What is hypoglycaemia and why is it important?

Hypoglycemia occurs when the amount of glucose in your blood falls lower than it should be (lower than 4 mmol/L). When blood glucose is too low, your body doesn’t have the fuel it needs to function appropriately. Hypoglycemia is a dangerous situation, and quick action is needed. Being prepared and educating your family and friends can be important for your safety.

You are more likely to get low blood sugar if you:

• Are treated with insulin 
• Are treated with sulfonylureas (such as gliclazide, glimepiride)
• Drink too much alcohol

Recent changes in your body weight, medication regimen, meal schedules, or exercise intensity might also increase your risk of having it.

What are the symptoms of hypoglycaemia?

• Feeling sweaty or cold with clammy skin
• Shakiness
• Dizziness
• Fast or pounding heartbeat
• Headache
• Hunger
• Feelings of being weak, tired or anxious
• Problems with vision, such as seeing double or blurry vision
• Changes in behaviour such as irritability, sleepiness or confusion
• Problems speaking clearly, such as slurring words.
• Seizures and loss of consciousness may also occur (if blood sugar continues to drop)

Treating hypoglycaemia:

1. If you suspect you have low blood sugar, check your blood glucose and determine if it is below 4 mmol/L.
2. If it is below 4 mmol/L, eat 15 to 20 grams of fast-acting carbohydrates such as:

1. 200 ml orange juice/apple juice 
2. 5 glucose or dextrose tablets
3. 5 jelly babies
4. Two tubes of a glucose gel.

1. Recheck your blood glucose 15 minutes after treatment has been given.
2. If blood glucose has not corrected above 4 mmol/L, then repeat fast-acting carbohydrates.
3. Recheck your blood glucose again after 15 minutes and repeat the above steps until the level is corrected.
4. When blood glucose has reached 4 mmol/L or above, eat 15-20g of long-acting carbohydrates (2 biscuits, 1 slice of bread) or 200-300ml milk.‍

You should explain to your family, friends, or co-workers that if significant drowsiness or loss of consciousness occurs when your blood glucose is low, they should avoid giving you any food by mouth. This is because there is a risk you could choke or aspirate the food. Alternatively, they should:

• Put you into the recovery position.
• Call 999.
• If available and competent to do so, administer an intramuscular injection of glucagon medication.

Driving and Hypoglycaemia 

Following the DVLA guidelines in the UK,  blood glucose must be above 5 mmol/L to drive. If your blood glucose is less than 5, consider eating a snack. If it is below 4 mmol/L or you feel symptoms of low blood sugar, do not drive before treating it. 

Other precautions you should follow when driving:

• Take an emergency kit with you (see how to create one of these in the section below)
• Check your blood glucose less than 2 hours before the start of your first journey and every 2 hours after driving has started.
• Take extra care after changes in your treatment regimen, lifestyle or exercise - more frequent testing may be required.
• If hypoglycaemia develops while driving, stop the engine safely, remove the keys from the ignition and move from the driver’s seat.
• If you need to treat hypoglycaemia and it has been corrected (at least 5.0 mmol/L), you must wait 45 minutes before driving again.

If you drive certain types of vehicles, you may be required to inform the DVLA of your medication regime. Speak to your clinician or GP if you are unclear which medication you are on.

Create a Hypoglycemia Emergency Kit

If you use medication to treat diabetes that increases your risk of having low blood glucose levels, you should prepare an emergency kit and always have it with you. Tell your friends and family about the signs and symptoms discussed above, and make sure they know the location of these resources. The kit should include:

• Emergency contact information
• Your medical ID, glucometer and test strips
• Glucose tablets or any other form of rapid-acting carbohydrates (to be used only if you are conscious and able to swallow)
• A glucagon pre-filled syringe
• Instructions for administering emergency glucagon

If you have any questions regarding this hypoglycaemia information, please reach out to your Roczen clinician.