Very often, hypoglycemia occurs when blood glucose levels fall below 70 mg/dl. However, many people have glucose readings below this level and feel no symptoms. Others may start to have symptoms of hypoglycemia when their blood glucose is higher than 70 mg/dl. All of this can be very confusing. To start, ask your provider or educator what glucose levels to look out for when you suspect hypoglycemia. Make note of the symptoms you are experiencing. You will soon learn what level is too low for you.
Hypoglycemia at Night
While it may seem difficult to figure out whether you’ve had hypoglycemia in your sleep, there are some clues.
• Pajamas or sheets are damp with sweat in the morning
• Restless sleep or nightmares
• A headache or feeling of tiredness when you wake up in the morning
• Ketones in your urine in the morning without a high blood glucose reading
You may want to check your blood glucose around 2 or 3 a.m. a few times to try to match your results with your food intake, physical activity, and medication doses from the previous day and evening. This will help you pinpoint what is really going on.
Hypoglycemia Unawareness
Some people have a hard time knowing when their blood glucose level has fallen to a dangerous level. People who tend to miss these early symptoms are said to have hypoglycemia unawareness. For them, the first symptom of low blood glucose can be impaired thinking.
Hypoglycemia unawareness seems to occur more frequently in people who have had a lot of low blood glucose episodes or who have had diabetes for a long time. In addition to unawareness, a person’s body may not respond properly. Someone with hypoglycemia unawareness may not respond immediately to treatment, and the hypoglycemia may last longer.
People with hypoglycemia unawareness are less likely to be awakened from sleep when hypoglycemia occurs at night, and they have less strong defenses against hypoglycemia during exercise. It is common in pregnant women and people who intensively manage their diabetes. There is some evidence that frequent episodes of low blood glucose can make someone have hypoglycemia unawareness.
This is a dangerous condition, and if you think you have hypoglycemia unawareness, you should consult with your health care team. Sometimes, just avoiding mild hypoglycemia can help restore a person’s awareness of the symptoms of hypoglycemia. Other times, the solution will be to increase blood glucose goals to higher numbers.
Some Safety Nets for Hypoglycemia Unawareness
• Increase the number of times you check every day or check at different times
• Always check before driving. If levels are under 100 mg/dl, eat and test again. If glucose levels are higher than that but falling, eat and test again before driving
• Discuss your hypoglycemic episodes with your health care team so you can look for patterns to use as warning cues
• Educate the people you’re with every day about hypoglycemia and how to help you
• Wear an ID bracelet that identifies you as a person with diabetes
• Ask for prescription glucagon, and be sure those around you know how to use it. (Find out more about glucagon later in this chapter.)
• Attend a class on blood glucose awareness training offered at a specialty diabetes clinic
Treatment of Hypoglycemia
Check your blood glucose level if you think you have hypoglycemia. Talk to your health care team about the blood glucose level at which you should begin treating for hypoglycemia. Although it’s best to check before treating, this may not always be possible. What if you don’t have your monitor with you? Should you wait until you get home? No! Eat or drink something immediately. Never wait until you get home, especially if you have to drive.
You need to eat or drink something that contains carbohydrate that can be rapidly absorbed from your digestive tract and into your blood. However, you shouldn’t go overboard. You’ll feel worse later on if you send your blood glucose levels soaring. There are many choices of fast-acting carbohydrates.
You’re best prepared for low blood glucose if you carry around a measured amount (15 grams) of “pocket carbohydrate.” The easiest and most convenient fast-acting carbohydrate is found in glucose tablets or gel, which come in a variety of flavors. Check the annual Diabetes Forecast Consumer Guide for a list of current over-the-counter products for treating low blood glucose. Usually, two to five glucose tablets or one package of glucose gel will bring quick relief, but check the instructions and dosing on the package to make sure.
Recheck your blood glucose 15 minutes after you’ve treated your low blood glucose. If you still have low blood glucose, you may need to take another dose of 10–15 grams. Check again in another hour. If blood glucose is low, you may need another 15 grams of carbohydrate.
Fast-Acting Carbohydrates for Hypoglycemia
Each has about 15 grams:
• 2–5 glucose tablets
• 1 gel tube
• 2 tablespoons raisins
• ½ cup regular soda (not diet)
• 4 ounces orange juice
• 5–7 Lifesavers
• 6 jellybeans
• 10 gumdrops
• 3 teaspoons sugar, honey, or corn syrup
• 6–8 ounces nonfat or 1% milk
After an episode of severe low blood glucose, readings may run high for some hours afterward, as a result of your body fighting back against the low blood glucose. High blood glucose readings immediately following a low reading can lead to a misinterpretation of the pattern. Talk to your health care provider about these patterns, because if you treat for the high readings, you may begin a dangerous cycle of fluctuating blood glucose levels.
Special Considerations for Hypoglycemia
Physical Activity
Exercise and other physical activity lowers blood glucose levels, so you have to be extra careful to avoid hypoglycemia during and sometimes after exercise (if you take insulin). When you first begin an exercise program, you will need to monitor your blood glucose levels after exercise to find out how your body responds. If you feel as though you are becoming hypoglycemic while you are working out, stop at once. Don’t say, “I’ll just do one more lap” or “Just 5 minutes won’t hurt.” Stop.
Treating Hypoglycemia during Physical Activity
• Check your blood glucose right away and treat hypoglycemia if you need to.
• If you want to continue your workout, eat a snack, take a 15-minute break, and check to make sure your blood glucose has come back up above 100 mg/dl before starting back. If you start too soon, your blood glucose may drop again, quickly.
• Studies show that hypoglycemia is even more likely to occur 4–10 hours after you exercise than during the activity or shortly after.
Sexual Activity
If you are prone to hypoglycemia when you work out or at night, you may also have a low blood glucose reaction following sexual activity. This can be especially true if you have sex at night. This is when your blood glucose levels typically dip, so you may need to adjust your insulin or have a snack before or after sexual activity. Be especially careful if you are combining sexual activity with alcohol.
Avoiding Lows During and After Sex
• If you use insulin, you need to be watchful for low blood glucose during or after