Best Diabetes Doctor Los Angeles –
Dr. Cora Lanyon, D.C.

Blood sugar will naturally vary throughout the day in response to various stimuli. However, when blood sugar drops precipitously fast or drops below 70 mg/dl and becomes symptomatic needing treatment, it is termed hypoglycemia. Symptoms of hypoglycemia may occur even if blood sugar does not drop below 70 mg/dl if the blood sugar drops rapidly from a higher number to a lower number without giving the body time to adjust. Then any one of the following hypoglycemic symptoms may occur:

Best Diabetes Doctor Los Angeles - Hacking Hypoglycemia in Type 2 Diabetes
  1. Feeling shaky
  2. Being nervous or anxious
  3. Sweating, chills and clamminess
  4. Irritability or impatience
  5. Confusion
  6. Fast heartbeat
  7. Feeling lightheaded or dizzy
  8. Hunger
  9. Nausea
  10. Color draining from the skin (pallor)
  11. Feeling Sleepy
  12. Feeling weak or having no energy
  13. Blurred/impaired vision
  14. Tingling or numbness in the lips, tongue, or cheeks
  15. Headaches
  16. Coordination problems, clumsiness
  17. Nightmares or crying out during sleep
  18. Seizures

Causes of Hypoglycemia

Hypoglycemia occurs in type 2 diabetes in people on either oral medications (not metformin) or insulin and may result in any one of the following scenarios:

  1. Takes too much insulin (or an oral diabetes medication that causes your body to secrete insulin)
  2. Does not eat enough food
  3. Exercises vigorously without eating a snack or decreasing the dose of insulin before hand
  4. Waits too long between meals
  5. Drinks excessive alcohol, or drinks alcohol without eating
  6. Timing of meals not consistent with type of insulin
  7. Not enough carbohydrates at meals or planned snacks
  8. The composition of the meal (protein, fats, carbohydrates) may affect the absorption of the carbohydrate making less glucose available when peak insulin is present
  9. Liquids are absorbed faster than meals with fiber and may affect timing of meals relative to medication delivery
  10. Eating meals with less carbohydrate than usual without adjusting insulin dose
  11. The intensity, duration and frequency of exercise relative to the timing of carbohydrate snacks and insulin are not in sync

Nocturnal hypoglycemia

This occurs most often at night when the sleeping individual is unaware of it. If it does not become severe it is bothersome enough that within the next 48-72 hours episodes of hypoglycemia may occur during waking hours but not show traditional symptoms. Nocturnal hypoglycemia often disrupts sleep but does not become severe enough to warn the individual of need for treatment.


Hypoglycemia Prevention

Many times, episodes of hypoglycemia can be prevented just by sticking to a scheduled meal plan and or adjusting insulin and carbohydrate levels when needed. Other times, it just happens and cannot be avoided – often this occurs in individuals who have had diabetes for an extended period of time or who are newly diagnosed and not educated yet on prevention.

The best way to avoid hypoglycemia (aside from following your meal plan) is to regularly test your blood sugars and know your glycemic targets set up between you and your provider.

Know your own body. Everyone has their own pattern of fluctuations. Become familiar with yours.

Check your blood sugar:

  • Check before and after meals
  • Check before and after exercise (or during, if it’s a long or intense session)
  • Check before bed
  • After intense exercise, also check in the middle of the night
  • Check more if things around you change such as, a new insulin routine, a different work schedule, an increase in physical activity, or travel across time zones
Keep necessary supplies on hand and next to your nightstand in case of night-time hypoglycemia.

In severe cases of low blood sugar, have glucagon injectable on hand. Glucagon is a hormone produced in the pancreas that stimulates your liver to release stored glucose into your bloodstream when your blood glucose levels are too low. Injectable glucagon is used to treat someone with diabetes when their blood glucose is too low to treat

Glucose tablets or gel should be on hand along with test strips and a glucometer.

Best Diabetes Doctor Los Angeles - Hacking Hypoglycemia in Type 2 Diabetes

Hypoglycemia Hacks

What should you do if you find yourself in a state of low blood sugar? Follow the 15-15 rule.

The 15-15 rule—have 15 grams of carbohydrate to raise your blood glucose and check it after 15 minutes. If it’s still below 70 mg/dL, have another serving.

A 15-gram serving of carbohydrate would be:

  • Glucose tablets (see instructions)
  • Gel tube (see instructions)
  • 4 ounces (1/2 cup) of juice or regular soda (not diet)
  • 1 tablespoon of sugar, honey, or corn syrup
  • Hard candies, jellybeans, or gumdrops—see food label for how many to consume

While it may be tempting to eat until you “feel better” this can cause your blood sugar to overshoot and begin a roller coaster ride when the goal is blood sugar stabilization. Take care to not overtreat.

If glucose is less than 54 mg/dl then the American Diabetes Association, 2019, recommends injecting glucagon and surrounding family members should be trained in its delivery.

Knowing the above hacks may help control hypoglycemia and manage it should it occur in those with type 2 diabetes.

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