While many people with diabetes tell me that they are afraid of having a ‘hypo’, not everyone who has diabetes is at risk.

Hypoglycaemia or a ‘hypo’ is an unwanted side effect of diabetes medication. A hypo is when the blood glucose level (BGL) drops too low, below 4.0mmol/L (with or without symptoms).

Understanding what causes hypos can help you to avoid them. If you have diabetes and you take medications such as sulphonylureas (e.g. Diamicron, Glyade, Dimirel), and/ or injected insulin (e.g. Lantus, Novomix, Protophane), you are at risk of hypos.

If you are on any of the medications mentioned above, you may experience hypos if:

• meals are delayed or missed
• physical activity is unplanned
• exercise is more strenuous than usual
• you drink alcohol
• you take too much medication and/or insulin.

When blood glucose levels are less than 4.0mmol/L the brain doesn’t get enough glucose and this can cause symptoms such as:

• palpitations
• sweating
• shaking
• dizziness
• weakness
• hunger
• lack of concentration
• behaviour changes (irritability, aggression).

Although not common, hypos can lead to fitting and unconsciousness.

Many people experience some of the symptoms, others may have no symptoms. The only way to know if a hypo is occurring is to check your BGL.

If you don’t experience symptoms of a hypo at 4.0mmol/L or less, this is a sign that you have impaired hypoglycaemia awareness (IHA). IHA is common in people who:
– have regular hypos
– are over 65 years old
– are a young child
– don’t treat their hypos immediately with appropriate amounts and type of carbohydrates
– have had type 1 diabetes for more than 25 years
– drink too much alcohol.

Knowing how to treat a hypo is very important

Step 1 Most important!
If your BGL is 4.0mmol/L or less, with or without symptoms, you should have 15g of fast acting carbohydrate immediately.

Examples include:

• glucose tablets equivalent to 15 grams carbohydrate, or
• 6–7 jellybeans, or
• ½ can regular soft drink (not ‘diet’), or
• 3 teaspoons sugar or honey, or
• ½ glass fruit juice.

Re-check your BGL in 10-15 minutes to see if it has risen above 4.0mmol/L

If symptoms are still present or your BGL remains below 4.0mmol/L, repeat step 1 regardless of whether you have symptoms or not.

Step 2
If your next meal is more than 20 minutes away, eat some longer acting carbohydrate:

• a slice of bread, 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 natural low fat yoghurt.