Hypoglycaemia in diabetes

This page from Great Ormond Street Hospital (GOSH) explains about hypoglycaemia when someone has diabetes and how it should be treated.

• Hypoglycaemia or ‘hypo’ is the word used to describe a low blood glucose level
• The blood glucose will be 3.9mmol/l or below

• Too much insulin
• Not enough food
• Extra activity/exercise
• Poor absorption of food
• Some medications
• Alcohol and drugs

• These can be varied and people may experience very different symptoms
• Common symptoms that occur are: hunger, feeling shaky, dizzy, sweating, headache, feeling angry and looking pale
• If blood glucose drops below 2.8mmol/l, the brain is not supplied with enough glucose and people may struggle to concentrate and/or their behaviour may change

• Treat a blood glucose of 3.9mmol/l or below (even if they feel all right)
• Treatment is by taking a fast-acting carbohydrate by mouth
• Treat as soon as possible, to prevent blood glucose dropping even further. Correct treatment will also prevent blood levels rising too high afterwards (rebound hyperglycaemia)
• Carry hypo treatment with them at all times
• They will need about 15g of fast-acting carbohydrate; this may vary depending on their age

• Once the hypo has been treated, they should wait for 15 minutes and re-test. The aim is to restore the blood glucose back to a normal level, aiming to reach 5.6mmol/L.
• Chocolate, biscuits, milk, bread, cakes and fruit are not suitable hypo treatments as the glucose is absorbed too slowly. The blood glucose could continue to drop while the food is being absorbed
• They should not need to eat more after treating their hypo. If they have a further hypo they may wish to consider eating some starchy carbohydrate.
• If this happens regularly they should contact their diabetes team as their insulin may need adjusting.
• If the hypo is just before a meal it is important to treat the hypo before eating. They may wish to consider taking insulin after eating in this situation.

• This is uncommon
• It is when blood glucose has dropped too low and your brain cannot work properly
• If they are conscious, they should use the 15 rule
• If they are unconscious, then nothing should be put in their mouth. They should be given the glucagon injection. A parent or carer can do this or they can call an ambulance and the paramedic will be able to give it instead. Glucagon works within 10 minutes
• Once they have regained consciousness, they should eat some starchy carbohydrate.
• After having the glucagon injection there is a risk of further hypoglycaemia so they need to be reviewed at their local hospital.
• Any severe hypoglycaemia should be discussed with their specialist diabetes team to prevent it from happening again