Sunday, August 5, 2012

Low blood sugar: treat it!


Low blood sugar: treat it!


Low blood sugar should be treated with or without symptoms.
Many people just don’t know this simple fact.

We routinely have those patients on insulin test their sugar when they come in for an office visit. It’s amazing how many have a low blood sugar with almost no symptoms.  A sugar below 70 milligram per deciliter (mg/dl) is considered low and a level that low is called hypoglycemia. Now to be clear, I am referring only to persons with diabetes in this post.

Too often patients decline treatment and say “but I feel fine!”
And some come in with their logbook showing repeated glucoses in the 60’s.
And they did nothing about that for weeks!
They wait to let me know until that office visit!

The brain needs glucose to function. The lower the glucose goes, the more likely there will be problems with brain function. With hypoglycemia, some people get angry, irritable or short tempered.
With hypoglycemia, others think more slowly or have changes in vision.

Sweating is a very common symptom of hypoglycemia. With a very low blood glucose, a person can pass out (lose consciousness) or have a seizure.
The level of glucose at which loss of consciousness or a seizure occurs varies but probably needs to be below about 35 mg/dl.

The more frequently someone gets hypoglycemia the fewer the typical symptoms of hypoglycemia they will feel. The typical symptoms are shakiness, heart beating fast, weakness and hunger.

When the glucose is repeatedly low, a person may not feel much at all. This is called hypoglycemia unawareness.

Because of hypoglycemia unawarenenss, we routinely test for hypoglycemia in our office in those people taking insulin.
The main concern with insulin therapy is the increased risk of hypoglycemia.
Those with hypoglycemia unawareness, usually have slower brain function when their glucose is low. But very often, they just don’t know that their brain is working slower.

Our brain adapts to low or high glucoses so we seem to function fairly well if our glucoses have often been low. And on the other hand, those who often have high glucose, hyperglycemia, may  not feel quite right when their sugar is normal.

By avoiding hypoglycemia, the person with hypoglycemia unawareness can regain awareness of hypoglycemia and start to feel symptoms again. That’s good.

It’s bad to not feel when your glucose is low.
We want our brains to work as well as possible. I do, and I assume you do too.

Of course, preventing hypoglycemia is the best approach. And smart insulin treatment as described in a previous post is the key to prevention of hypoglycemia. Here are some specifics on treatment.

And patients and doctors need to understand how to interpret results from blood glucose testing. Continuous glucose monitor systems such as the Dexcom system are a major advance in our goals to minimize hypoglycemia.

Two key points to keep in mind about blood glucose testing.
Expired blood glucose test strips can give goofy, unreliable readings.  So expired strips should not be used.

Also a blood glucose meter that is really cold or hot may give false readings.
I’ve seen that before with someone who left their meter in a cold car and had a glucose reading of 25 with no symptoms. And his Mom said he looked and acted just fine.
You would not be fine if your glucose is really 25. When the meter came to room temperature, his glucose tested 132.

Most meters usually are not accurate below a temperature of 40 F or above about 110 F.

But in the usual setting, a glucose below 70 mg/dl should be treated and not ignored. 
As we strive to get our diabetes under good control, we need to minimize hypoglycemia. And when we detect hypoglycemia, we should promptly treat it.


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