Hypoglycaemia (low blood glucose level)
In Leeds, we want people with diabetes and the people around them to be aware of hypoglycaemia so they know how to recognise it and how to manage it.
Glucose is a sugar carried in the bloodstream that your body uses for energy. If you have diabetes and take certain treatments like sulphonylureas (Gliclazide or Glimepiride) and insulin, your blood glucose levels can sometimes become too low.
Hypoglycaemia (or a “hypo”) and is when your blood glucose level drops below 4 mmol/L.
Do test your blood glucose levels if you feel that you are having a hypo.
What are the symptoms?
Early signs and symptoms of a hypo include:
- Tingling of the lips
- Hunger
- Palpitations
- Trembling and shaking
- Becoming pale
- Sweating heavily
- Feeling anxious
Symptoms may vary from person to person, but you will feel “different” very quickly.
If you miss these early signs, the symptoms may get worse and include:
- Slurring your words.
- Behaving oddly
- Being unusually aggressive or tearful.
- Having difficulty concentrating.
If you do not treat your hypo at this stage, you may become unconscious.
Who gets a hypo?
- If you are injecting insulin or taking diabetes medications such as Gliclazide or Glimepiride, which make your body produce more insulin, then you may be at risk of hypos.
- If you are not sure how your diabetes medications work, discuss this with your local pharmacist or diabetes team.
What causes a hypo?
A number of situations can cause a hypo:
- Drinking too much alcohol or drinking alcohol without food
- Too much insulin or too much diabetes medication.
- Delayed or missed meals
- Eating less starchy foods than usual
- Unplanned or strenuous activity
- Incorrect insulin injection technique
Sometimes there is no obvious cause, but treatment should always be carried out immediately.
How to treat a hypo
If you recognise that you are having a hypo, you should treat it immediately with something that will raise your blood glucose quickly.
Suitable quick-acting glucose treatments to provide 15g to 20g carbohydrate are:
- 200ml (a small carton) of smooth orange juice
- 60 ml Glucojuice (Lift)
- 5 Glucotabs (Lift)
- 6 Dextrose tablets
- 5 standard jelly babies
If you do not feel better after 10 to 15 minutes (or your blood glucose level is still less than 4 mmol/L) repeat 1 of these treatments.
When you start to feel better, and if you are not due to eat a meal, eat some starchy food, like 2 plain biscuits or a small banana.
If you cannot treat the hypo yourself, but you are still conscious and able to swallow, someone can give you glucose gel if you have this available.
You will need 2 tubes of glucose gel to treat a hypo.
How to avoid hypos
- Eat three regular meals a day and include a small portion of starchy carbohydrate at each meal, such as bread, rice or potatoes.
- You may need to eat more carbohydrate before and after physical activity.
- Keep to sensible alcohol limits and avoid drinking on an empty stomach.
- Take your medication at the recommended dose and times.
- If you are testing your blood glucose levels and notice your readings are regularly dropping, discuss this with your diabetes team as you may need a change in medication or your insulin adjusting.
- Always carry glucose with you to treat hypos quickly.
If you become unconscious, you will need immediate emergency treatment.
Someone should dial 999 for an ambulance. You should be put on your side with your head tilted back.
Glucose treatments should not be put in your mouth if you are unconscious.
Driving and hypos
- Keep glucose treatments in the car within easy reach at all times.
- Check your blood glucose before driving and every 2 hours if it is a long journey.
- Your blood glucose level should be more than 5 mmol/L to drive.
If you have a hypo while driving, stop the car as soon as possible. Remove the keys to demonstrate you are not in charge of the car and move into the passenger seat if safe to do so. Treat the hypo as advised.
You should not drive for at least 45 minutes after recovering from a hypo because your response rates will be slower.
The DVLA has guidance in place for reporting episodes of hypoglycaemia. It is important that you notify them in line with this guidance. The latest Medical Standards of Fitness to Drive can be found on the DVLA website.
Remember:
- Having a hypo means that your blood glucose level is too low (less than 4mmol/l).
- Act immediately by eating or drinking something that will raise your blood glucose quickly.
- Never ignore the warning signs.
- Make sure other people know what to do when you are having a hypo.
- Always carry glucose and diabetes identification.
Consequences of frequent hypos:
- You may not recognise future hypos.
- Fear and anxiety of getting further hypos.
- Effects on employment and driving.
If you are concerned about anything within this section, please discuss this with your healthcare professional.
