Treating Hypoglycemia in Diabetes

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Treating Hypoglycemia (mild) in Diabetes

(blood sugars under 4 mmol or 70 mg/dl )

Education on treating hypoglycemia is essential if you take insulin or insulin producing pills. As a diabetes educator I'm frequently counselling people on the importance of recognizing the symptoms of lows and treating immediately. Few people are aware of the dangers of lows during driving - and that a driver's license can be suspended because of hypoglycemia.

One treatment for hypoglycemia is:

15 grams of glucose (B-D glucose tabs; Walgreens Glucose; Dextrosol etc - see your pharmacist and check the label to take the right amount to equal 15 grams of carb). This is the best treatment.
6 Life Savers candy (if each is=2.5 g carb)
3/4 cup (175mL) Regular soda pop
1 tablespoon (15 mL) honey
1 tablespoon (15 mL) sugar dissolved in water

Wait 15 min and check blood glucose levels.. If not above 4 mmol or 70 mg/dL, treat again.

Why is glucose the best?

Since glucose is the form of fuel in the bloodstream, any pure glucose product is a fast fix to most low blood sugars. Glucose afterall, has a glycemic index of 100, assuming it is eaten alone and without other foods to slow it down.

Sucrose (white table sugar) most often has a glycemic index in the mid to high 60s. Sucrose is one part glucose which is fast and one part fructose which is slow since it must be converted into glucose. This makes sucrose a medium speed sugar. Still, it works well as a treatment in raising low blood sugar.

Orange juice has a glycemic index of 47 since it is mostly fructose and must be converted into glucose. It will work - but slowly for most people. Not the best choice. Milk too is very slow with a glycemic index of 32-40.

Picture glycemic index like miles per hour. Imagine being at the start line on a racetrack. You can choose one of two cars. The one that goes 100 mph or the one that goes 47 mph. Of course, you want the quickest - choose the glucose!

Avoid Overtreating Hypoglycemia

Quite frequently I hear patients with diabetes complain of how long it takes them to feel better after treating hypoglycemia. Because of this, they tend to eat more or what we call "overtreat", which results in high blood sugars later. To avoid overtreating hypoglycemia when you have diabetes consider the following:

Use the fastest treatment - glucose tablets.
Have glucose tablets in purse, in wallet, in meter case, in car, or on the bedside table with a glass of water already there. So you don't need to think "now what do I take?" This avoids you raiding the kitchen cupboards for anything and everything.
Use the RIGHT amount. 15 grams of carbohydrate from glucose. One glucose tablet won't do.
Treat low blood sugars even if they are before the meal. Wait 10-15 minutes. Don't just eat the meal without treating. There's nothing worse than a low blood sugar on a full stomach! Yes, this can happen when blood sugars drop faster than the slow food of the meal gets into the blood. Avoid this, use glucose first before anything slow gets into your stomach.

Important if Treating Hypoglycemia and on Alpha-glucosidase Inhibitors

Acarbose, Prandase, Precose, Miglitol or Glyset are alpha-glucosidase inhibitors used in the management of diabetes. People on these pills should treat low blood sugars with glucose. NOT WHITE TABLE SUGAR OR CANDY, which are mostly sucrose. Alpha-glucosidase inhibitors slow the breakdown of sucrose into its two parts - glucose and fructose. So treating hypoglycemia with table sugar while on these pills with be very, very slow. This is not what you want. Of note, these pills alone do not cause the low blood sugar. You must be on other diabetes pills or insulin along with an alpha-glucosidase inhibitor to be concerned with this warning.

Treating Hypoglycemia that is Severe

Severe hypoglycemia exists when the person experiencing the low sugar cannot treat the problem himself. People with a history of severe hypoglycemia, hypoglycemia unawareness or those on insulin (particularly those with type 1 diabetes) should consider talking with their doctors about keeping a glucagon kit at home. Treating hypoglycemia with glucagon usually means another person is acting to treat the low for you.

Glucagon can be injected into muscle or fat by a family member or friend. It is a hormone that tells the liver to make sugar. So essentially, it has the opposite action of insulin. If glucogon is used for treating hypoglycemia, emergency services should still be called.

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Symptoms of low blood sugar.
Causes of Hypoglycemia: common and rare
Hypoglycemia: definition and concerns.
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Reference: Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2003;27(Suppl 2):S1-152. 2005

University of Sydney, Australia. Glycemic Index Database, 2005.

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