Hypoglycemia is a condition in which the glucose concentration in the blood is below the lower limit of normal values. Nerve tissue, especially in the brain, suffers from this condition most since glucose is the basic energy source for nerve cells. If hypoglycemia is present over a longer period of time or if the level of glucose concentration decreases very quickly, the patient can fall unconscious due to the restricted brain activity.
The fall of glycemia below the normal levels is accompanied by a number of characteristic symptoms which signal danger. The symptoms may come in a random order, with different levels of intensity. A number of them may very often be absent, especially if the decrease in glycemia is rapid.
The most frequent symptoms of hypoglycemia are:
an intense feeling of hunger
nervousness
pale skin
rapid heart beat
sweating
shakiness, especially of hands
The symptoms of severe hypoglycemia are:
blurred vision
difficulty speaking
confusion
loss of consciousness
It is necessary to act immediately if these symptoms occur. Experienced patients are able to identify a coming hypoglycemic event. Less experienced should verify their glucose concentration by a glucometer. If hypoglycemia is present, it is necessary to immediately take a small dose of sugar, either in the form of glucose concentrate, a cube of sucrose or sugar from a soft drink (not a light one). The recommended amount of sugar ranges between 5 – 40 g depending on the severity of symptoms (1 – 4 dl of fruit juice or coke, tea with 1 – 4 cubes of sugar, etc.).
It may happen in the case of severe hypoglycemia that the patient is unable to help himself (due to confusion or unconsciousness). Then we may try to spread an adequate amount of sugar in the mouth. This is not usually particularly effective. It is generally recommended to apply a glucagen injection (Glucagen- Hypokit) which every patient should carry. In any case, it is necessary to call for medical assistance (the ambulance) immediately.
When can hypoglycemia be expected?
Hypoglycemia usually occurs under one or more of the following circumstances:
- The riskiest period for hypoglycemia is, in a standard diabetic regimen, in 3 hours following a short-acting insulin injection.This is when a relatively high amount of insulin is still being released from under the skin but most of the glucose from the consumed food has already been “driven“ to the appropriate areas. Therefore, eating a small snack in this period is recommended so as to prevent hypoglycemia.
- If the insulin dose is relatively high in relation to the amount of saccharides in the consumed food.
- If the patient administers insulin when the glucose levels are relatively normal and does not eat any food or postpones it by more than 10 – 15 minutes compared to his habits.
- If the insulin dose has not been adjusted or more food consumed to accommodate increased physical activity (sport, physical work, long intensive walking…).
- If more than 0.5 l of wine or a few shots of distilled drinks has been consumed. Alcohol
blocks the release of glucose from the liver which is the body‘s basic mechanism for protecting an organism against hypoglycemia. In this case even a glycagen injection may be ineffective.
Note
The aim of diabetes treatment is, of course, to keep blood glucose levels within normal limits. It is, however, necessary to point out that mild hypoglycemia will occur in patients from time to time. Even in experienced, well treated patients it may occur 2 –3 times a week.