Hypoglycemia, or low blood glucose, is one of the most feared consequences of diabetes treatment in people who use certain diabetes medicines. Part 2 of this video interview series with Gary Scheiner, MS, CDE, the AADE’s 2014 Educator of the Year, addresses strategies for preventing lows.
Hypoglycemia Part 2: Strategies for Prevention
Gary Scheiner, Owner and Clinical Director, of Integrated Diabetes Services in Wynwood, Pennsylvania.
How to Prevent Hypoglycemia?
Preventing hypoglycemia really starts with how to match ones’ insulin or medication to what their day is like, and what their needs are. Matching insulin properly to your food intake, meaning taking the right amount for the right amount of carbohydrate that’s consumed. So, you know, learning how to count carbs properly is an important aspect. If you overestimate your carb intake, you’re going to take more insulin than you need or if you are on fixed doses of insulin, and you just don’t eat as much, you are going to wind up low. So, learning how to estimate the carbohydrate in your meals, and being consistent about that, is an important way to prevent a low.
How to Manage Hypoglycemia?
We also teach people how to adjust insulin for physical activity, because exercise of any kind is going to burn extra glucose and make the body very sensitive to insulin. So, blood sugars can drop quite a bit. So, for people who take insulin at a meal and then exercise, they usually have to reduce the insulin dose. If the activity takes place before a meal, they usually have to consume extra carbohydrate to offset what’s going to be burnt up during the exercise session.
So, in general, it’s a matter of making moment to moment decisions about ones’ insulin and medication to compensate on what’s going on in ones’ daily life.
How to Control Hypoglycemia?
Glucose monitoring is also an important element to preventing hypoglycemia, not just detecting when it happens. People who check their blood sugar just a couple of times a day are going long stretches between knowing what their blood sugar is, and a lot can change in that time period. The more frequently blood sugars are checked, the better the chances are of catching something before it becomes dangerous. And even better yet, the use of a continuous glucose monitor is a great tool for preventing hypoglycemia, as those systems are monitoring you continuously. Every 5 minutes they update with a glucose value. And they can be set to alert the user if the blood sugar is approaching a low. You don’t have to wait until you’re hypoglycemic. They can alert you when you’re approaching a low, so, that you can eat and prevent a further drop and avoid a low entirely.
Hypoglycemia at Night
Overnight, blood sugars that drop low can be particularly dangerous. Because, you know, there is always the risk that the person won’t wake up from it. And middle of the night lows can be a bit dramatic because you wake up, you might be bathe in sweat, it’s a difficult thing to deal with. The most effective ways to prevent these lows during the night is to make absolutely sure that your long acting, or base insulin dose is set up properly. Those insulin doses overnight is designed to keep the glucose steady. And if its not keeping on steady, then the dose is set incorrectly. Beyond that, if people can still experience lows during the night, even if that dose is set right. So, lets say someone has gotten a lot of exercise during the day, they may need an extra snack at bed, or they may need to reduce that base insulin dose to prevent the low while they’re sleeping.