Hypoglycemia is commonly associated with diabetes, but even non-diabetics are vulnerable to decreases in blood sugar levels. When teaching patients about hypoglycemia, be sure to explain this complicated condition in simple terms so patients are equipped to avoid its dangers.
Blood Sugar Levels
Many body functions are dependent on the availability of food to supply energy to its cells. The internal mechanism by which the body maintains a normal blood sugar level (70-130mg/dl or 3.9–7.2 mmol/l) is important in ensuring that glucose is always available for these functions. The danger of low blood sugar is especially marked in the nervous system, since the brain cannot store energy and is totally dependent of the availability of sugar in the blood as a substrate for normal function. Therefore, new patients must be aware of the causes, manifestations and treatment of hypoglycemia to avoid its complications.
What is Hypoglycemia?
A low level of blood sugar (<70 mg/dl or 3.9 mmol/L) alone may be used to define hypoglycemia. Other symptoms include shakiness, palpitations and headaches plus relief of these symptoms with intake of glucose. In some people, symptoms may not be apparent and they may not know they are experiencing decreased blood sugar levels until the levels fall below a threshold of 40 to 55 mg/dl. At these levels patients may suddenly suffer more severe symptoms including unconsciousness and seizures. It is important when teaching new patients about hypoglycemia that they are able to recognize symptoms early and be able to manage and monitor their blood glucose levels as needed.
Signs and Symptoms of Hypoglycemia
New patients must be made aware of how one suffering from low blood sugar level may feel. The variety of symptoms of hypoglycemia may range from mild to severe depending on the patient’s blood sugar levels at the moment, his age and presence of other concomitant diseases.
Common symptoms include:
- Feelings of nervousness, anxiety and shakiness
- Feeling warm and then sweating, sweaty palms and skin
- Rapid pulse
- Feelings of hunger, abdominal discomfort, urge to vomit
- Feelings of weakness, tiredness and numbness
- Irritability, changes in mood
Younger children and older adults are usually unaware of these symptoms and cannot express their feeling effectively. Aside from helping them to become more aware of these possible symptoms, their caregivers must also be taught how to recognize the signs of low blood sugar such as:
- Lack of activity, refusal to feed
- Changes in speech, moods and mental ability
- Changes in blood pressure, pulse rate, dilated pupils
- Irritability, jitters, seizures
- Changes in breathing, hypothermia
Causes of Hypoglycemia
Glucose is the main substrate or simplest form of food the body cells can absorb from the blood. Insulin is the hormone secreted by the pancreas which facilitates its transport to the cells. After eating carbohydrates, blood sugar levels increase and this is detected by the body and insulin is released. Absorption of the glucose ensues and once again, blood sugar levels return to normal.
In between meals and after regular physical activity, glucose is used up and becomes less available to the cells. Normally this triggers the individual to eat to relieve the hunger and slight weakness. But if an individual skips a meal or delays eating, hypoglycemia may ensue. To raise blood sugar levels back to normal, the pancreas now secretes another hormone, glucagon, which causes the release and breakdown of stored sugars in the liver, known as glycogen which is converted to glucose. This process is slow, however, and before it is completed an individual may experience the signs and symptoms of hypoglycemia.
Factors that cause hypoglycemia are:
- Lack of food intake, especially carbohydrates - usually due to skipping meals or eating too little food
- Prolonged starvation, fasting or malnutrition
- Strenuous exercise with lack of food intake
- Severe stress brought about by diseases, trauma and surgery
- Excessive alcohol consumption
- Drugs like acetaminophen, steroids and MAO inhibitors
- Drugs for diabetics to control increased blood sugar - usually due to multiple insulin injections
- Presence of tumors (insulinoma) and other diseases like hypopituitarism and hypothyroidism.
How to Prevent Hypoglycemia
Hypoglycemia can lead to other complications like seizures and death. Extremely low blood sugar levels may be prevented by the following ways:
- In patients who have experienced recent trauma, surgery or other stressful situations, adequate nutrition supervised by physicians, dieticians and care givers may be necessary. Nutritional requirements may be specific, and meal plans may be recommended by medical professionals. Patients must be taught about compliance to these recommendations.
- Many patients may be experiencing less stressful circumstances, and yet they may be vulnerable to low blood sugar levels. They must be taught about taking their meals and snacks on time and to avoid skipping meals.
- Health professionals must tailor diets and food recommendations to each person’s needs, according to their body weight, on-going diseases, age and other considerations. Patients must then be taught on how to choose and prepare the right foods that includes adequate amounts of sugar to help keep their blood sugar levels and other nutritional needs at a normal state. Advise patients about the importance of taking three meals and light snacks in between.
- Teach patients and care givers how to recognize initial symptoms of hypoglycemia so immediate monitoring and sugar intake may be done.
- Teach diabetic patients how to monitor blood sugar levels using a glucose meter. Self monitoring of blood glucose must be done 3 or more times a day for those using insulin injection or pumps. This can be done less frequently in patients who are using oral hypoglycemic.
- Ask patients to consult a physician for possible adjustments in medication doses and suggested diet if symptoms are present or if blood sugar levels are difficult to control.
- Teach patients about the importance of following his recommend diet and exercise plans. Adjustments may be done in consultation with his physician on frequency of meals and details in nutrition. Physical activities may be regulated as needed, and balanced with snacks or meal intake before and after exercise.
- For patients who are frequently unaware of hypoglycemia, raising the blood sugar limit slightly from the goal for several weeks can reverse unawareness help patients detect changes in the body.
- Advise patients on the possible need for evaluation and treatment of other causes of hypoglycemia, such as medical conditions, diseases and drugs leading to decreased blood sugar.
How to Treat Hypoglycemia
Temporary hypoglycemia due to decreased food intake or increased physical activity may be immediately resolved by the intake of pure simple sugars. Teachings to patient, family and friends include:
- A conscious patient whose blood sugar is low must take 15 to 20 g of glucose or carbohydrate-containing foods immediately. A glass of orange or apple juice, candy or glucose tablets can quickly raise blood sugar. This can be repeated after 15 minutes if blood glucose levels do not improve. Protein and fat containing foods like ice cream, eggs and meat products are absorbed slowly, and must be avoided.
- Teach family members and other related people to recognize the signs of hypoglycemia to be able to assist the patient when needed.
- Severe hypoglycemia usually occurs in diabetics being given insulin. The unconscious patient may not be able to take glucose immediately and must be treated with an emergency glucagon kit. This is usually prescribed, and used by anyone who assists an unconscious patient. Again, this must be taught to family and friends, who do not need a license to safely administer the drug.
Teaching new patients about hypoglycemia is essential to the safety and well being of all patients. Doctors, nurses and other health care providers can provide valuable help for the patient and his family by teaching them on how to prevent it and deal with its management and complications.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
American Diabetes Association, “Standards of Medical Care in Diabetes -2010", http://care.diabetesjournals.org/content/33/Supplement_1/S11.full.pdf+html
Clinical Diabetes, “Hypoglycemia", http://clinical.diabetesjournals.org/content/26/4/170.full