Hypoglycemia and type 2 diabetes
What is hypoglycemia unawareness?
Hypoglycemia unawareness occurs when someone has low blood sugar without any symptoms, or he is unable to recognize the symptoms. In such cases, a patient could lose consciousness from low blood sugar without ever recognizing the early warning signs.
This acute complication of type 2 diabetes is more common in people who've had the condition for years and in older adults. That's because about five years after a diabetes diagnosis, the symptoms of low blood sugar tend to fade.
After 20 years with type 2 diabetes, symptoms can sometimes be too subtle to detect or may occur only after a patient's glucose level has been too low for too long, rendering him incapable of treating the condition himself.
This situation is also more likely to occur if the person in your care has neuropathy (nerve damage) or if he takes certain heart or high blood pressure medications.
How can I tell if hypoglycemia unawareness is happening?
- Often there are no symptoms of low blood sugar -- hence the name.
- Sometimes while the physical and behavioral signs of low blood sugar aren't apparent, the patient (or his caregiver) may still detect mental red flags for hypoglycemia, such as difficulty concentrating, slowed speech, slowed thinking, or lack of coordination.
Dealing with hypoglycemia when someone has diabetes
He's unconscious. What should I do?
- Call 911 if the person is unconscious.
- Give a glucagon injection if he's unconscious or unable to swallow -- if the person has a glucagon emergency kit and you (or another caregiver) know how to use it. While you're giving the shot, someone else should call 911.
He's conscious. How should I proceed?
- Call his main diabetes doctor and treat for low blood sugar if he's conscious and able to swallow.
Typically, hypoglycemia can be addressed by consuming a quick-fix, sugar-rich food. Each of the following contains about 15 grams of carbohydrates:
- 3 to 4 glucose tablets
- 1 serving of glucose gel
- 1/2 cup (4 ounces) of fruit juice
- 1 cup (8 ounces) of milk
- 1 to 2 teaspoons of sugar or honey
- 5 to 6 hard candies
Have the person in your care consume one of the above, then follow the 15-15 rule: After 15 minutes, check his blood sugar level again to make sure it's at 70 or above. If not, have him eat or drink another 15 grams of carbohydrates.
Even if his numbers bounce back, if it's an hour or more before his next meal, give him a carbohydrate- and protein-rich snack, such as peanut butter on toast or half a turkey sandwich.
How to prevent hypoglycemia unawareness
- Keep on the lookout for mental indications of low blood sugar, and point them out to him so he can stay on top of his condition.
- Make sure he checks his blood glucose on a routine basis.