Hypoglycaemic and Hyperglycaemic Episodes

Hypoglycaemic Episodes

A hypoglycaemic episode, or "hypo" is the term used to describe an episode of low blood sugar. This occurs when the blood sugar drops below a certain point (around 3.0 mmol/litre).

However, the precise level varies with different people; for example, people with autonomic neuropathy may not be aware of symptoms until the blood sugar level drops well below this level.

The features of Hypoglycaemia may include:

• Sweating
• Pallor
• Shakiness
• Palpitation
• Irritability
• Poor concentration
• Hunger

If untreated it may progress to:

• Drowsiness
• Detachment (mental)
• Clumsiness
• Aggression
• Confusion
• Convulsions
• Coma
• Death

• Main causes of Hypoglycaemia
• Awareness of Hypoglycaemia
• Hypoglycaemia during the night
• Hyperglycaemic Episodes

Main causes of Hypoglycaemia in the diabetic patient

Hypoglycaemia may occur when the dose of insulin or certain medications (e.g. sulphonureas) is too high for the patient’s dietary intake of carbohydrates. It may also occur when the exercise output is unusually high (exercise lowers glucose levels in the blood, and therefore affects the need for insulin). It can also be caused by irregular eating habits and alcohol excess, when less insulin is needed, as alcohol has the effect of lowering blood sugar.

All persons taking insulin or some diabetic tablets such as sulphonureas should have glucose tablets, sweets or a drink with them at all times in order to cope quickly with a hypoglycaemic episode.

Awareness of Hypoglycaemic Episodes

Most diabetics are able to recognise when they are hypoglycaemic by the symptoms: sweaty, irritability, hunger, shakiness etc. True unawareness of impending hypoglycaemic episodes is uncommon.

Most diabetics are aware that they are hypoglycaemic and are able to take appropriate steps (i.e. taking glucose tablets, having milk or juice etc) but some, especially those who have had diabetes for a long time or who habitually keep their blood sugar level on the low side, are not able to discern the initial symptoms. The symptoms, although not apparent to the patient, may be apparent to other people.

In more serious cases, that is, if the person is losing or has lost consciousness, an ambulance may need to be called, and the paramedic will need to administer intravenous glucose (or glucagon, a glucose - releasing hormone) intramuscularly.

Relatives, as well as patients, need to be educated in the symptoms and signs of hypoglycaemia and the need to administer an appropriate, rapidly - absorbed, sugar source. Sometimes, relatives are trained to administer glucagon as well.

A new, very useful source of sugar for hypoglycaemia is Hypostop, now known as Glucogel. This pack contains plastic sachets of liquid glucose in gel form, which if put in the oral cavity or on the gums, is rapidly absorbed in 10 seconds raising blood sugar quickly. It is recommended to all diabetics, especially active diabetics and people who drive long distances or who drive frequently.

Patients may carry a card, or wear a bracelet or necklace, which has information identifying them as a diabetic in case a “hypo” occurs away from home.

A Hypo can be diagnosed by a simple blood glucose test (BM stix) and ambulance staff are able to do this.

Hypoglycaemia which occurs at night

This probably happens more often than realised, but it is difficult to assess, because frequently the person sleeps through it, but wakes in the morning feeling irritable and "hung over". (The partner may report that the bedclothes are wet with sweat, the patient sleeps very restlessly and may fall out of bed.)

This may be prevented by doing a blood glucose test before going to bed, and having a snack, if the reading is less than 6 mmol / litre. This may prevent a nocturnal "hypo", but it is always wise for the patient to keep a source of sugar at the bedside.

Hyperglycaemic Episodes

Hyperglycaemic episodes or "Hypers" build up over a period of time and the symptoms are easily recognised by the person (e.g. excessive thirst and passing large volumes of urine). The person may be able to counter the symptoms themselves, if mild or will be able to recognise the need for medical intervention.