Hypoglycemia

What is hypoglycemia? When blood glucose drops below normal levels, it is called hypoglycemia. Glucose, an important source of energy for the body, comes from food. Carbohydrates are the main dietary source of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods. After a meal, glucose is absorbed into the bloodstream and carried to the body’s cells. Insulin is a hormone that helps glucose conversion to energy in cells. If a person takes in more glucose than the body needs at the time, the body stores the extra glucose in the liver and muscles in a form called glycogen. The body can use glycogen for energy between meals. Extra glucose can also be changed to fat and stored in fat cells. Fat can also be used for energy. When blood glucose begins to fall, glucagon—another hormone made by the pancreas—signals the liver to break down glycogen and release glucose into the bloodstream. Normal levels then ensue. In some people with diabetes, this glucagon response to hypoglycemia is impaired and other hormones such as epinephrine, also called adrenaline, may raise the blood glucose level. But with diabetes treated with insulin or pills that increase insulin production, glucose levels can’t easily return to the normal range. Hypoglycemia can happen suddenly. It is usually mild and can be treated quickly and easily by eating or drinking a small amount of glucose-rich food. Confusion, clumsiness, and fainting occur when it is left untreated. Severe hypoglycemia can lead to seizures, coma, and even death. In adults and children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment. Hypoglycemia can also result, however, from other medications or diseases, hormone or enzyme deficiencies, or tumors. What are the symptoms of hypoglycemia? Some symptoms of hypoglycemia are: hunger shakiness nervousness sweating dizziness or light-headedness sleepiness confusion difficulty speaking anxiety weakness Hypoglycemia can also happen during sleep. Sleep signs are: crying out or having nightmares finding pajamas or sheets damp from perspiration feeling tired, irritable, or confused after waking up What causes hypoglycemia in people with diabetes? Diabetes Medications Hypoglycemia can occur as a side effect of some diabetes medications, including insulin and oral diabetes medications—pills—that increase insulin production, such as Other Causes of Hypoglycemia With people using insulin and pills, blood glucose levels that are low can be because of: meals or snacks that are too small, delayed, or skipped increased physical activity alcoholic beverages How can hypoglycemia be prevented? Diabetes treatment plans are designed to match the dose and timing of medication to a person’s usual schedule of meals and activities. Bad matches can be become hypoglycemia. For example, taking a dose of insulin—or other medication that increases insulin levels—but then skipping a meal could result in hypoglycemia. To help prevent hypoglycemia, people with diabetes should always consider the following: Their diabetes medications. Doctors will tell you which ones cause hypoglycemia and how to properly use them. For good diabetes management, people with diabetes should take diabetes medications in the recommended doses at the recommended times. In some cases, health care providers may suggest that patients learn how to adjust medications to match changes in their schedule or routine. Their meal plan. A registered dietitian can help design a meal plan that fits one’s personal preferences and lifestyle. Eating right is important. People with diabetes should eat regular meals, have enough food at each meal, and try not to skip meals or snacks. Snacks are particularly important for some people before going to sleep or exercising. Some snacks may be more effective than others in preventing hypoglycemia overnight. The dietitian can make recommendations for snacks. Their daily activity. To help prevent hypoglycemia caused by physical activity, health care providers may advise checking blood glucose before sports, exercise, or other physical activity and having a snack if the level is below 100 milligrams per deciliter (mg/dL) adjusting medication before physical activity checking blood glucose at regular intervals during extended periods of physical activity and having snacks as needed checking blood glucose periodically after physical activity Their use of alcoholic beverages. Hypoglycemia can be caused by drinking on an empty stomach. Heavy drinking can be particularly dangerous for people taking insulin or medications that increase insulin production. Alcoholic beverages should always be consumed with a snack or meal at the same time. A health care provider can suggest how to safely include alcohol in a meal plan. Their diabetes management plan. Intensive diabetes management—keeping blood glucose as close to the normal range as possible to prevent long-term complications—can increase the risk of hypoglycemia. Those whose goal is tight control should talk with a health care provider about ways to prevent hypoglycemia and how best to treat it if it occurs. What to Ask the Doctor about Diabetes Medications These are things you should ask your doctor: whether their diabetes medications could cause hypoglycemia when they should take their diabetes medications how much medication they should take whether they should keep taking their diabetes medications when they are sick whether they should adjust their medications before physical activity whether they should adjust their medications if they skip a meal How is hypoglycemia treated? Different people have different symptoms and signs of hypoglycemia. People with diabetes should get to know their signs and symptoms and describe them to their friends and family so they can help if needed. School staff should be told how to recognize a child’s signs and symptoms of hypoglycemia and how to treat it. People who experience hypoglycemia several times in a week should call their health care provider. Treatment plans may need to be changed: less medication or a different medication, a new schedule for insulin or medication, a different meal plan, or a new physical activity plan. Prompt Treatment for Hypoglycemia Blood glucose meters need to be checked if you think the blood sugar is too low. If the level is below 70 mg/dL, one of these quick-fix foods should be consumed right away to raise blood glucose: 3 or 4 glucose tablets 1 serving of glucose gel—the amount equal to 15 grams of carbohydrate 1/2 cup, or 4 ounces, of any fruit juice 5 or 6 pieces of hard candy 1 tablespoon of sugar or honey Recommended amounts may be less for small children. The child’s doctor can advise about the right amount to give a child. Recheck your blood sugar in fifteen minutes to make sure it is 70 mg/dL or above. If it’s still too low, another serving of a quick-fix food should be eaten. These steps should be repeated until the blood glucose level is 70 mg/dL or above. If the next meal is an hour or more away, a snack should be eaten once the quick-fix foods have raised the blood glucose level to 70 mg/dL or above. Help from Others for Severe Hypoglycemia Severe hypoglycemia—very low blood glucose—can cause a person to pass out and can even be life threatening. Severe hypoglycemia is more likely to occur in people with type 1 diabetes. People should ask a health care provider what to do about severe hypoglycemia. Another person can help someone who has passed out by giving an injection of glucagon. Glucagon will rapidly bring the blood glucose level back to normal and help the person regain consciousness. A glucogen emergency kit can be prescribed by your doctor. Family, friends, or coworkers—the people who will be around the person at risk of hypoglycemia—can learn how to give a glucagon injection and when to call 911 or get medical help. Physical Activity and Blood Glucose Levels Lowering blood sugar is a benefit of exercise. However, physical activity can make levels too low and can cause hypoglycemia up to 24 hours afterward. A health care provider can advise about checking the blood glucose level before exercise. For those who take insulin or one of the oral medications that increase insulin production, the health care provider may suggest having a snack if the glucose level is below 100 mg/dL or adjusting medication doses before physical activity to help avoid hypoglycemia. A snack can prevent hypoglycemia. Your doctor may want you to check your blood sugar more often. Hypoglycemia When Driving Hypoglycemia is particularly dangerous if it happens to someone who is driving. People with hypoglycemia may have trouble concentrating or seeing clearly behind the wheel and may not be able to react quickly to road hazards or to the actions of other drivers. Check your glucose levels before driving if you have hypoglycemia. During longer trips, they should check their blood glucose level frequently and eat snacks as needed to keep the level at 70 mg/dL or above. If necessary, they should stop for treatment and then make sure their blood glucose level is 70 mg/dL or above before starting to drive again. Hypoglycemia Unawareness Hypoglycemia unawareness is low blood sugar for diabetics, and some have no symptoms of it. This condition occurs most often in people with type 1 diabetes, but it can also occur in people with type 2 diabetes. People with hypoglycemia unawareness may need to check their blood glucose level more often so they know when hypoglycemia is about to occur. They also may need a change in their medications, meal plan, or physical activity routine. Hypoglycemia unawareness develops when frequent episodes of hypoglycemia lead to changes in how the body reacts to low blood glucose levels. When blood glucose is too low, the body stops releasing the hormone epinephrine. The loss of the body’s ability to release stress hormones after repeated episodes of hypoglycemia is called hypoglycemia-associated autonomic failure, or HAAF. Epinephrine causes early warning symptoms of hypoglycemia such as shakiness, sweating, anxiety, and hunger. Without the release of epinephrine and the symptoms it causes, a person may not realize that hypoglycemia is occurring and may not take action to treat it. When frequent hypoglycemia leads to HAAF and hypoglycemia a vicious cycle can occur, which in turn leads to even more severe and dangerous hypoglycemia. Studies have shown that preventing hypoglycemia for a period as short as several weeks can sometimes break this cycle and restore awareness of symptoms. Health care providers may therefore advise people who have had severe hypoglycemia to aim for higher-than-usual blood glucose targets for short-term periods. Being Prepared for Hypoglycemia People who use insulin or take an oral diabetes medication that can cause low blood glucose should always be prepared to prevent and treat low blood glucose by find out the triggers for low glucose having their blood glucose meter available to test glucose levels; frequent testing may be critical for those with hypoglycemia unawareness, particularly before driving a car or engaging in any hazardous activity always having several servings of quick-fix foods or drinks handy wearing a medical identification bracelet or necklace make a plan of what to do in case of severe hypoglycemia telling their family, friends, and coworkers about the symptoms of hypoglycemia and how they can help if needed  Hypoglycemia in People Who Do Not Have Diabetes Diabetics get these two types of hypoglycemia: Reactive hypoglycemia, also called postprandial hypoglycemia, occurs within 4 hours after meals. Fasting hypoglycemia, also called postabsorptive hypoglycemia, is often related to an underlying disease. Symptoms of both reactive and fasting hypoglycemia are similar to diabetes-related hypoglycemia. Symptoms may include hunger, sweating, shakiness, dizziness, light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness. Laboratory tests are used by doctors to determine the cause of hypoglycemia. Points to Remember Diabetes-related Hypoglycemia When people with diabetes think their blood glucose level is low, they should check it and treat the problem right away. To treat hypoglycemia, people should have a serving of a quick-fix food, wait 15 minutes, and check their blood glucose again. They should repeat the treatment until their blood glucose is 70 mg/dL or above. Quick fix foods should be kept in the car. People at risk for hypoglycemia should be careful when driving. They should check their blood glucose frequently and snack as needed to keep their level 70 mg/dL or above. Hypoglycemia Unrelated to Diabetes In reactive hypoglycemia, symptoms occur within 4 hours of eating. People with reactive hypoglycemia are usually advised to follow a healthy eating plan recommended by a registered dietitian. Certain medications, illnesses, enzymes, or hormone deficiencies cause fasting hypoglycemia. Treatment targets the underlying problem.

Compliments of Kshamica Nimalasuriya MD, MPH

Preventive Medicine & Public Health

Best Way to Take Cinnamon

 Best Way to Take Cinnamon

• Cinnamon has been used as a spice in several cultures for centuries. It was traditionally used to relieve stomach pain and gas; it is still used for these conditions today. The bark of two cinnamon species (Cinnamomum zeylanicum and Cinnamomum cassia) is used as a spice (cinnamon bark).
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• Cinnamon has been granted GRAS (Generally Recognized as Safe) status as a food additive by the U.S. Food and Drug Administration (FDA). GRAS substances are considered safe by the experts and not restricted, as is the case with other food additives.

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