Instructions
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Aim for a More Realistic Blood Sugar Target And second, they should be instructed to aim for a higher target blood sugar range. Within the hypoglycemia unaware population, it’s very important that they are instructed to raise their target blood sugar range at least slightly. As an example, while you may normally instruct your patients to aim for a target of 90mg/dL when dosing insulin for meals and corrections, consider having them aim for 100mg/dL or 110mg/dL. This will help to alleviate the low blood sugar levels by keeping their blood sugar slightly above the line between normal and low.
False Hypoglycemia As with hypoglycemia unawareness, where patients don’t realize they have low blood sugar levels because they’re not feeling any of the usual symptoms, there is also another somewhat similar scenario where patients with consistently high blood sugar levels--including those with A1cs above 8%, and those struggling with diabulimia (also known as ED-DMT1 behavior which involves taking only enough insulin to function in an effort to lose weight, resulting in dangerously high blood sugar levels), find that their bodies have adjusted to the higher blood sugar levels. This means that when their blood sugar levels come down, their bodies might show symptoms of low blood glucose (even though they are in a safe, good range). This is a difficult situation, but one which can be reversed. Treatment requires setting a new target blood sugar range that is lower than the level their blood sugar has been sitting at, and not quite as low as the normal blood sugar targets. This is required for at least several weeks, at which the point the body will be able to reacclimate itself to the new, lower target range, without triggering low blood sugar symptoms.
The Causes of Hypoglycemia Low blood sugar levels are generally caused by an imbalance of food, activity and insulin—or other diabetes medications which are either designed to, or as a side effect of their use, lower blood sugar. There are several scenarios which can cause low blood sugar: Exercising without altering insulin dose or carbohydrate intake Taking a walk after eating lunch can cause a severe low blood sugar event if the normal, full dose of insulin was taken at mealtime. The walk would increase the rate at which the body burns up glucose from the meal thereby lowering blood sugar. Or it could simply be a case of extending a workout beyond what was planned, or an unplanned workout without compensating by making an adjustment to the insulin dose. Skipping or delaying a meal Skipping or delaying a meal can cause blood glucose to drop. This can occur because of mistakes in the kitchen causing meals to be delayed, skipping a meal out of necessity, desiring weight loss by not eating, or simply falling asleep during a time when they usually eat a meal. Insulin dosing problems A common problem many diabetics face is taking too much, or too little, insulin for certain foods. This is especially easy to do when deciding on the size of an apple, for instance, and taking too much insulin resulting in a low blood sugar level. Weight-loss increases sensitivity to insulin While weight loss in any amount can result in the body eventually needing less insulin, even a few pounds lost can change the body’s insulin requirements enough that frequent low blood sugars begin to appear, signaling to the patient that it’s time to reduce their insulin doses. Alcohol use Special precautions should be followed for the diabetic wanting to drink alcohol, as it causes blood sugar levels to rise or fall, and has a lot of calories. For diabetics following a calorie-controlled meal plan, one drink of alcohol should be counted as two fat exchanges.
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