Updated July 25, 2006

Understanding Hypoglycemia

by Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E., and Belinda O’Connell, M.S., R.D., C.D.E.

Avoiding hypoglycemia
Avoiding all episodes of hypoglycemia may be impossible for many people, especially since maintaining tight blood glucose control brings with it a higher risk of hypoglycemia. However, the following tips may help to prevent excessive lows:

• Know how your medicines work and when they have their strongest action.
• Work with your diabetes care team to coordinate your medicines or insulin with your eating plan. Meals and snacks should be timed to coordinate with the activity of your medicine or insulin.
• Learn how to count carbohydrates so you can keep your carbohydrate intake consistent at meals and snacks from day to day. Variations in carbohydrate intake can lead to hypoglycemia.
• Have carbohydrate-containing foods available in the places you frequent, such as in your car or at the office, to avoid delays in treatment of hypoglycemia.
• Develop a plan with your diabetes care team to adjust your food, medicine, or insulin for changes in activity or exercise.
• Discuss how to handle sick days and situations where you have trouble eating with your diabetes team.
• Always check your blood glucose level to verify any symptoms of hypoglycemia. Keep your meter with you, especially in situations where risk of hypoglycemia is increased.
• Wear a medical alert identification tag.
• Always treat blood glucose levels of 70 mg/dl or less whether or not you have symptoms.
• If you have symptoms of hypoglycemia and do not have your blood glucose meter available, treatment is recommended.
• If you have hypoglycemia unawareness, you may need to work with your diabetes care team to modify your blood glucose goals or treatment plan.
• Check your blood glucose level frequently during the day and possibly at night, especially if you have hypoglycemia unawareness, are pregnant, or have exercised vigorously within the past 24 hours.
• Check your blood glucose level before driving or operating machinery to avoid any situations that could become dangerous if hypoglycemia occurred.
• Check the expiration date on your glucagon emergency kit once a year and replace it before it expires.
• Discuss alcohol intake with your diabetes care team. You may be advised not to drink on an empty stomach and/or to increase your carbohydrate intake if alcohol is an option for you. If you drink, always check your blood glucose level before bed and eat any snacks that are scheduled in your food plan.

Don’t risk your health
Although hypoglycemia can, at times, be unpleasant, don’t risk your health by allowing your blood glucose levels to run higher than recommended to avoid it. Meet with your diabetes care team to develop a plan to help you achieve the best possible blood glucose control safely and effectively. Think positive, and learn to be prepared with measures to prevent and promptly treat hypoglycemia should it occur.

Laura Hieronymus is the program coordinator/nurse educator for Drs. Borders and Associates, PSC, an American Diabetes Association–recognized education service in Lexington, Kentucky. Belinda O’Connell is a Diabetes Nutrition Specialist at the International Diabetes Center in Minneapolis, Minnesota, and a freelance health and science writer.

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