Hypoglycemic Reaction
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Friday, March 31, 2006 |
Q: "I've been diagnosed as type 2 since March of this year with a BG of 547 (I had infections). I take one 10 mg Glucotrol® in the morning and one 500 mg Metformin in the morning and one in the afternoon. I was ready for the high BG but sometimes I go as low as 54 or 60 if I skip a meal or work hard physically. Has my body lost the ability to regulate my body sugar entirely? I was ready to fight the highs but nobody told me about the lows."
A: It sounds like you were not taught how your diabetes medication works and what the side effects are.
First, I must urge you to call your doctor for help, as well as to ask for a referral to a diabetes educator for some diabetes education ASAP.
Next, I'd recommend you read the related question below titled “Long-term effects of oral agents” which talks about how different pills work.
In this Q&A you'll learn that Glucotrol (also called Glipizide) stimulates the pancreas to produce more insulin; if you miss a meal or you are more active than usual, your glucose can go too low. It is not related to your body's inability to regulate the glucose, but rather that "you can't take your pill back" meaning that if you took this medication, you should have been told that you cannot skip a meal and that extra activity might cause a low glucose.
I’ll review Hypoglycemia related to diabetes pills and insulin:
Defined: Hypoglycemia means low blood glucose. Various textbooks define hypoglycemia as glucose below 50 or 60 mg/dl. Many diabetes clinics define hypoglycemia clinically as glucose below 70mg/dl if you are taking diabetes medication. You need to confirm this specific level with your doctor. Note: technically, if you were not taking diabetes medication, you could not get too low.
Causes:
- Too much diabetes medication (insulin or oral agent)
- Too little food, or too little carbohydrate
- A delayed or missed meal
- Too much exercise
- Alcohol on an empty stomach
Symptoms: Each person’s reaction can have different symptoms, and it is unlikely that you would have all of these:
- Nervousness
- Shakiness
- Hunger
- Light-headedness
- Weakness, fatigue
- Poor coordination
- Headache
- Irritability, sadness, or anger
- Mental confusion or lack of concentration
- Numbness, tingling of lips or fingers
- Tongue feels thick; speech is difficult or slurred
- Night time symptoms: nightmares, palpitations, restless sleep, night sweats, early morning headache, or confusion
- If unrecognized and left untreated, could result in severe symptoms of convulsions or loss of consciousness (generally related to someone taking insulin, and this is a rare occurrence)
- Also note that some people have lost their ability to recognize low blood glucose, which is called hypoglycemia unawareness.
Treatment:
- Ideally test first to determine if your glucose is low. However, if you are unable to test your glucose, treat your symptoms immediately. Note: you should first ask your doctor to advise you at what level of blood glucose is considered too low for you.
- Treat with: a rapidly absorbing sugar food/drink of 15-20 grams of carbohydrate, such as: 3-5 glucose tablets, glucose gel (these are products specific to treating hypoglycemia, which you can find in any pharmacy), ½ can of regular soda, 4-6 ounces of fruit juice, or 3-5 teaspoons of sugar or sugar packets. Chocolate and candy bars are not recommended because the fat in these foods slows down the absorption of the glucose. Likewise, hard candies are not the first choice, as they can take longer to absorb.
- Wait 15 minutes. If you don’t feel better, repeat the treatment with sugar. If your blood glucose is still too low and/or you are having trouble functioning, call your doctor.
- Eat a snack (such as ½ sandwich or a few crackers with peanut butter or cheese) unless the mealtime is within ½ hour.
- For severe hypoglycemia if you were confused or unable to take anything orally, someone could administer Glucagon. This would generally apply only if you are taking insulin.
Evaluate and Prevent Problems:
- Try to analyze why the hypoglycemia occurred. If you don’t know, or if the symptoms were severe, call your doctor.
- Make sure to note this event in your logbook.
- Learn your body’s warning signs so you know what to do.
- Carry a snack (and keep snacks available at work and in your car) in case your meal is delayed.
- Talk to your healthcare team about how to handle exercise: options are either to decrease your medication before exercise, or to take extra carbohydrates before unexpected activity.
- Always wear diabetes identification.
- Educate family members, friends and coworkers about the symptoms and treatment of hypoglycemia.
Please discuss this with your doctor and diabetes educator so they can help sort it all out for you. But as you can tell, as long as you are taking a medication that can stimulate insulin release, it is important to not skip meals, and to plan ahead before strenuous activity.
Related Questions
Hypoglycemia Unawareness
Q:
"I never feel myself going low until I'm there so I need to remember to
take a snack before I exercise. Why don't I get a warning? I used to but don't
anymore and I'm insulin resistant too."
Long-term effects of oral agents
Q:
"I currently take Avandia® 4mg twice daily and Glucophage® 850mg twice
daily. My typical fasting is 120. My question is: What are the long-term
effects of the two drugs I ..."
The effect of alcohol on blood glucose
Q:
How does alcohol consumption affect blood glucose levels? What is a rule of
thumb when considering alcohol intake? What amount is allowed, and do you take
extra diabetes medication for alcohol? What, ..."
Related Links
American Diabetes Association (ADA)
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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