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Symptoms of Hypoglycemia
While it may seem straight forward enough, the symptoms of low blood sugar are quite common, and they can be easy to miss. The American Diabetes Association (the ADA) includes the following in their list of symptoms for hypoglycemia:
And now for the Severe Symptoms:
Unable to eat or drink Seizures or convulsions (jerky movements) Unconsciousness
Not everyone feels the same symptoms in the same way. So it’s important for patients to be instructed to recognize what symptoms they have from low blood sugar--and to be aware when they’re present. Equally important, then, is knowing what to do to treat them—and we will talk about that a little later.
Hypoglycemia Unawareness Hypoglycemia unawareness is an interesting phenomena. Some diabetics who have had diabetes for a long time (a couple decades or so) can experience the situation where their blood sugar goes low but they don’t feel any symptoms. They still have low blood sugar and all of the problems that come with it, but they don’t feel it—so they don’t realize it. Long-term effects will still occur as well, and these patients have an increased risk of diabetic ketoacidosis (where the body doesn’t have enough insulin for energy, causing the body to break down fat for energy. This process produces toxic acids known as ketones which accumulate in the blood and eventually begin to get excreted in the urine. Left untreated, diabetic ketoacidosis can lead to a diabetic coma and be life-threatening). Another long-term problem is called a hyperglycemic hyperosmolar state. This condition occurs when the body produces insulin, but it doesn't work properly. Blood glucose levels may become very high — sometimes greater than 1,000 mg/dL, and because insulin is not working properly, the body can't use either glucose or fat for energy. Glucose is then spilled into the urine, causing increased urination. Left untreated, this condition can lead to life-threatening dehydration and coma.
The American Diabetes Association says it is possible for individuals with hypoglycemia unawareness to regain the symptoms of hypoglycemia, but it takes some direct changes in the way they handle their disease management. This can provide the diabetic patient with the safety of knowing when they have hypoglycemia so they can treat it immediately. The ADA’s recommendation is to regain control in an effort to avoid all hypoglycemic episodes for several weeks. This allows the body to regain its ability to re-learn and react to low blood glucose levels. To do this may require increasing their target blood glucose level (at the recommendation of their healthcare team). It may even result in a higher A1C level but, says the ADA, regaining the ability to feel symptoms of low blood glucose is worth the temporary rise in blood glucose levels.
Use of a Continuous Glucose Monitor There are a couple of keys, then, to long-term hypoglycemia awareness. And that is to instruct your patients to keep their blood glucose level in check. All the time. Here’s how: To do this they should first be instructed to use a continuous glucose monitor (or CGM). One of the newer devices is pictured on this slide. They are ideally suited to people who don’t experience the normal symptoms of low blood sugar because of their ability to alert the wearer of predicted low blood sugar levels, allowing them time before the occurrence to prevent it. CGMs allow the wearer to set specific levels for low alerts, allowing not only time to react if the alarm goes off, but the peace of mind in knowing they are safe from hypoglycemia unawareness.
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