A bitter-sweet truth

A decrease in blood sugar levels can lead to a fatal condition called hypoglycaemia .

Man sleeping during office hours

In order to keep diabetes in control, there are constant efforts taken to create awareness about it, which helps people identify the condition at an early stage. But the seriousness of diabetes is not just because of hyperglycaemia [high sugar].

Here we would like to focus on the less discussed low-blood-sugar condition to help people manage it better.

Hypoglycaemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. This is when the blood glucose levels are below 80mg per cent [Normal range: 80-120mg per cent]. This can cause dysphoria or ‘bad feeling’, coma, seizures and permanent brain damage or death.

People with diabetes have the greatest chances of experiencing hypoglycaemia, if they don’t eat enough or if they take too much insulin—the medicine most commonly used to treat diabetes. If left untreated, hypoglycaemia can get worse and cause confusion, clumsiness, or fainting.

Why does blood sugar level drop?

Glucose which is an important source of energy is primarily obtained from food. Usually after a meal, glucose is carried to the blood cells and stored for generating energy. Excessive glucose consumed will be stored in the body in the form of glycogen. Alternately, it could also be stored as fat in fat cells and later on could be utilised for energy. Glycogens are stored in liver and muscles and are utilised whenever there is need for the same.

When we eat food our blood sugar level increases. In normal circumstances, if our blood glucose level increases, the pancreas will stabilise them by secreting insulin into the bloodstream. In people with hypoglycaemia, the pancreas secretes much more insulin putting pressure on the pancreas resulting in excess of glucose being taken out of the bloodstream.

What causes hypoglycaemia?

Over doses of diabetes medications are said to be the major cause of hypoglycaemia. In diabetics, the glucose chains may not be broken, making it harder for your glucose levels to return to normal.

Hypoglycaemia can also occur as a side-effect of some diabetes medications, including insulin and oral diabetes medications—pills—that increase insulin production. In non-diabetics, when your blood sugar level decreases, the pancreas will break down glycogen to produce glucose. Apart from these, there are some other causes like delayed meals, increased activity or exercise and excessive alcohol abuse.

What are the symptoms?

These include:

  • Hunger
  • Shakiness
  • Nervousness
  • Sweating
  • Dizziness or light-headedness
  • Sleepiness
  • Confusion
  • Difficulty speaking
  • Anxiety
  • Weakness.

How can it be prevented?

To help prevent hypoglycaemia, people with diabetes should keep the following in mind:

Medications. It is best to consult a professional to understand diabetes medications, how they can cause hypoglycaemia and when to take them.

Meal plan. A registered dietician can help design a meal plan that fits one’s personal preferences and lifestyle. People with diabetes should eat regular meals, and should not skip meals.

Daily activity. To prevent hypoglycaemia due to physical activity, it is better to check blood glucose before sports, exercise, or other physical activity.

For people at a risk of hypoglycaemia, it is best to carry details of your diabetes condition and glucose-containg supplement along with you while travelling.

Medicines at work

The commonest cause of hypoglycaemia is anti-diabetes therapy in people suffering from diabetes.

The most effective way to deal with a hypoglycaemic attack is to consume natural sugars [fruits] or artificial sugars [sugar crystals, or chocolate].

Hypoglycaemia is particularly dangerous in patients with heart disease, kidney disease and liver disease. A simple way to prevent such attacks is to introduce a bedtime snack.

In the past, oral anti-diabetes treatments were synonymously classified as oral-hypoglycemics. It was not till the year 2007 that the advent of newer medications influenced the way healthcare physicians think—as being anti-hyperglycaemic rather than hypoglycaemic.

A study called the ACCORD published in 2008 showed a significant increase in number of deaths when an attempt was made to achieve strict blood sugar control.

Strict blood sugar control is required to decrease diabetes-related complications. The main factor to the increased mortality in the study was weight gain and hypoglycaemia.

With the introduction of a new class of anti-diabetes drugs, this is now possible to keep sugar in strict control, without weight gain or hypoglycaemia. These drugs have also found a unique place in the United Kingdom Diabetes treatment guidelines. The main indication for its usage exploits these very advantages [i.e. being weight neutral and anti-hyperglycaemic rather than hypoglycaemic].

The future diabetics holds a lot of promise with drugs being researched whose primary goal is safety [little or no hypoglycaemia] and efficacy.

Recent research on diabetes reveals the important role of incretin hormones, which are produced in the gastrointestinal tract, to maintain glucose levels. These insights create a unique platform for new therapeutic options that improve the function of pancreas, including insulin secretion by the beta cells and glucagons [important hormone in carbohydrate metabolism] secretion by the alpha cells.

Vishal Gupta, MD, MRCP [UK], is a consulting endocrine, diabetes and metabolic physician. He is also the director of the Endocrine And Diabetes Centre in Mumbai.

This was first published in the January 2010 issue of Complete Wellbeing.

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