WHEN THE BLOOD SUGAR GOES LOW

These 2 conditions can be detrimental if not recognized and treated early.

Hypoglycemic Episode:

It is defined as a syndrome which is associated commonly with blood sugar levels of less than 70 mg/dl.

It is classified into 3 types:

• Mild: CBG between 50-70 mg/dl + Neurogenic Symptoms
• Moderate: CBG between 50 - 70 mg/dl + Neuro-glycopenic Symptoms
• Severe: CBG < 50 mg/dl

What can cause it?

• Too little food or carbohydrates (poor oral intake)
• Skipped or delayed meals
• More active than usual
• Too much insulin or too many diabetic pills
• Infection

How does one recognize the signs and symptoms of hypoglycemia?

Depending on the blood glucose levels, patients can be asymptomatic or symptomatic with varying degrees of severity of signs & symptoms secondary to low blood glucose levels.

Patients with Mild Hypoglycemia present with the following symptoms:

• Palpitations / fast heart beat
• Tremors
• Sweating
• Anxiety
• Hunger
• Paraesthesia / numbness

Patients with Moderate Hypoglycemia present with the following symptoms:

• Behavioural Changes
• Confusion
• Altered Mentation
• Headache
• Nausea
• Extreme Sweating
• Irritability
• Dizzy / Giddiness

Patients with Severe Hypoglycemia present with the following symptoms:

• Severe confusion
• Lack of coordination
• Extreme fatigue
• Seizures / fits
• Impaired Vision
• Coma
• Unconsciousness
• Death

What to do when the blood sugar goes low?

• Check the CBG if a capillary blood glucose testing machine is available.
• If the patient is conscious and alert or talking and responding, yet symptomatic - Oral sugars (1-2 spoons of sugar mixed in 1 glass of milk or chocolate bar) can be given.
• If the Patient is semi-conscious or unconscious - Pl take the patient to the hospital for IV dextrose correction and observation.

What should not be done?

• Never Give Oral sugar water / ORS / water - to an unconscious or semi-conscious patient as one can aspirate these contents into the lungs causing further complications.
• Do not ignore assuming patient is sleeping.
• Do not delay to review with the Physician or Diabetologist.

Treatment of Hypoglycemic Episode:

• For mild symptomatic hypoglycemic episodes - oral sugars (1-2 spoons with 1 glass of milk or Chocolate bar) can be given.
• For Moderate and Severe Hypoglycemic Episodes - IV dextrose is suggested at hospital.
• Review of medications by the Physician or Diabetologist.
• Treatment of the cause:
• If the precipitating factor is an infection - treat with appropriate antibiotics
• If the precipitating factor is poor oral intake - improve nutrition
• Prevent recurrent attacks by close monitoring of blood sugar levels.