is below 70 mg/dL, it should be treated by consuming a food or beverage containing 15 grams of carbohydrate. Sugary drinks and hard candies are preferred as they are rapidly absorbed into the bloodstream. It doesn’t take much juice to get to 15 grams of carbohydrates; about one-half cup is enough.

Glucose tablets are a popular hypoglycemia treatment because they’re easy to have on hand in all different types of situations. They dissolve quickly and provide pure glucose, so they are rapidly absorbed into the bloodstream as glucose.

Each tablet contains 4 grams of carbohydrates, so in the case of a hypo, 3-4 tablets should be used in order to provide 12-16 grams of carbohydrates. A common brand of glucose tablet is Dex4, but other brands make similar products. They are available over the counter without a prescription.

Fructose (fruit sugar) and sucrose (table sugar) are each two different sugar molecules bonded together. These linked sugars need to be broken down to be metabolized by the body, so they take slightly longer to become available as glucose in the blood compared to pure glucose.

Foods consisting mainly of protein and fat, such as cheese and peanut butter, shouldn’t be used to treat a hypo. In fact, eating those types of foods may prolong the hypo, so simple sugars are ideal.

After taking some carbohydrates, blood sugar should be rechecked in 15 minutes. If blood sugar levels are still below 70 mg/dL, the treatment should be repeated and blood sugar retested in another 15 minutes. That process should be repeated until blood sugar is above 70 mg/dL; if it’s not working, a healthcare provider should be notified.

If blood sugar levels don’t rise despite treatment, or if they are dangerously low and/or the person is unresponsive, a glucagon emergency kit may be used. Glucagon must be prescribed by a medical professional, and it’s in the form of an injection. Glucagon is a hormone that helps convert the body’s stored sugar (glycogen) into blood sugar. Glucagon is helpful when the person with the hypo is too unresponsive to be able to take in food or drink since it is injected under the skin and done by another person.

When to see a doctor

If a person with a hypo is unresponsive, emergency medical services should be notified right away. Otherwise, a healthcare provider should be notified in the case of a hypo that is not responding to treatment. Someone with persistent hypoglycemia should also speak with their healthcare provider to determine the hypos’ underlying causes and come up with a treatment plan to prevent them. 

Conclusion

Hypoglycemia is when blood sugar levels fall below 70 mg/dL and are often referred to as a hypo. It can be inconvenient at best and life-threatening at worst. Hypos most often affects people with diabetes, but can also occur in people without diabetes.  

Many preventable steps can be taken to avoid hypoglycemia, such as eating consistently and taking diabetes medications as prescribed. Hypoglycemia can be treated at home with food, beverages, or glucose tabs. For emergency cases, injectable glucagon may be used. People with persistent hypos should seek medical attention, and anyone who is unresponsive with a hypo should seek emergency medical care.

Understanding what a hypo is and its causes and treatment options is essential for those with diabetes. Family and friends of people with diabetes (or who are prone to hypoglycemia) should also educate themselves on hypos’ treatment to help keep their loved ones safe.

Sources

  1. https://www.diabetes.co.uk/how-to/treat-a-hypo.html
  2. Epipen as an Alternative to Glucagon in the Treatment of Hypoglycemia in Children With Diabetes Teresa P.C. MonsodWilliam V. TamborlaneLuisa CoraluzziMary BronsonTony Yong-Zhan MaJo Ann Ahern
  3. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=a0845f53-edad-e28f-e053-2995a90a31cf&type=display
  4. https://www.ncbi.nlm.nih.gov/books/NBK21190/

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