Living with Hypoglycaemia: Advice and Solutions

Introduction

It is defined as a fall in blood glucose concentration below 3.8 mmol/l. Severe hypoglycaemia refers to fall in blood glucose concentration below 40 mg% ( 2.2 mmol/l) requiring help from outside for recovery. Managing hypoglycaemia effectively is crucial to maintaining overall health and preventing complications. This blog provides practical advice and solutions for living with hypoglycaemia.

What is blood sugar ? 

Blood sugar, also known as blood glucose, is the concentration of glucose present in the blood. Glucose is a type of sugar that serves as the primary source of energy for the body’s cells. It comes from the food we eat, particularly from carbohydrates, and is also produced and stored by the liver.

Classification of hypoglycaemia

Hypoglycaemia is classified into postprandial or reactive which occurs only in response to meals and fasting which occurs after a few hours of fasting. Fasting hypoglycaemia usually occurs in the presence of disease, while postprandial hypoglycaemia occurs in the absence of a recognisable disease. Understanding these classifications helps in diagnosing and managing the condition effectively.

• Postprandial hypoglycemia 
  1. Alimentary e.g dumping syndrome
  2. Galactosaemia and hereditary fructose intolerance
• Fasting hypoglycemia
  1. Hyperinsulinism
  2. Insulinoma
  3. Non-pancreatic tumor secreting insulin-like growth factor 1
  4. Excessive exogenous insulin
  5. Drugs like quinine, salicylates etc.
• Endocrine causes 
  1. Hypopituitarism
  2. Glucagon and catecholamines deficiency
• Liver diseases
  1. Severe hepatitis
  2. Cirrhosis of liver
• Renal disease
  1. Renal failure
• Enzymatic defects
  1. Glycogen synthetase
  2. Liver phosphorylase
• Substrate deficiency
  1. Malnutrition
  2. Pregnancy

Causes

• Medications: Insulin or other diabetes medications can lower blood sugar too much.
• Diet: Skipping meals, eating less than usual, or consuming alcohol without food.
• Exercise: Physical activity uses up glucose, sometimes faster than it can be replenished.
• Medical Conditions: Certain illnesses and hormonal imbalances can also lead to hypoglycaemia.

Factors responsible for hypoglycaemia in diabetes

Several factors can contribute to hypoglycemia, and understanding these is crucial for effective management and prevention. Here are the primary factors responsible for hypoglycemia:

• Diabetes medications ( Insulin, Meglitinides ) 
• Dietary factors ( Skipping meals, prolonged fasting ) 
• Physical activity ( unplanned exercise , prolonged exercise ) 
• Medical conditions ( Liver disease, Endocrine disorders, kidney disease etc) 
• Hormonal imbalance ( insulin overproduction) 
• Genetic disorders ( Congenital Hyperinsulinism ) 

Symptoms and signs of hypoglycaemia

• CVS : Palpitation, tachycardia, anxiety, cardiac arthritis.
  

• CNS : Tremors, confusion, headache, tiredness, difficulty in concentration, drowsiness, convulsions, coma.
  

• GI Tract : Nausea, vomiting
  
• Skin : Sweating, hypothermia

Practical Advice for Managing Hypoglycaemia

1. Monitor Blood Sugar Levels Regularly

• Frequent Testing: Use a glucose meter to check blood sugar levels multiple times a day, especially before and after meals, before bedtime, and when you feel symptoms of low blood sugar.
• Continuous Glucose Monitors (CGMs): These devices provide real-time blood sugar readings and can alert you to highs and lows.

2. Eat Balanced Meals and Snacks

• Regular Meals: Do not skip meals. Eating every 3-4 hours can help keep blood sugar levels stable.
• Carbohydrate Counting: Learn to count carbohydrates to balance your insulin doses with your food intake.
• Healthy Snacks: Keep snacks like fruits, nuts, and whole grains handy to maintain blood sugar levels.

3. Be Prepared

• Carry Fast-Acting Carbs: Always have glucose tablets, juice boxes, or candy with you to quickly raise your blood sugar if it drops.
• Medical ID: Wear a medical ID bracelet that indicates you have diabetes or are prone to hypoglycemia.
• Inform Others: Educate family, friends, and colleagues about your condition and how they can help in case of an emergency.

4. Adjust Your Lifestyle

• Exercise Wisely: Consult your doctor to create an exercise plan that balances physical activity with your blood sugar levels. Carry snacks and monitor your blood sugar before and after exercise.
• Limit Alcohol: Drink alcohol in moderation and always with food, as it can lower blood sugar.

5. Manage Stress

• Relaxation Techniques: Practice stress-reducing techniques such as meditation, yoga, or deep-breathing exercises.
• Adequate Sleep: Ensure you get enough rest, as lack of sleep can affect blood sugar levels.

6. Educate Yourself and Stay Updated

• Continuous Learning: Keep yourself informed about hypoglycemia and diabetes management by reading reputable sources, attending workshops, and joining support groups.
• Medical Advice: Regularly consult your healthcare provider to review your management plan and make necessary adjustments.

Solutions for Severe Hypoglycaemia

1. Glucagon Kits

• Emergency Use: Glucagon injections can quickly raise blood sugar levels in cases of severe hypoglycemia. Ensure that those close to you know how to administer it.

2. Hospital Treatment

• IV Glucose: In extreme cases, you may need to go to the hospital for an intravenous glucose solution.

Conclusion

Living with hypoglycaemia requires vigilance, preparation, and a proactive approach to health management. By monitoring your blood sugar levels, eating balanced meals, staying prepared, and educating yourself and those around you, you can effectively manage hypoglycaemia and maintain a high quality of life. Always consult with your healthcare provider to tailor a plan specific to your needs.