Prevention of Hypoglycaemia
Every diabetic and the parents or spouse of a diabetic should know the warning signals of hypoglycaemia. A colleague or a work mate of a person with diabetes and a class teacher of a diabetic child should also be able to recognise hypoglycaemia and know its prevention and treatment.
Blood glucose tests should be done regularly so that the correct dose of insulin or the oral drugs can be determined. Meals should be uniform and regular. Diabetics taking insulin should have carbohydrate containing snacks at the time of the peak action of insulin.
Rapid acting insulin analogues may prevent hypoglycaemia in between the meals and insulin glargine may prevent hypoglycaemia at night.
Blood glucose before dinner and at bedtime should be tested when hypoglycaemia occurs at night. A snack at bedtime is essential, to prevent hypoglycaemia at night..
Nonselective beta blockers should be avoided.
A diabetic, taking insulin or oral drugs should carry some glucose or sugar and keep it at his/her place of work. He/she should take two teaspoons of glucose or sugar, dissolved in water and rest, at the onset of hypoglycaemia. If hypoglycaemia does not subside within 10 to 15 minutes of taking glucose or sugar, two to three teaspoons of glucose or sugar should be repeated. If glucose or sugar is not available, he/she can have a fruit, fruit juice, a couple of biscuits, syrup or candy. He can have the next meal, if it is due within half an hour. Do not ignore hypoglycaemia, hoping that it would correct itself.
The quantity and timings of meals, the dose of insulin, the Sulphonylurea drugs and the exercise should be reviewed, to determine the cause of hypoglycaemia. If there is no obvious error as regards the diet or the exercise, the dose of insulin should be reduced by 25 per cent and doctor should be consulted.
A diabetic should carry on his/her person an identification card (fig. 8) or a disc. Such a card is of great value in treating an unconscious person.
If symptoms of hypoglyaemia occur while driving a vehicle, the vehicle should be stopped and dismounted. One should resume driving only after complete relief is obtained after taking glucose/sugar. Otherwise, serious accidents can occur.
Identification Card If I am injured or suddenly ill please tell the attending physician that I am a DIABETIC and show him this card (To be filled in by family physician) * I am on Insulin therapy (No. of units ____ per day) * I am on oral hypoglycaemic drugs. * I am allergic to ___________________________________ * My blood group is _______ If I can swallow, give me sugar or a sweet drink. If I do not recover promptly send me to a hospital at once. My doctor's / clinic's name :Address:___________________________________________ Tel:__________________________________
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What to do when hypoglycaemia is severe - Treatment:
The person should not be forced to drink a glucose solution if he/she is unable to swallow or is drowsy. A thick sugar paste can be given in the gap between the teeth and gums if the patient is unable to swallow. A doctor should be summoned or the patient should be removed to a hospital, if hypoglycaemia is severe. An admission to hospital is also necessary when hypoglycaemia is due to sulphonylureas, since hypoglycaemia is often recurrent in such cases and observation for a couple of days is essential. An intravenous injection of glucose is necessary in such cases. An intramuscular injection of 0.5 - 1 mg of glucagon raises the blood glucose level and arouses the patient sufficiently to take sugar orally.
Episodes of hypoglycaemia are inconvenient and embarrassing. They can shake the confidence of a diabetic. Frequent and severe hypoglycaemia should, of course, be avoided. An occasional and mild hypoglycaemia may occur in spite of the best management, if tight control of diabetes is attempted.
Medical tests, fasting and adjustment of treatment
Overnight fasting is necessary before a number of medical tests and procedures. After some tests, the patient may not be allowed to eat for a few hours. In order to avoid hypoglycaemia, in such situations, an adjustment of treatment is necessary.
A diabetic should know the time of the test or the procedure, the duration of fast before the test and when to eat. He should discuss the adjustment of the treatment with the doctor.
General guidelines for tests which are carried out in the morning after an overnight fast and which are over by lunch time are as follows: (it is assumed that diabetes is reasonably well controlled).
If you are on a tablet which is taken once at breakfast time, omit the tablet in the morning of the test and take half the dose, when you resume eating at lunch time. If you take tablets more than once a day, omit the morning dose of the tablets and take the usual dose with lunch and dinner.
If you are on once daily insulin, reduce the dose on the day prior to the test by 10 per cent (or 20 per cent if you are prone to develop hypoglycaemia). If you are taking insulin twice a day, reduce the dose of the intermediate-acting insulin (NPH or lente or monotard) in the evening before the test, by 10 per cent (20 per cent if you have a tendency to have hypoglycaemia). On the morning of the test, omit the short-acting insulin and take 70 per cent dose of the intermediate-acting insulin.
You must have some glucose tablets or powder with you when you go for the test. You should go accompanied by someone to the hospital. You should not drive to and from the hospital. It is worth-while reminding the hospital staff that you have diabetes, especially if you are going to have a general anaesthetic or a sedative.
Religious fasts
A person with diabetes may observe, religious fasts at times. Religious fasts may be of different types and the restrictions may be on eating certain foodstuffs or on the timings of meals. A diabetic treated with insulin or oral drugs should not fast totally. An overweight diabetic, treated with diet alone can omit solid foods for a day but should drink plenty of water. Many people take supper before sunset. If such persons need antidiabetic drugs or insulin, they should take drugs with a short action. Supper should be taken an hour and half before actual sunset, the snack containing carbohydrate should be taken just before sunset to prevent hypoglycaemia at night. Many people, omit most cereals, pulses and certain vegetables when they fast. Meals comprising of milk and its products, vari, cucumber, ladies fingers, red pumpkin, fruits and sago can be taken by diabetics on such fast days.