Preventing hypoglycemia

Carefully following the diabetes management plan you and your doctor developed is vital in preventing hypoglycemia. Your diabetes management plan is designed to match the dose and timing of your medication/s to your usual schedule of meals and activities. Any mismatch in your medication/s and meals/activities could result in hypoglycemia. For example, if you inject insulin or take an oral diabetes medication that increases insulin levels (e.g., sulfonylurea or glinide) and then skip a meal or exercise vigorously, you are likely to develop hypoglycemia.

To lower hypoglycemia risk, take your diabetes medications in the recommended doses at the recommended times. Your doctor can teach you how to adjust your medications to match changes in your schedule or routine. Meals should be taken consistently in terms of timing and portion size. Check your blood glucose with a glucometer before engaging in sports, exercise or other physical activities; have a snack if the level is below 100 milligrams per deciliter (mg/dl).

You can also adjust your medication before physical activity. Check your blood glucose at regular intervals during extended periods of physical activity and have snacks as needed. Check your blood glucose periodically after physical activity as well.

Never drink alcohol on an empty stomach—this can cause hypoglycemia even a day or two later. Always drink alcohol with a meal or snack. Drink moderately; heavy drinking is very dangerous for people taking insulin or oral medications that increase insulin production.

Be aware of common hypoglycemia signs and symptoms (these were discussed in the previous column). If you think you are hypoglycemic, eat any of the following foods immediately to raise your blood glucose: half a cup of any fruit juice or regular (not diet!) soft drink; five or six pieces of hard candy; a tablespoon of sugar; or 2 tablespoons of raisins.

If you experience hypoglycemia several times a week, consult your doctor: You may need a change in your diabetes management plan. Your doctor may lower your medication dose or prescribe a different medication. Your doctor may also draw up a new insulin or medication schedule or revise your meal plan or physical activity plan.

Hypoglycemia symptoms usually develop when blood glucose levels fall below 70 mg/dl. However, many people have blood glucose readings below this level and feel no symptoms. This condition is called hypoglycemia unawareness. People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night.

Hypoglycemia unawareness occurs more often in individuals who experience frequent episodes of hypoglycemia which can desensitize or “numb” them from the early warning signs of hypoglycemia. Those who have had diabetes for a long time and those who tightly control their diabetes, i.e. their blood glucose levels are always within normal or near-normal range (this increases hypoglycemia risk), are also at risk for hypoglycemia unawareness. Certain medications like beta blockers may also cause hypoglycemia unawareness.

If you think you have hypoglycemia unawareness, talk to your doctor. Your doctor may adjust your blood glucose targets to minimize your risk for hypoglycemia unawareness and prevent future hypoglycemic episodes.

DIABETES TRIVIA

CONTEST: At what blood glucose level does hypoglycemia symptoms usually occur? E-mail your answer to [email protected] and get the chance to win a prize! Congratulations to Darwin Loro! Your correct answer to the question in the Sept. 14, 2013 column was chosen as this week’s winner in the Diabetes Trivia Contest. You will receive an e-mail on how to claim your prize.

Dr. Susan Yu-Gan is  a  diabetes specialist and immediate past president of Diabetes Philippines. The “Changing Diabetes” column commemorates the 92nd anniversary of insulin’s discovery. It aims to increase awareness on diabetes prevention, diagnosis and management. Novo Nordisk supports “Changing Diabetes.” Headquartered in Denmark, Novo Nordisk is a global healthcare company with 90 years of innovation and leadership in diabetes care. For questions or comments, e-mail [email protected].