Hypos and me
Hypoglycaemia (Hypo) is my most disliked part of diabetes. Despite continuously monitoring my blood glucose (BG) I still get hypos. On the brighter side, I am able to see glucose trends and prevent some hypos since I started using * FreeStyle Libre. Unfortunately, it is impossible to prevent them all, especially at night. Everything in this article is my own opinion and based on my experience and research. It is not medical advice.
Hypoglycaemia is a serious and potentially life-threatening complication of insulin-treated diabetes and occurs when blood glucose (BG) level drops below 4.0 mmol/l (72 mg/dl). See http://theartisandiabetic.ie/hypoglycemia-hypo/ for details.
In http://theartisandiabetic.ie/hypoglycemia-hypo/ I have detailed the possible reasons for and the prescribed method for dealing with hypos. My hypos don’t fall into nice neat packages. I might be able to prevent one, have a very mild one and the next one could involve a quickly dropping BG during the day or night. Sometimes taking the prescribed 15 grams of fast acting carbs, followed by slower acting carbs works well, but mostly it sends my BG into orbit, so I take hypos on a case by case basis.
My ‘go to’ items for hypos depends on whether it is slowly or quickly dropping BG, how much fast acting insulin I have in my system, when and what I have eaten recently and whether I am exercising or not. I confirm my hypo symptoms with a finger blood test.
My aim is to get my BG back into normal range quickly, without overdoing the quick acting carbs and ending up with a high BG later on. I want to be able to do this wherever I am and with the least amount of inconvenience. To achieve this I always carry several types of fast acting carbs. Depending on the low BG or severity of the hypo I will choose the best option to take. Logical thinking can be severely affected by low blood sugar which adds to the challenge.
In the right-hand corner of the main picture are the outright winners for stopping a low blood sugar in its tracks. Glucose is the quickest acting remedy for a hypo. It is the body’s preferred method of raising BG because it requires less digestion than sugar before it is delivered to the bloodstream.
Glucose is available in supermarkets or pharmacies in the form of glucose powder, liquid glucose, glucose tablets or gels. I always have it available. Dextro Energy tablets and Lift fast acting glucose chews are my preference for pockets and bags. Glucogel tubes become very messy once opened and the top can’t be put back on, so I have ruled them out for handbags and pockets. It’s bad enough feeling a bit ugh after a hypo without having sticky glucose gel in your hair! They are fine for anywhere you can dispose of the tube immediately afterward.
Glucagen HypoKit is available on prescription and it helps to counteract critical low blood sugar episodes (severe hypo) in an unconscious diabetic. It is prescribed to be administered by another person, but if I had an emergency where I couldn’t take an edible form of glucose fast enough to bring up my BG I would take it myself. E.g. I have given a large dose of fast acting insulin (bolus) instead of background (basal) insulin by mistake and couldn’t consume enough quick acting carbs to stay safe or was so sick that I couldn’t drink juice or eat anything but BG was very low. It contains a hormone which forces the liver to release glucose into the bloodstream. I always have 2 in my fridge and I take it with me for all overnight stays for emergencies.
I used to rely on Lucozade or jelly sweets to bring up my blood sugar when I had a hypo, but Lucozade is no longer effective, due to the reduction of sugar in the formula. It isn’t as effective to drink twice as much to get the same amount of sugar……….the more liquid the more diluted the sugar becomes. Sugar in these drinks has been replaced with lots of unhealthy additives too. No thanks!
Now I prefer to use healthier alternatives like fresh fruit juice, honey or plain old sugar. I can get the benefits of the honey or the fruit as well as increasing BG. Sugar has fewer harmful additives than many labeled hypo treatments.
There are lots of different brands of dried fruit and fruit bars available which work well for hypos. Drying or juicing fruit brings it into the fast acting carbs category, similar to sugar. I pick ones which only contain dried fruit. Bars containing nuts or any other fat, protein or fiber aren’t suitable because they slow the rate in which the sugar in the bar gets to work. The ones in the picture contain 20g of carb per bar and are available in Aldi. Sometimes a full bar or packet will send my glucose levels through the roof, so restraint is needed!
For BG that has dropped or is dropping but not very quickly I like to choose a healthy option. These could include fresh fruit juice, honey or regular sugar. If my glucose level is in a normal range but too low to go for a long walk I eat a banana to help prevent a hypo.
I used to use jelly sweets, but not since I researched the ingredients in them! Sweets aren’t the best option but if you go for that option make sure it is a glucose type sweet and not a chocolate type. An example is Jakeman’s Honey & Lemon menthol sweets, available at most pharmacies. You have to do the maths for the carbs yourself for these. There are 15 sweets in a pack, which weighs 100 grams. There are 97.6 grams of carbohydrate, 91.5 grams from sugar in each 100 grams. Each sweet contains 6.5 grams of carbohydrate, 6.1 grams from sugar. One or two of these will often see off a dropping BG or a very mild hypo.
Sorry to say, chocolate or cake is too slow to raise BG at any kind of speed!
Regular sugar works well for a dropping BG or a very mild hypo. A couple of spoons of sugar in a coffee or a milky coffee will see off a dropping blood sugar, depending on what it is. Glucose is best for an actual hypo.
The little packets of sugar usually contain 4g of carbohydrate per packet and are handy if you are running low on glucose tablets.
Sugar lumps vary in size, but 5 of the small ones contain approx. 15g of carbohydrate. Not a great option – who wants to eat 5 or 6 sugar lumps? OK in an emergency.
Sugar has fewer additives than sweets and fizzy drinks. Cheap and always available, no matter where you go!
* FreeStyle Libre is a continuous glucose monitor (CGM) which measures glucose in extracellular (cell) fluid which surrounds all cells in the body. Glucose comes from food that we eat and some is secreted by the liver. Lots of things contribute to blood glucose levels, but that is a discussion for another day. Our body digests food by mixing it with acids and enzymes in the stomach. The digestive process breaks down food containing carbohydrate (starch and sugar) into glucose. The stomach and small intestine absorb the glucose and release it into the bloodstream. It is at this point that blood glucose tests are performed using conventional meters for personal use by people with diabetes. From there glucose is distributed through cell fluid to the parts of the body that need it for energy. It is at this point that FreeStyle Libre measures glucose.