Treatment for Hypoglycaemia

Family and friends, as well as the affected person, need to learn how to recognize hypoglycaemia and what action to take and this forms an important part of education about diabetes. A person subject to 'hypos' should always carry some form of readily absorbed sugar with them such as glucose tablets, sugar lumps, soft sweets, honey, chocolate or a sweet drink. Action at an early stage quickly restores the person to normal and averts the development of further symptoms.

Mild Hypoglycaemia
Symptoms most commonly experienced are the adrenergic ones or those in the non-specific category. Treatment is simply a matter of taking in a small amount (10 g) of rapidly absorbed glucose, such as four glucose tablets or sweets, two teaspoons of honey, or a small sweet drink. An affected person should sit down quietly for five minutes and when feeling better should eat a snack containing carbohydrate (e.g. a sandwich or fruit), or have the next meal, if it is due. This is to prevent a recurrence of the hypoglycaemia. It may be advisable to check the blood glucose level after eating to ensure that this is returning to a safe level, and the next insulin dose should be given as normal. If symptoms arise while driving (or operating machinery), find a safe place to pull in and stop the car. Remove the keys from the ignition and move to the passenger seat. Do not start driving again until fully recovered.

Moderate Hypoglycaemia
Brain function is affected and typical symptoms include confusion, irritability and odd or aggressive behaviour, sometimes mistaken for drunkenness. The affected person requires help from someone else but may try to refuse aid. The most effective treatment, as long as the person is conscious, is to persuade him or her to take some sugar in liquid form. A thick glucose gel is available from diabetes clinics and this can be squirted into the mouth. Alternatively, honey, treacle, a sweet drink or sugar dissolved in warm water are equally good alternatives. They should be spooned into the person's mouth, and even if he or she is resisting swallowing, some will be absorbed through the membrane lining the mouth and this will improve symptoms. Once this occurs, the person usually becomes more co-operative and will then accept some more. When he or she feels better, a carbohydrate-containing snack or meal should be eaten, as for mild hypoglycaemia. It is advisable to monitor blood glucose levels for a time, following recovery.

Severe Hypoglycaemia
This stage is marked by unconsciousness and obviously, the person requires outside aid in order to recover. The standard treatment is an injection of glucagon beneath the skin, this being the hormone that stimulates the release of glucose by the liver. The glucagon is supplied in an easy-to-use kit, containing simple and clear instructions and is available from diabetes clinics. Usually, a family member is shown how to use the kit as part of the general education about diabetes offered by the clinic, but anyone can administer the injection in an emergency. Once the person regains consciousness, he or she must be given a small amount of readily absorbed glucose by mouth, followed by a carbohydrate-containing snack or meal, once he or she has recovered sufficiently to be able to eat. Blood glucose levels should be monitored during the recovery period and the person may feel the need to rest for the remaining part of the day. If the glucagon injection does not work and the person dremains unconscious, or there is any other cause for concern, emergency medical help should be summoned.

Severe, Sulphonylurea-induced Hypoglycaemia
This is a medical emergency requiring expert treatment in hospital. In sulphonylurea-treated patients, recurrence of the hypoglycaemia after initial recovery is common and so the person has to be closely monitored. The mainstay of treatment is dextrose given by intravenous infusion and this may be required for several days. Glucagon is not an appropriate treatment for sulphonylurea-induced hypoglycaemia because one of its effects is to stimulate the release of insulin, which is likely to make the situation worse. Although rare, this type of hypoglycaemia is serious and especially worrying if it occurs in older people.

Nocturnal Hypoglycaemia
Hypoglycaemia occurring during sleep is quite common in Type 1 diabetes and often produces no symptoms. It is particularly worrying for parents when it occurs in young children who can be at risk of impairment of brain function if the attacks are frequent. For this reason, parents are given special and detailed advice on how to reduce the risks and the appropriate action to take. In adults, nocturnal hypoglycaemia sometimes produces symptoms of night sweats or the person may have a headache on waking. It is advisable to carry out home blood glucose monitoring between 2 and 3 a.m. for a few nights, if it is suspected that nocturnal hypoglycaemia is occurring. It is usually necessary to alter the dose of evening insulin and recent research suggests that it is the dose of short-acting clear insulin that is the most critical in nocturnal hypoglycaemia. Also, it is often necessary to eat a carbohydrate-containing snack before going to bed. It is very important to be extremely careful about alcohol consumption, especially if nocturnal hypoglycaemia is a problem. Even a modest amount of alcohol can cause problems in susceptible people and alcohol-related hypoglycaemia can be triggered many hours after the drinks have been consumed.

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