Earth Day, first observed in 1970, is expected to energize a billion people in over 180 countries on April 22 to dramatize the need to protect our environment.
Several years ago, when Julie’s children were 7 and 11 year olds, she and her husband decided not to eat for the entire day on April 22 (for the children, it meant not having dessert). The plan was to use the money they would have spent on food to buy and plant a tree. Something strange happened that day.
Julie skipped breakfast and lunch but around 1:30 p.m. that afternoon she started to complain of a headache, being anxious, feeling tired and weak. Shortly thereafter, she had to lie down because the headache became excruciating, she felt lightheaded, agitated and said, “My heart is racing. I feel as if I’m going to die.”
She saw her internist who ordered a five hour glucose tolerance test. Julie had nothing to eat or drink for eight hours before the test. Blood was obtained just before the test began and a blood samples were taken at one hour intervals thereafter;
At the fifth hour Julie complained of a worsening headache and the cascade of symptoms as described above soon followed. The laboratory reported the glucose level (sugar in the blood) after the fifth hour to be dangerously low at 45 mg/dL (normal for that lab is 80-120 milligrams/deciliter).
Hypoglycemia means low levels of glucose/sugar in the blood. It can be scary. .It’s not a disease but, like a backache, a warning of a potential, serious underlying health problem. It’s found in the young and old, in people with diabetes or without diabetes. It requires a thorough investigation. Patients with insulin dependent Type 1 diabetes are at an increased risk to experience severe hypoglycemia (see below).
Symptoms
Symptoms of hypoglycemia vary from mild to severe. They often come on quickly and are different from individual to individual. A constant supply of glucose is necessary for the body to run smoothly. It sputters with symptoms when it doesn’t get enough glucose in the cells to function normally.
Mild to Moderate Symptoms
- Lightheadedness or dizziness
- Off balance, unsteadiness
- Feeling tired, weak
- Headachy
- Fast or irregular heartbeat
- Pale, sweaty skin
- Nervous, shaky, jittery
- Hungry
- Argumentative, irritable
- Disoriented, confused
Severe Symptoms
Severe hypoglycemia is frightening and a medical emergency. In this state, the person’s blood glucose level is dangerously low and he/she may be unable to eat or drink, be unconscious or have seizures.
Causes of Hypoglycemia
Too much circulating insulin in the body causes a precipitous drop in the blood glucose level. Patients with diabetes who are insulin dependent (those who need insulin injections, (Type 1 diabetics) are especially prone to the dramatic, severe side effects of hypoglycemia.
Below are factors that impact low blood sugar.
- Doesn’t use diabetic medication properly (takes too much insulin, diabetic pills)
- Food — The person who…
- Skip meals Fasts (fasting)
Eats late at night
Does not eat nutritiously
Does not eat enough good carbohydrates
On ‘fad’ diets — doesn’t eat enough food or eats unhealthy foods
- Is too active physically (without compensating with carbohydrates)
- Drinks too much alcohol
Patients who are not Type1 or Type 2 diabetics are also susceptible to hypoglycemia for a variety of reasons. Tumors, certain diseases, medications, hormone or endocrine deficiencies can bring about low blood sugar. Treatment depends on diagnosing the underlying cause and initiating proper treatment.
Treatment is aimed at reversing hypoglycemia. In patients without diabetes, the main objective is for patients to consume sugar in any form. In patients with diabetes, the main objective is to properly administer insulin at the right times in the proper dosage. Oral medications that cause hypoglycemia may have to be discontinued or their dosage decreased.
Know your body! If you have one or more of the above symptoms, check your blood glucose level (Finger test — see below). If the blood glucose level is too low, consume15-20 grams of simple sugar or glucose. For example:
- Glucose tablets or
- 1 tablespoon of sugar, honey or
- 2 tablespoons of raisins or
- 6 ounces of soda (not diet soda) or
- 4 ounces of fruit juice (not for kidney patients).
- Adjust insulin dosage; modify or eliminate oral diabetic medications
- Consider obtaining a glucagon kit (see below)
After consuming sugar or tablets, wait 15 minutes and check your blood glucose level. Check the level until it is within a normal range. Eat a healthy snack (not sugary) once the blood glucose has returned to normal.
Severe hypoglycemia can make you pass out, causing injuries and even death. So it’s crucial to know your signs and symptoms and your laboratory results. It’s helpful to wear a Medical ID, usually worn as a bracelet or necklace, indicating that you suffer from potentially dangerous low blood sugar.
A recent study out of Johns Hopkins suggests that just one episode of severe hypoglycemia necessitating an emergency room visit can increase the risk of death and stroke in older Type 2 diabetes patients. Hypoglycemia has been underdiagnosed and at times, unrecognized and unappreciated.
Back to Julie, mentioned above, who said, “I’ve been on almost every imaginable diet.” Most recently, she was on a high protein and virtually no carbohydrate diet. After receiving counseling by a dietician, she now avoids fasting, enjoys small, healthy snacks in between meals (and in the middle of the night) eats well-balanced meals and thus far hasn’t had any severe episodes of hypoglycemia.
Following a strict dietary regimen is of paramount importance for people with a history of low blood sugar. If you get up in the middle of the night, another snack at that time might make you feel less tired when you rise and shine in the morning.
Glossary
Type 1 Diabetes: Patients take insulin by injection or by injection pump because of complete or near total insulin deficiency.
Type 2 Diabetics: The body doesn’t produce enough insulin for proper function or the cells do not react to insulin (“insulin resistance”)
Pre-Diabetes: the body is becoming resistant to insulin.
Hypoglycemic Unawareness
Certain medications can mask, make you unaware of the symptoms of hypoglycemia. For example, if a person with hypoglycemia takes a beta blocker, the person may not experience the early warning signs of low blood sugar that of shakiness and palpitations. Check with your doctor and pharmacist concerning the masking effects of drugs.
Fingertip method to test your blood sugar
One method is to prick the side of your finger (less painful) with a sharp needle, place a drop of blood on a test strip and then insert the strip into the glucose meter that shows your blood sugar level within 20 seconds. Record your results in a diary book. Certain conditions, the weather or high altitude can affect the results.
Glucagon kit
Glucagon is a hormone that raises blood glucose levels. It stimulates the liver to release stored glucose into the bloodstream when the blood glucose level becomes dangerously low. Severe, untreated hypoglycemic episodes can lead to coma and seizures. The kit provides glucagon and instructions on how to administer the hormone.
References
Cryer, Philip E et al; Evaluation and Management of Adult Hypoglycemic Disorders;
J Clin Endocrnol Metab; March 1, 2009
NIDDK National Institute of Diabetes, Digestive and Kidney diseases. Low Blood Glucose (Hypoglycemia), August 2016
American Diabetes Association; Hypoglycemia (Low Blood Sugar); July I, 2015
Selvin, Elizabeth, PhD; Lee, Alexandra MSPH; Severe Hypoglycemia reported in Johns Hopkins News, March 10, 2017
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.