Hypoglycaemia (also called a ‘hypo’, low blood glucose or insulin reaction), is when your blood glucose level has dropped too low. This occurs when your level falls below 4 mmol/L, although this can vary. Some people may feel symptoms when their level is greater than 4 mmol/L and sometimes it just depends on the situation.
While hypoglycaemia can be experienced by people taking certain tablets for their diabetes, it is more common in people who inject insulin. It is generally not a problem for people with type 2 diabetes who can manage their diabetes through a healthy eating plan and physical activity alone, however, it is possible.
It is important to treat a ‘hypo’ immediately to stop your blood glucose level from dropping lower.
Talk to your Credentialled Diabetes Educator about preventing, managing and treating hypos that is unique to you and your lifestyle. The information covered in this Topic is a general guideline only.
In this Topic
Causes of Hypoglycaemia
Symptoms of Hypoglycaemia
No Symptoms or Changing Symptoms
Treating Hypoglycaemia
Not Treating Hypoglycaemia
Unconscious, Drowsy or Unable to Swallow
Glucagon
Avoiding & Managing Hypoglycaemia
Hypoglycaemia can be caused by one or a number of events, such as:
- Delaying or missing a meal
- Not eating enough carbohydrate
- Unplanned physical activity
- More strenuous exercise than usual
- Drinking alcohol - the risk of hypoglycaemia increases, the more alcohol you drink
- Too much insulin or diabetes tablets.
While these are known causes of hypoglycaemia, in many cases, no specific cause can be identified.
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Symptoms of hypoglycaemia vary from person to person, however common feelings are:
- Weakness, trembling or shaking
- Sweating
- Light headedness
- Headache
- Dizziness
- Lack of concentration/behaviour change.
- Tearful/crying
- Irritability
- Hunger
- Numbness around the lips and fingers.
If you feel any of these symptoms, test your blood glucose level if time and circumstances permit. If you are unable to do so, treat as hypoglycaemia.
Treat low or dropping glucose levels even if you feel fine.
If you have low blood glucose levels without any symptoms you should discuss this with your doctor or Credentialled Diabetes Educator.
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Some people have no symptoms of hypoglycaemia. They may lose consciousness without ever knowing their blood glucose levels were dropping. This is called hypoglycaemia unawareness and tends to happen to people who have had diabetes for many years.
Symptoms can also change over time, which may make it harder to recognise.
If you have hypos without symptoms or your symptoms change, you may need to check your blood glucose more often and alert your friends and family to watch out for changes. Treat low or dropping sugar levels even if you feel fine. If you have low blood glucose levels without any symptoms should discuss this with your doctor or Credentialled Diabetes Educator.
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Firstly, make sure you’re safe. For example, if you’re driving a vehicle, pull over to the side of the road.
Then have some quick acting carbohydrate that is easy to consume. For example:
- 1/2 can of regular soft drink (not ‘diet’) OR
- 1/2 glass of fruit juice OR
- 3 teaspoons of sugar or honey OR
- 6-7 jellybeans OR
- Glucose tablets equivalent to 15 grams carbohydrate.
Wait 10-15 minutes. If it isn't rising, eat another quick acting carbohydrate from the above list.
If your next meal is more than 20 minutes away, eat some longer acting carbohydrate. This could be one of the following:
- A sandwich OR
- 1 glass of milk or soy milk OR
- 1 piece of fruit OR
- 2-3 pieces of dried apricots, figs or other dried fruit OR
- 1 tub of natural low fat yoghurt OR
- 6 small dry biscuits and cheese.
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If hypoglycaemia is not treated quickly, the blood glucose level can continue to drop, which may progress to:
- Loss of coordination
- Slurred speech
- Confusion
- Loss of consciousness
- Fitting.
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If a person with diabetes is unconscious, drowsy or unable to swallow THIS IS AN EMERGENCY.
Do not give them any food or drink by mouth.
Here’s what needs to be done:
- Place them on their side making sure their airway is clear
- Give an injection of Glucagon if available and you are trained to give it
- Phone for an ambulance (dial 000) stating a ‘diabetic emergency’
- Wait with them until the ambulance arrives
- When they regain consciousness, given them carbohydrate to maintain their blood glucose level.
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Glucagon is a hormone which raises the blood glucose level and is injected in a similar way to insulin. Glucagon is recommended to reverse severe hypoglycaemia in people with diabetes. If you are able to treat your own 'hypo', you do not need Glucagon which is always given by another person. Your doctor or Credentialled Diabetes Educator will recommend you have Glucagon on hand in case of a severe ‘hypo’ and will show you, your family and friends how to use it.
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There are a number of things that you can do to manage and avoid hypoglycaemia including:
- Carry a ‘Hypo’-pack.
- Wear an identification band that says you have diabetes, that way people will know that you need urgent medical help if you have one
- Make a note in your monitoring book of any ‘hypos’ you have and discuss it with your doctor or Credentialled Diabetes Educator at your next visit
- Make sure your family, friends, co-workers, school staff and carers know how to recognise and treat hypoglycaemia
- Look for the cause of your ‘hypo’ so you can try to prevent the situation from occurring again
- Contact your doctor or Credentialled Diabetes Educator if you are having ‘hypos’ often
- If you are on insulin or certain types of diabetes medication, always carry quick acting ‘hypo’ treatment with you
- If you’re taking medication called Acarbose (Glucobay®) carry pure glucose with you such as glucose tablets, glucose gel or Lucozade
- Eat carbohydrates if you are drinking alcohol
- Test your blood glucose level and ensure it is above 4 mmol/L before driving a motor vehicle.
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A 'Hypo' pack is a pack for treating episodes of hypoglycaemia. Contents of a hypo pack may include:
- Name of the person it belongs to
- List of contents
- Written descriptions of hypo symptoms
- Instructions for how to treat a hypo (in case friends and family need to treat)
- Fast—acting carbohydrate such as juice boxes or jelly beans
- Slow—acting carbohydrate such as muesli bars, fruit bars and biscuits
- Doctors and hospital contact numbers
- Emergency contact details, such as nearest relative.
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