Past Feature Article

Understanding and Treating Hypoglycemia.

By: Ethel Bailey, Rite Aid Pharmacist and Diabetes Care Specialist at Store 5292 in Wenatchee, Washington

What is Hypoglycemia?

Hypoglycemia, or low blood sugar, can be defined as blood sugar levels less than 70 mg/dL. As a newly diagnosed person with diabetes starting on insulin or certain oral medications, such as sulfonylureas, it is important to understand the causes and treatment, and be aware of the symptoms of hypoglycemia.

Symptoms of Hypoglycemia

The more common symptoms include:

Fast heart beat (tachycardia), palpitations or a pounding heart
Shakiness
Sweating
Irritability
Confusion
Visual disturbances
Hunger
Emotional outbursts
Unconsciousness

Some people may experience hypoglycemia without being aware of it since they may not be experiencing the more common symptoms mentioned above. This person may only experience:

Slowed thinking
Blurry vision
Slurred speech
Clumsiness
Numbness
Dizziness
Fatigue
Sleepiness

A person may experience mild symptoms of hypoglycemia at normal blood glucose levels depending on how fast a person’s blood glucose levels are dropping, or the person’s normal blood glucose control. It is therefore important to test before treating.

People with reduced hypoglycemic awareness are at an increased risk of having severe hypoglycemia and should test their blood glucose levels more frequently. Not only does the person with diabetes need to be aware of the symptoms and treatment of hypoglycemia, but also friends, family, and co-workers, in case the episode is severe.

Causes of Hypoglycemia

What may cause a hypoglycemic episode?

Taking too much insulin or oral medication
Delaying or missing meals
Drinking too much alcohol without eating enough food, especially after injecting insulin
Exercising when insulin is peaking or when enough food containing carbohydrates has not been eaten

Follow the 15/15 Rule in the Treatment of Hypoglycemia

Treatment of hypoglycemia is dependent upon severity. All treatments follow the 15/15 rule with variations on treatment after the occurrence. The 15/15 rule is to consume 15 grams of carbohydrate and recheck blood sugars in 15 minutes. This process should be repeated until blood glucose levels reach normal levels.

Quick Carbohydrates for Treating Hypoglycemia

15 grams of quick carbohydrates can be obtained from:

Glucose tablets 3 to 4
Lifesaver candies 8 to 10
Hard candies 8-10
Raisins 2 tablespoons.
Nondiet soft drinks 4-6 ounces
Fruit juice 4-6 ounces
Milk (no fat or low fat) 8 ounces

One should avoid foods such as ice cream, doughnuts, candy bars, cheese, pizza, French fries, milk shakes, and potato chips since they have a high fat content and are not rapidly absorbed.

How a Person with Diabetes can Treat Hypoglycemia

If a person with diabetes is experiencing mild hypoglycemic symptoms, including a racing and pounding heart beat, shakiness and irritability, the person may feel the need to eat something immediately. However blood sugar levels should be checked before beginning treatment. It is important not to over-treat a blood sugar reaction, as this may result in hyperglycemia (or high blood sugar). Hence the 15/15 rule: Consume 15 grams of carbohydrate, recheck blood sugars in 15 minutes as mentioned above.

Treating Moderate Hypoglycemia

A person with moderate hypoglycemia usually presents with confusion, slurred speech, blurred vision, extreme fatigue, drowsiness, and the inability to concentrate. In this case, treatment needs to be immediate using the 15/15 rule.

Test blood glucose level, consume 15 grams carbohydrate, check blood glucose in 15 minutes.
If levels are still low, the person needs to consume another 15 grams carbohydrate and continue to follow the 15/15 rule until his or her blood glucose levels reach normal levels.
If the person’s next meal is greater than an hour away, blood glucose levels may drop again, so the quick acting carbohydrate should be followed by a small snack containing protein.

Treating Severe Hypoglycemia

Severe hypoglycemia impairs a person to the point where they need assistance with treatment. Symptoms may include loss of consciousness, seizures, and being unable to be awakened. Blood glucose levels are usually 40-50 mg/dl. This usually occurs at night and may go undetected. This is frequently seen in a person new to insulin therapy, so it is often advised that people starting insulin or having changes made in their therapy should check their blood glucose level at 3 am. Treatment of severe hypoglycemia involves an assessment by asking a quick question: Can the person swallow?

If yes, give glucose gel, honey, or jelly in the side of the mouth.
If not, inject glucagon IM or SQ remembering this may cause some nausea or vomiting.
Once the person regains consciousness, give a rapid acting carbohydrate source such as orange juice, then a small snack or meal.
Monitor the person closely for a couple hours to be sure blood glucose level does not drop again.
A person who experiences a severe episode of hypoglycemia should also contact their physician.

Where to Get Support

Work with your diabetes care team to establish an action plan so you and your family understand how to recognize and properly treat the symptoms of hypoglycemia. At any time, you can consult with a Rite Aid Pharmacist or Diabetes Specialist at your local Rite Aid. Of course, you can also learn more about hypoglycemia at RiteAidDiabetes.com.