How to handle or head off a ‘hypo’
YOUR mouth goes dry and you feel light-headed. Suddenly there’s a terrible feeling of impending doom. You know something is not right.
If you don’t get something to drink or eat right now, you are going to fall over. You try not to, and, amid it all, you feel unbearably selfconscious, because you know people are staring. But it’s out of your control … if you could only sit down.
Dr Shenaz Seedat, a senior medical adviser (diabetes) and endocrinologist at Novo Nordisk South Africa, says many people know the anxiety and fear of low blood glucose (sugar). But for most, severe hypoglycaemia is uncommon.
“There are those, however, for whom low blood glucose is a constant threat, and in whom it may not only interfere with activities, but could cost a life,” she says. “The most common form of diabetes (type 2) occurs when the body stops making enough insulin, or does not respond properly to the insulin it has.”
This deficiency of effective insulin causes glucose to accumulate in the bloodstream, rather than entering cells to provide energy. The sustained abnormally high blood glucose level causes damage to blood vessels and nerves, predisposing you to a heart attack, stroke, kidney disease, infection and painful feet.
“However, when it is treated with medication, diabetes may not be characterised by high blood glucose alone. Medication, combined with missed meals and over-exertion, may also cause glucose to fall too low.”
Furthermore, Seedat says, especially in long-standing diabetes, the body may lose its ability to respond properly and correct abnormally low blood sugar.
“In fact in some people with diabetes, the first sign of abnormally low blood sugar (hypoglycaemia, sometimes called a ‘hypo’) may be fainting, leaving no time to rectify the situation before loss of consciousness occurs. If this happens during driving, swimming or other potentially hazardous activities, the outcome can be disastrous.”
The most obvious initial symptoms of a hypo are a racing heart, shakiness, anxiety, irritability and hunger, and these can have a massive impact on daily life.
“Fear of a hypo is a daily battle for many people with diabetes and their relatives, especially those who are on medication, such as insulin, that makes the chance of a hypo an everpresent, and unpredictable, risk,” says Seedat.
“The loss of personal control is a cause of embarrassment and stress. It may require assistance from others, especially if it results in loss of consciousness.”
Hypos, she said, could prevent people getting proper diabetes treatment.
“They can have a dramatic and adverse effect also on how well people manage their diabetes. Because they fear hypos, they may deliberately maintain their blood glucose at higher levels, which can increase the risk of the other long-term adverse health consequences of poorly treated diabetes.
“Conversely, especially in older people, many of whom already have some degree of heart disease, the profound effects of a hypo on the heart can provoke a heart attack or heart failure.”
People need to become aware of the importance of hypoglycaemia, says Seedat.
“If they know the causes and things that increase the risk of it happening, they can take steps to avoid these or intervene before it’s too late. This involves being aware of the symptoms and appropriate treatment of hypoglycaemia, and sometimes requires speaking to your doctor to reassess your medication and glucose treatment targets.”
Sufferers also needed to be aware of the potential dangers of hypoglycaemia while driving, and ensure they received guidance from their treating doctor.
“There are some medications, and even new types of insulin, that have a lower risk of hypoglycaemia.
“Today diabetes is a very manageable condition. With proper assessment and treatment, people need not fear the long-term consequences. Diabetics who have well-controlled blood glucose levels and are well educated can have full and healthy lives. It is also fortunate that we now have treatments which reduce the risk of potentially dangerous side effects.”