Database of diseases - Diabetes

   

In diabetes, it is dangerous for health to lower the blood glucose level below the acceptable threshold, which is considered to be 2.8 mmol / l (50 ml / dl). Such a condition is called severe hypoglycemia or in colloquial language - a strong hypoglycaemia.


Symptoms of hypoglycaemia are divided into:

- not felt by the patient, detected accidentally while measuring the level of sugar in the blood;
- feeling, mild or moderate when the patient is able to control the hypoglycaemia itself;
- severe - requiring rapid medical intervention.
 
 

How often does severe hypoglycaemia occur?

Too low blood sugar, or hypoglycaemia, happens to every fourth person who suffers from type 1 diabetes and only a few patients with type 2 diabetes.

Most often it results from an insulin overdose in type 1 diabetes or from an unconscious decrease in glucose.

In type 2 diabetes, severe hypoglycaemia is not likely to occur. Even if this type of diabetes is inadequately controlled, the body gradually becomes accustomed to periodic shortages of sugar, which reduces the severity of the symptoms of hypoglycaemia and dulls the alertness of patients. Meanwhile, such chronic hypoglycaemia is very slow, but it also damages the nervous system, especially the brain that is particularly susceptible to damage resulting from insufficient glucose supply.

What are the symptoms of severe hypoglycaemia?

These are: muscle tremors, hunger, yawning and drowsiness, heavy thinking, dizziness, nervousness, abundant sweats, weakness, memory disorders and illogical behavior, aggressiveness for no reason, blurred vision, loss of consciousness, convulsions, hypothermia. These symptoms grow - from mild to severe.

Severe hypoglycaemia (hypoglycaemia) is life-threatening!

If the blood sugar level falls below 2.8 mmol / l (50 ml / dl) - it means severe hypoglycaemia. The patient is threatened by a hypoglycemic shock - ie loss of consciousness, coma and an immediate threat to life. Incidents of this type usually occur in type 1 diabetes requiring insulin injections, after overdose.

What should we do in case of severe hypoglycaemia?

You should immediately take measures to counteract hypoglycaemia, i.e. giving conscious patients 10-20 g glucose or its equivalents - a glass of juice, sweetened tea, chocolates. Undertaking treatment usually eliminates the threat. When a hypoglycaemic person is unconscious, immediate treatment of hypoglycemia and injection (1-2 mg) of glucagon from the diabetic patient's first aid kit should be undertaken. (Details at the end of the article).

In the case of mild hypoglycaemia

Symptoms are usually limited to the lack of ability to focus, paleness, irritability, drowsiness, dizziness, muscle tremors, weakness, abdominal pain, acceleration of the heart rate. There may also be hyperactivity and a tendency to anger.

Help relies on

giving 10-20 grams of glucose or its equivalents to a patient - a glass of juice, sweetened tea, chocolates

DIABETES TYPE 2 - AUTHORIZATION IN HYPOGLYCAEMIA

Dealing with mild hypoglycaemia in type 2 diabetes

In cases when a diabetic person feels unwell and suspects that it is due to hypoglycaemia, and at the same time there is no way to control the level of sugar - he should eat something sweet to prevent further hypoglycaemia. If he feels better, it will mean that the cause of his malaise was hypoglycaemia. If the glycemia was high, the extra sugar would be less harmful than the potential risk of loss of consciousness.

Hypoglycemia at night - how to deal with it?

Hypoglycemia at night is manifested by insomnia and other symptoms mentioned above.In this case, you should first test the blood glucose with a meter. It's best to do it at one o'clock and four o'clock in the morning. Prevention of nocturnal hypoglycaemia consists of: reducing the dose of the drug taken at night or eating a meal with slow absorbed protein and carbohydrates (eg cottage cheese or lean meat with bread) before going to bed.

Hypoglycaemia in type 2 diabetes may occur due to errors in the initial phase of treatment.

Such a mistake can be eg starting treatment with the standard dose recommended in the medicine leaflet. Treatment with a sulphonylurea should be started with the lowest possible dose, which should be determined by the physician individually. Sometimes caution in this respect will not help if the patient has an unrecognized, so-called decreased glomerular filtration in the kidneys. Then he is at risk of hypoglycaemia. People who have low hypoglycaemia on an empty stomach are also at risk of hypoglycaemia, often after physical exertion.

The most common causes of hypoglycemia include:

increased glucose consumption due to significant unplanned physical activity (when the body does not receive an ordinary portion of carbohydrates), intensive weight loss, fasting, food diarrhea or vomiting. The cause of hypoglycaemia may also be beta-blockers, alcohol, liver disease, and sometimes menses (these causes are even more related to those treated with insulin). People with diabetes should therefore take special care and consult a doctor - if any of the above-mentioned circumstances apply to them.

The best medication for glycemic normalization

So in type 1 diabetes - insulin delivery

glucose to normal. Similarly in type 2 diabetes - using the right drugs. Indeed, even if diabetes was already poorly controlled in type 2 diabetes, the normalization of blood glucose and further good leveling of the disease (and thus long-term avoidance of hypoglycaemia) makes the patient's body re-sensitized to hypoglycaemia and to feel its symptoms. It can be said that good glycemic normalization can restore mild hypoglycaemia that is not previously noticeable. As a result, we effectively prevent dangerous complications of severe hypoglycaemia.



FIRST AID IN PRESENT HYPOGLY

Finally, important remarks on medical self-help in severe hypoglycaemia:
(mainly affects people with type 1 diabetes - dependent on insulin injections)

The family and the patient's surroundings must know about the risk of hypoglycaemia. They should know the typical symptoms of hypoglycemia and be able to respond to them. They should also know that if, for example, a glucose meter indicates a severe hypoglycaemia - specifically, when blood glucose is already lower than 3.3 mmol / l (60 ml / dl) - then you should intervene immediately. If you live alone, you should immediately ask someone close to you for supervision until the risk is completely resolved!


Strong hypoglycemia requires immediate medical attention as it can worsen!

If the person is conscious - it will help her to drink a liquid sweetened with sugar. If this does not help or the patient is already unconscious, an immediate injection of glucagon from the diabetic patient's first aid kit, professional medical help or hospitalization is needed.


What should your relatives do - family, friends, colleagues at work - when you lose consciousness?

1. Put you on your side with your head down. Note - never give drinking fluids to an unconscious patient - because the fluid can enter the airways and cause breathing difficulties.

2. Give the injection containing the rescue hormone glucagon. After getting the glucagon into the syringe from the vial from the first aid kit, remove the air bubbles from the syringe and give glucagon either subcutaneously or intramuscularly.

3. If, after injection of glucagon (which is included in the kit for immediate help) patient within 10 minutes does not regain consciousness, relatives should immediately call an ambulance


What is the role of glucagon?

Glucagon is a hormone that rescues a patient with diabetes in conditions of acute hypoglycaemia.
Despite the best therapy and good patient education, episodes of hypoglycaemia can happen to any patient. Glucagon is particularly necessary in situations where there is no medical help available - and such situations can happen to any diabetic patient: on the street, at work, at home, etc.An injection of glucagon can easily be made by untrained people: in any muscle tissue. It is best to avoid episodes of hypoglycemia in general, however, because it is not always possible, every insulin-treated patient should be allowed to carry glucagon ready for rapid use.

WARNING! Severe hypoglycaemia - below 2.2 mmol / l (40 ml / dl) requires immediate hospitalization!
 


PREVENTION OF HYPOGLYMIA


The prevention of hypoglycemia depends on the patient's education

However, when severe hypocuntemia (hypoglycaemia) in type 1 diabetes is repeated too often despite education, the doctor should think about verifying the target glucose level. In other words - to reduce some of the requirements for the desired maximum glycemic value. Relaxing slightly this criterion may reduce the incidence of hypoglycaemia.


Can changing your medication or how it can be used to help control your diabetes?

Yes, in type 1 diabetes, the use of human insulin analogs, intensification of dosage - reduces the incidence of hypoglycaemia. When you use the right insulin before meals and the insulin with prolonged sleep time, the incidence of hypoglycaemia at night also decreases.


Does pharmacological progress reduce the risk of hypoglycaemia?

Pharmacological progress makes it possible for patients with diabetes to normalize blood sugar levels more and more effectively. In type 2 diabetes, which does not require insulin injections, "intelligent" sulfonylureas of the third generation have already appeared, the use of which minimizes the risk of hypoglycaemia. Unfortunately, new, highly effective drugs can also cause periodic hypoglycemia - the so-called drug-induced hypoglycaemia. This type of hypoglycaemia is, as research shows, a quite common sudden condition in diabetology. It occurs, not only as a complication of insulin therapy, but also as a sulphonylurea, metformin or acarbose.


ed. Edward Ozga Michalski, MA
Consultation by prof. dr hab. med. Andrzej Danysz