Job Osazuwa
Torrents of strong warnings and recommendations on the dangers and how to prevent or overcome high blood sugar level flood the traditional and social media platforms, but little or none is heard of low blood sugar and its inherent dangers.
Low blood sugar, which is called hypoglycaemia, is a condition that occurs when your blood sugar (glucose) is lower than normal. This may occur in people with diabetes who are taking insulin or certain other medicines to control their diabetes.
Experts have warned that low blood sugar could cause dangerous symptoms. It could harm the patient when a blood sugar level is below 70 mg/dL (3.9 mmol/L). A blood sugar level below 54 mg/dL (3.0 mmol/L) is a cause for immediate action.
As much as consuming and retaining excess sugar could be dangerous to the body, doctors have raised concerns on the need to watch any level of sugar and to consult a doctor when it appears abnormal. However, sometimes, no matter how hard one tries to keep his or her blood sugar in the range as advised by one’s doctor, it can just be too high or too low. This situation could make the person very sick and could lead to an emergency.
A family physician with over 25 of experience in the United States of America, Mrs. Kehinde Akinbo, warned that low blood sugar level kills faster than high blood sugar, especially when the patient doesn’t get intervention on time. She said a patient in a very critical condition might die within a few minutes, adding that people with diabetes get hypoglycaemia when their bodies don’t have enough sugar to use as fuel.
On when your blood sugar is too high or too low, she explained: “For us to understand the condition very well, there is the need to first look at what high blood sugar is and at what point it will be considered too low and risky. But for the purpose of emphasis, considering the types of foods Nigerians eat, it will be difficult for anyone to come down with hypoglycaemia.
“About 90 per cent or more of all the foods consumed by most Nigerians contain carbohydrate, which is further broken down to sugar. For example, if you eat just one wrap of eba, semo, pounded yam or amala, and when they are converted, you must have gotten all the sugar you need for that day. But some people will repeat this same class of foods three times a day and still go ahead to take carbonated drink with high sugar concentration.
“If your blood sugar stays over 240, it is too high. The danger there is that high blood sugar usually comes on slowly. It happens when you don’t have enough insulin in your body. High blood sugar can happen if you miss taking your diabetes medicine, eat too much or don’t get enough exercise. Sometimes, medicines you take for other problems may cause high blood sugar. Having an infection or being sick or under stress can also make your blood sugar too high. That is why we always recommend that it is very important to test your blood and do the necessary follow-up.
“Then for low blood sugar, it must be noted that if your blood sugar drops too low, you can have a low blood sugar reaction. A low blood sugar reaction can come on fast. This can be caused by taking too much insulin (for diabetes patients), missing a meal, delaying a meal, exercising too much or drinking too much alcohol. Sometimes, medicines you take for other health problems can cause blood sugar to drop.”
Symptoms
According to Akinbo, “most people feel symptoms of hypoglycaemia when their blood sugar is 70 milligrams per decilitre (mg/dL) or lower. Each person with diabetes may have different symptoms of hypoglycaemia. You’ll learn to spot yours.
“A low blood sugar reaction can make you feel shaky, mixed up, unhappy, hungry, weak or tired. You may sweat a lot or get a headache, feel uneasy, have pale skin, or anxious, fee cranky, trouble thinking clearly, double or blurry vision, fast or pounding heartbeat.
“Your legs may shake. If your blood sugar drops lower, you can get very confused, sleepy or irritable or might make you pass out or have a seizure. Without treatment, you might get more severe symptoms, including: Poor coordination, poor concentration, numbness in mouth and tongue, nightmares or bad dreams and coma.
“I must also stress that sometimes your blood sugar may be too low even if you do not have symptoms. If it gets too low, you may faint, have a seizure or go into a coma. Some people who have had diabetes for a long time stop being able to sense low blood sugar. This is what we call hypoglycaemic unawareness.
“But, there is always a way out in every medical situation. We advise that you simply ask your health care provider if wearing a continuous glucose monitor and sensor can help you detect when your blood sugar is getting too low in order to help prevent symptoms. This is important because every patient comes with his or her own peculiarities in terms of reaction to drugs and response to treatment.”
Those at risk
You are at risk for low blood sugar if you have diabetes. According to one of the leading medical journals, Health Matters, diabetes drugs linked to hypoglycaemia are, Insulin, glyburide (micronase), glipizide (glucotrol), glimepiride (amaryl), repaglinide (prandin), or nateglinide (starlix), chlorpropamide (diabinese), tolazamide (tolinase), acetohexamide (dymelor) or tolbutamide (orinase). You are also at increased risk of having low blood sugar if you have had previous low blood sugar levels. You shouldn’t get hypoglycemia if you take alpha-glucosidase inhibitors, biguanides (such as metformin), and thiazolidinediones alone, but it can happen when you take them with sulfonylureas or insulin.
According to health specialists, if you don’t use insulin ensure to tell your doctor about other medicines you may be taking. If you take diabetes pills you can also have low blood sugar reactions. The doctor may need to make a change in your medicine or eating plan. Experts have always maintained that if you are not a diabetic patient, and you don’t take pills or insulin, you don’t have to really worry about low blood sugar reactions.
Talk with your provider about when you should check your blood sugar every day. People who have low blood sugar need to check their blood sugar more often. You must know how to tell when your blood sugar is getting too low.
Most common causes of low blood sugar
The following factors have been identified to be responsible for some of the reasons people could break down with hypoglycaemia: Taking your insulin or diabetes medicine at the wrong time; taking too much insulin or diabetes medicine; not eating enough during meals or snacks after you have taken insulin or diabetes medicine; skipping meals and waiting too long after taking your medicine to eat your meals.
Others are exercising a lot or at a time that is unusual for you; not checking your blood sugar or not adjusting your insulin dose before exercising and drinking alcohol.
How to manage low blood sugar
Patients have been advised to treat low blood sugar quickly. If you have signs of low blood sugar, eat or drink something that has sugar in it. Some things you can eat are hard candy, sugar-sweetened soda, orange juice, or a glass of milk. Special tablets or gel made of glucose (a form of sugar) can be used to treat low blood sugar. You can buy these in a drug store. Always have some of these items handy at home or with you when you go out in case your blood sugar drops too low. After treating a low blood sugar reaction, eat a small snack like half a sandwich, a glass of milk, or some crackers if your next meal is more than 30 minutes away.
In case of a medical emergency, be sure that you carry medical identification (a tag or card) that says you have diabetes and lists the medicines you take. It should also give the name and telephone number of your doctor. Tell your family, friends, teachers, or other people you see often about the signs of low blood sugar. Explain how to treat it. You may need their help some day.
You can prevent most low blood sugar reactions by eating your meals on time, taking your diabetes medicine, and testing your blood sugar often. Testing your blood will show if your sugar level is going down. You can then take steps, like eating some fruit, crackers or other snack, to raise your blood sugar level. Always be prepared for a low blood sugar reaction. Keep a snack handy. Ask your doctor or diabetes educator for a list of snacks to treat low blood sugar.
Tell your doctor if you have low blood sugar reactions often, especially if they happen at the same time of day or night. Tell your doctor if you have passed out from low blood sugar or if you ever needed someone’s help. Ask your doctor about “glucagon.” Glucagon is a medicine to raise blood sugar. If you pass out from low blood sugar, someone should call emergency numbers if available.
Prevention
The general practitioner advised that preventing low blood sugar was far better than having to treat and manage it. She recommended that Nigerians should always have a source of fast-acting sugar with them.
She said: “Before and after you exercise, check your blood sugar levels. Exercise 30 minutes to one hour after meals and make sure you have snacks with you. For diabetics patients talk to your doctor about reducing insulin doses on days that you exercise. Ask your health care provider if you need a bedtime snack to prevent low blood sugar overnight. Protein snacks may be best. Try and follow your meal plan. Eat at least three evenly spaced meals each day with between-meal snacks as prescribed. Plan your meals no more than four to five hours apart. Double-check your insulin and dose of diabetes medicine before taking it. Know when your medicine is at its peak level.
“This is a strong warning. Do not drink alcohol without eating food. Women should limit alcohol to one drink a day and men should limit alcohol to two drinks a day, though rule not applicable to everybody. Family and friends should know how to help. They should know: The symptoms of low blood sugar and how to tell if you have them. How much and what kind of food they should give you. Know when to call for emergency help. Master how to inject glucagon, which is the hormone that increases your blood sugar. Your doctor or nurse will tell you when to use this medicine.
“If you have diabetes, always wear a medical alert bracelet or necklace. This helps emergency medical workers know you have diabetes as well as when you are stuck with hypoglycaemia. There is no shame in it; it will only save your life,.”
Diet and Hypoglycaemia
Akinbo explained: “It should be worthy of note that people have hypoglycaemia because they consistently avoid foods that contain sugar. These are mainly diabetes patients. And because the ailment must be treated, you can get low blood sugar if you take too much insulin for the amount of carbohydrates you eat or drink. For instance, it can happen: After you eat a meal that has a lot of simple sugars; if you miss a snack or don’t eat a full meal; if you eat later than usual; if you drink alcohol without eating any food and don’t skip meals if you have diabetes, particularly if you’re taking diabetes medications.”
Treatment
If you have diabetes and think you have hypoglycaemia, the first stage is to check your blood sugar level. Then take into cognizance if your levels often drop after meals that include a lot of sugars? When that is figured out, there might arise the need to change your diet. Avoid sugary foods, and eat frequent small meals during the day.
If you get low blood sugar when you haven’t eaten, have a snack before bedtime, such as a protein or a more complex carbohydrate. Your doctor may find that you take too much insulin that peaks toward the evening-to-morning hours. In that case, the health care provider may lower your insulin dose or change the time when you get your last dose of it.
When you have low blood sugar, first, eat or drink 15 grams of a fast-acting carbohydrate, such as: Three to four glucose tablets, one tube of glucose gel, four to six pieces of hard candy (not sugar-free), a cup of fruit juice, one cup skim milk, one or half cup of soft drink (not sugar-free) and one tablespoon honey (put it under your tongue so it gets absorbed into your bloodstream faster).
Fifteen minutes after you have eaten a food with sugar in it, check your blood sugar again. If your blood sugar is still less than 70 mg/dL, eat another serving of one of the foods listed above. Repeat these steps until your sugar becomes normal.
Hypoglycaemia may make you pass out. If so, you’ll need someone to give you a glucagon injection. Glucagon is a prescription medicine that raises blood sugar, and you may need it if you have severe hypoglycaemia. If you see someone having a severe hypoglycaemic reaction, call emergency numbers or take him or her to the nearest hospital for treatment. Do not try to give an unconscious person food, fluids, or insulin, as they may choke.
Do not drive when you have low blood sugar. It’s very dangerous. If you’re driving and you have hypoglycaemia symptoms, pull off the road, check your blood sugar and eat a sugary food. Wait at least 15 minutes, check your blood sugar and repeat these steps if necessary. Eat a protein and carbohydrate source (such as peanut butter crackers or cheese and crackers) before you drive on.