DR. PONDER: Be prepared for low blood sugar

Low blood sugar (better known as hypoglycemia) is a down side of having insulin-requiring diabetes. The average person with diabetes, taking insulin or a blood sugar lowering medication, can expect an average of 5,000 episodes of low blood sugar in their lifetime. Granted, this statistic is usually applied to younger patients taking insulin shots to stay alive for decades.

If efforts are made to keep blood sugar readings as close to the non-diabetic normal range as possible, that prior prediction rises to 15,000 episodes of low blood sugar in an average lifetime. No one is really keeping count, but anyone with diabetes of any duration has most likely experienced several low blood sugar events. Some happen daily.

Low blood sugar can be categorized three ways: mild, moderate and severe. By far, most low blood sugar events are mild in severity. This is a practical definition. It means that the low sugar is sensed by the diabetic, or another person close by, and effectively self treated with a source of fast-acting carbohydrate such as hard candy, 4 ounces of fruit juice, or equal amount of a sugary soft drink. Blood sugars are generally between 55 mg/dl and 70 mg/dl. The signs and symptoms are numerous: fatigue, sleepiness, sweating, difficulty concentrating, pallor, irritability and rapid heart rate just to name a few.

Severe low blood sugar is when the person cannot self treat the problem because they are too impaired by the low blood sugar. This usually means a blood sugar level below 35 mg/dl, but the actual cutoff is different from person to person. Signs and symptoms include twitching, seizure like activity, irrational behavior or unconsciousness. Depending on the circumstances, cause and the duration of the low sugar level, the person may come out of the event, have serious residual complications, or even die. This is every diabetic’s greatest deep seated fear.

I should add that moderate low blood sugar falls between mild and severe. The blood sugar is usually between 35 mg/dl and 55 mg/dl and the person requires help to treat the problem. If driving, you’ll be just as impaired as a drunk driver and appear intoxicated to others in how you slur words or deny that you have a problem. The person is still fairly alert and partly able to assist in his/her own treatment with the help of another person assuming they don’t resist help. But if no treatment is given, severe low blood sugar is imminent.

Treatment for low blood sugar is 15 grams of fast acting carbohydrate by mouth. It’s best to check the blood sugar first to make sure you know what you are treating. Plus it is even more important to check your blood sugar 15 minutes after treating to ensure the blood sugar level is rising. If not, the treatment should be repeated and rechecked in another 15 minutes until a more acceptable result is reached.

Every diabetic who takes insulin or a sulfonylurea drug to manage their blood sugar should have a glucagon emergency kit in their home and someone who knows how and when to use it properly. Glucagon is a hormone that triggers release of sugar from inside the body to combat a severe low blood sugar. In most cases it is used to treat severe low blood sugar or an impending severe low. It is prepared from a powder and liquid solution in separate vials, then immediately given as a shot into the arm, leg or hip. Within 20 minutes, blood sugar levels will start to increase. Nausea is a common side effect in the next hour or so. This allows the caregiver to make other arrangements to treat the diabetic, such as calling 9-1-1. Glucagon emergency kits are a prescription item. Unused kits expire after a couple of years. Make sure your kit is current.

Keeping low blood sugars at bay is a challenge for every diabetic. New tools and self care techniques are available to reduce their risk, but it takes your time and interest to learn and apply them. Continuous glucose monitoring devices are very helpful and can reduce episodes of severe low blood sugar if used properly.

Contact him at swponder@gmail.com, or follow him at twitter.com/dr_steve_ponder.