UNDERSTANDING HYPOGLYCEMIA IN DIABETES

Hypoglycemia, which is defined as blood glucose levels below 3.5 mmol/L (63 mg/dL), is a common complication of diabetes. It most often occurs due to insulin therapy, occasionally from the use of oral medications like sulfonylureas, and in very few cases, with other anti-diabetic drugs. For people with type 1 diabetes, hypoglycemia is a frequent challenge.

How The Body Prevents Low Blood Sugar

In healthy people, the body has several mechanisms to maintain stable blood sugar levels. When blood glucose begins to drop:

The pancreas suppresses insulin release to prevent further glucose reduction.
More glucagon is released, prompting the liver to release stored glucose.
The autonomic nervous system is activated, releasing stress hormones like adrenaline, cortisol, and growth hormone. These hormones reduce glucose use in the body and encourage glucose production by the liver to ensure a steady energy supply to the brain.

However, for people with type 1 diabetes, injected insulin continues to work regardless of falling glucose levels, as it cannot be regulated naturally. This contributes to the increased prevalence of hypoglycemia in Type 1 diabetes as opposed to Type 2 diabetes.

Recognising Hypoglycemia

Some symptoms of hypoglycemia include:

Shaking
Sweating
Confusion
Dizziness
Rapid heartbeat
Anxiety
Difficulty concentrating
Seizures (in severe cases)

Symptoms may vary based on age, duration of diabetes, and individual differences. Learning to recognise these early signs is a crucial part of managing diabetes.

Hypoglycemia is classified by severity:

Mild hypoglycemia can be self-treated.
Severe hypoglycemia requires help from someone else for recovery.

Risk Factors and Triggers

People with diabetes who take insulin or sulfonylureas may experience hypoglycemia due to:

Skipping or delaying meals.
Increased physical activity without adjusting medication or food intake.
Excessive alcohol consumption.
Incorrect insulin dosage.

Severe hypoglycemia can lead to serious complications, such as seizures, coma, or even death in rare cases. One example is the “dead-in-bed syndrome,” where a healthy young person with type 1 diabetes dies unexpectedly in their sleep due to what is suspected to be hypoglycemia-induced heart rhythm problems.

Nocturnal Hypoglycemia

Hypoglycemia during sleep is common among people with type 1 diabetes but often goes unnoticed. Symptoms may include:

Poor sleep quality.
Morning headaches.
Nightmares or vivid dreams.
Sweating
Restlessness or seizures observed by a partner.

The most reliable way to detect nocturnal hypoglycemia is by checking blood sugar levels during the night.

Hypoglycemia from Exercise

Physical activity can trigger hypoglycemia in well-controlled people using insulin. Exercise increases the body’s glucose usage, and without proper adjustments in insulin or food intake, blood sugar levels can drop dangerously low.

Treatment of Hypoglycemia in Diabetes

Hypoglycemia requires prompt action to restore blood sugar levels to normal. Here’s a simple guide to managing hypoglycemia in diabetes:

The first step in treatment is recognising the symptoms or confirming low blood sugar with a glucose test, if available.
Take some sugar. You can drink a glass of soda or fruit juice, lick a tablespoon of sugar or honey, or lick some glucose powder.
Check your blood glucose level in 15 minutes. If it’s still low, take some more sugar.
In severe cases, glucagon may be administered by a medical practitioner.
To prevent any more episodes, the trigger is identified and managed.

Conclusion

Hypoglycemia is a challenging aspect of living with diabetes, particularly for those on insulin therapy. Recognising the symptoms, understanding the triggers, and learning effective prevention strategies can significantly improve the quality of life for people with diabetes. Regular education and support from healthcare providers are essential for managing and minimising the risks of hypoglycemia.