Awareness and Management of Hypoglycemia

What is hypoglycemia?

Hypoglycemia refers to a condition of low glucose (blood sugar) level in your body. When your blood sugar level falls below 70 mg/dl, it requires an immediate attention as hypoglycemia can be fatal if left untreated. Hypoglycemia is most often caused by the medications used to treat diabetes, however, there are other disorders or medications that can lower your blood sugar level.

Symptoms of hypoglycemia

It is important to recognize the symptoms of hypoglycemia so that you can properly treat it. If you experience following symptoms, you should check your blood sugar level. If severe hypoglycemia occurs, one can experience seizures or coma.

Medications / disorders that can cause hypoglycemia

Some medications that are used to treat diabetes have a higher risk of causing hypoglycemia especially if the medication is taken without food. Below are those medications:

Other disorders or medications that can cause hypoglycemia include:

• Excessive alcohol consumption
• Severe hepatitis
• Beta blockers (metoprolol, atenolol, carvedilol, etc): not only beta blockers may cause hypoglycemia, they can also mask certain symptoms such as shakiness, palpitation, and anxiety. Sweating and hunger are not masked.
• Ciprofloxacin / levofloxacin

How to treat hypoglycemia

Rule of 15: Steps to treating hypoglycemia

1. Take 15-20 grams of glucose or simple carbohydrates. Do not use chocolate or peanut butter for initial treatment of hypoglycemia. Added fat will delay absorption of sugar and prolong hypoglycemia.
2. Recheck blood sugar after 15 minutes
3. If blood sugar is still less than 70, repeat 15-20 grams of glucose or simple carbohydrates and recheck blood sugar again after 15 minutes
4. If blood sugar is greater than 70, eat a small meal or snack that contains some carbohydrates, protein, and fat in order to prevent hypoglycemia from recurring. The fat and protein will help to stabilize the blood sugar.

15 grams of glucose or simple carbohydrates

Glucagon

Glucagon is recommended to be prescribed for all diabetic patients at increased risk of severe hypoglycemia. It is only used when the patient not conscious enough to treat their hypoglycemia. Caregivers, school personnel, or family members of these patients should be trained on when and how to administer glucagon. Carbohydrates should be administered as soon as possible after glucagon. It is important to note that glucagon will not work for patients with alcohol induced hypoglycemia due to depleted glycogen stores in those individuals. If no response to glucagon, IV dextrose may need to be administered.

Administration:

Place patient lying sideways to prevent choking upon return to consciousness. Mix powder for injection by adding 1 mL of manufacturer-supplied sterile diluent or sterile water for injection to a vial containing 1 unit of the drug, to provide solutions containing 1 mg of glucagon/mL. Shake vial gently to dissolve. Use syringe to withdraw glucagon. May administer intramuscular injection in the upper arms, thighs, or buttocks.

Conclusion

Episodes of hypoglycemia are dangerous for patients. They decrease quality of life, and if severe enough can be fatal. Increasing awareness, recognizing causes, and recognizing symptoms can help to prevent disastrous consequences that can arise due to hypoglycemia. Knowing the steps to treatment will help patients and caregivers remain calm and in control during the event. If hypoglycemia occurs often, re-evaluation of current treatment may need to be considered.

Written By: Eddie Chang and Ellie Sung

References

1. Cryer PE, Davis SN. Hypoglycemia. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 20e New York, NY: McGraw-Hill; . http://nv-ezproxy.roseman.edu:2759/content.aspx?bookid=2129&sectionid=192288656. Accessed February 25, 2019.
2. American Diabetes Association. 6. Glycemic targets: Standards of Medical Care in Diabetes 2019. Diabetes Care 2019;42(Suppl. 1):S61–S70.