Learn to manage low blood sugar

All patients with insulin-treated diabetes can experience low blood sugar levels. In general, we talk about the presence of low blood sugar, when blood sugar levels drop to below 3.9 mmol/l.

Having low blood sugar can be described in different ways depending on how the episode is experienced. Low blood sugar should be treated by consuming fast-acting carbohydrates. However, the treatment depends on how affected you are by your low blood sugar.

How you will experience low blood sugar

Low blood sugar can be experienced in three ways

1.  Hypo-sensation:

You are aware of your blood sugar being low. You are capable of helping yourself.

What you need to do: Consume 10 grams of rapid-acting carbohydrates such as e.g. 1 dl juice, 3-4 pieces of dextrose or one Hypo-fit. Measure your blood sugar 10-15 minutes after having ingested rapid-acting carbohydrates. If your blood sugar has risen to more than 4 mmol/l, you should eat 15-20 grams of slow-acting carbohydrates, such as e.g. a slice of rye bread, to stabilise your blood sugar. If your blood sugar has not increased, you should take another 10 grams of rapid-acting carbohydrates and then measure your blood sugar after the passage of 10-15 minutes.

2. Insulin attack:

You are conscious but incapable of taking action yourself. You need help.

What others must do: They must offer you 10 grams of rapid-acting carbohydrates and, when your blood sugar has begun to rise, a slice of rye bread to stabilise your blood sugar. You are encouraged to measure your blood sugar after the passage of 10-15 minutes.

3. Insulin shock:

You are unconscious and may also have convulsive fits. You need help.

What others must do: If you have a GlucaGen® HypoKit, and if you are together with someone who has been instructed in how to use it, you need to have glucagon injected into a muscle. The injection will take effect after about 10 minutes, and you will regain consciousness. After a GlucaGen® injection, your blood sugar should be measured every 10-15 minutes and until your blood sugar levels are once again stable.

If you have experienced an insulin shock, you should subsequently contact the Nursing Advisory Service (Sygeplejerådgivningen) at SDCC at phone number 39 68 08 00 .

Let others know about your diabetes

It is a good idea to tell others about your diabetes and about how they can best help you in case of low blood sugar levels.

What causes low blood sugar

To prevent low blood sugar levels from occurring, it is important that you are familiar with possible causes for low blood sugar. You risk low blood sugar levels if you:

• have been physically active in connection with e.g. gardening, cleaning or sport/exercise.
• have taken a larger dosage of insulin than usual.
• have taken insulin in connection with a meal without carbohydrates.
• have been eating and/or drinking fewer carbohydrates than planned.
• have been drinking alcohol. Alcohol may disguise the symptoms to the effect that you will not notice if your blood sugar is dropping. We therefore recommend that you are extra attentive to your blood sugar levels and eat something before going to bed if you have been drinking alcohol.
• are ill owing to a stomach infection with nausea, vomiting and, possibly, diarrhea.
• have mistakenly taken rapid-acting insulin instead of slow-acting – or the other way around.
• have taken too much insulin immediately before an extremely fatty meal.

Low blood sugar levels may also be caused by the way in which you take your insulin. Ask your therapist to help you run through the procedure. Searching the titles on www.sdcc.dk, you can also find the leaflets 'How you take insulin or GLP-1' and 'How you distribute insulin and GLP 1 injections'.

Always remember to tell your therapist about incidents with low blood sugar.

The most common symptoms of low blood sugar levels:

• Shaky hands and an inner sensation of restlessness in your body
• Mood swings
• Hunger
• Visual disturbances and dizziness
• Outbreaks of sweat
• Fatigue, headache and concentration problems
• Heart palpitation
• Troubled night's sleep.

The symptoms of low blood sugar may change over time.

After an episode of low blood sugar

Many people experience high blood sugar (hyperglycemia) after low blood sugar. This is owing to the extra carbohydrates you have been eating or drinking to elevate your blood sugar. As a point of departure, you should not take extra insulin if you get high blood sugar in the wake of a low blood sugar episode, as you will then risk that, once again, your blood sugar levels will drop and become too low. Discuss with your therapist how you can best cope with such situations.

Inability to register low blood sugar levels

Patients having suffered from diabetes for many years may lose the ability to register symptoms of low blood sugar levels (called unawareness). Thus, they are at greater risk of insulin attacks or insulin shocks, and it will thus be necessary to get help from others – e.g. relatives, colleagues or healthcare staff. If you experience low blood sugar without symptoms, or if you first notice that your blood sugar is low when it is below 3 mmol/l, you will have to discuss this with your therapist.

Contact

If you have questions or are in doubt, you are welcome to contact the Nursing Advisory Service at phone: 39 68 08 00 on weekdays from 8:00 AM to 4:00 PM.