The first thing to say about diabetic hypos (hyperglycaemia) is that they are pretty much inevitable for someone with diabetes – perhaps even more so if you are well-controlled.

Being well-controlled means mostly having blood test results in the 4.0 – 8.0 mmols/L range, which can be a small window to aim for, particularly if you have Type 1 and you’re using blood tests and injected insulin to achieve it. You will often find yourself close to or under the 4.0 mmols/L lower guideline. 

But if you’re well-controlled then you should have diabetic hypo symptoms and good strategies to handle a diabetic hypo in the best possible manner. 

Diabetic hypos: definition and terminology

Normal blood sugars should be between 4.0 – 8.0 mmols/L. A diabetic hypo can be defined as being under 4.0 mmols/L. A mild diabetic hypo might be a reading of 3.7mmols/L, while a more severe diabetic hypo would be so low that the blood test meter you are using may just say ‘low’, meaning that you’re off the scale when it comes to reading a glucose result.

It’s a good habit to ‘make 4 the floor’ – i.e. make 4.0 mmols/L the lowest reading you get. In fact, many diabetics make 5 the floor – if they get a reading of 5.0, they would have a biscuit to avoid going any lower and risking a diabetic hypo. 

Any diabetic can tell you what they feel when having a diabetic hypo – in the main, you get shaky, irritable, find it hard to concentrate and often have a very strong urge to eat anything that you can lay your hands on ( I know I do!). Your diabetic hypo, and how to treat it, will be very specific to yourself and your needs – how your diabetic hypo was induced, where you are, what you last ate, what your activity levels are (or have been) and what you have to hand when the diabetic hypo strikes. 

Some people get good diabetic hypo symptoms – and by good I mean that it is good that you have symptoms, not that it’s good that you’re having a diabetic hypo! It’s my belief that diabetic hypos should be avoided like the plague for the obvious reasons that they feel bad and because they tend to lead to at least a few hours of ‘up and down’ blood test results. 

One of the big factors in coping with your diabetes is ‘keeping your head above water’ – it is not easy having diabetes, and having diabetic hypos can seriously undermine your confidence in your ability to live with the condition.

Diabetic hypo handling

It’s very easy to over-do it when it comes to treating a diabetic hypo and that’s one thing you need to get used to handling. Some diabetic hypos are worse than others – in as much as they can come on more suddenly or you get to be very low – with a reading of 3.0 mmols/L or lower.

You may get to the point when you know your blood sugar level and you know exactly what you need to do to correct it. For example, if you’re at 3.5 mmols/L you need a 200ml glass of orange juice or if you’re at 2.5 mmols/L you need a glass of orange juice and a mini-Mars bar or two.

The thing that non-diabetics can fail to understand is that you are deeply addled when having a diabetic hypo. You are confused, annoyed and perhaps not able to make good decisions or explain yourself well. Let those around you know how a diabetic hypo tends to affect you. You’re best off keeping them informed so they can be a help not a hindrance. It’s very likely that they will be able to tell you are going into one, possibly even before you do.

Diabetic hypo treatments

The lower the reading, the more sugar you will need to ‘pull yourself out of it’. Treatment is also known simply as a ‘sugar source’ because any sugar can be a diabetic hypo treatment, but some might be better (faster or more effective) than others. 

Nothing can legitimately be claimed to be a diabetic hypo treatment until it has been clinically tested, which is true of very few products indeed. Neither sugar, cola, orange juice or chocolate have had clinical trials but, as any diabetic can tell you, they work when it comes to pulling you out of a diabetic hypo. 

A liquid will work faster in your system than a solid – so smoothies, fruit juice or one of the gluco gel products (see glossary) are a good bet for an initial reaction to a diabetic hypo. Solids need a bit of digestion before the sugars are released – they will work, but they’ll just take a bit longer to do so. 

Likewise, a boiled sweet will take longer to deliver than say a chewy toffee or a crunchable tablet.

A list of sugar sources

I’m listing these as a sort of scale, with the most dramatic diabetic hypo-stoppers at the top and the weaker ones at the bottom. The amount of response required to treat the diabetic hypo will be indicated by the severity of the diabetic hypo (so do a blood test to find out what you’re dealing with). 

• Glucagon injection (GlucaGen HypoKit): this is for someone in a bad diabetic hypo, possibly past the point of being able to help themselves (who may be unconscious). It’s an injection that contains glucagon – a pure form of energy that gets straight into the system without having to be digested. You can get these on prescription from your GP. Keep refrigerated when not in use and do not use when any other diabetic hypo treatments are available. 
• Fruit juices and smoothies: astonishingly sugary (as sugary as a cola – read the labels!), but there’s a sense that they’re healthier than a fizzy drink.
• Soft drinks: good, but fizzy ones can be quite harsh on the throat if you need to drink them quickly.
• Sugar cubes: old-fashioned but easy; keep a box handy for emergencies.
• Gluco-tabs: available from Boots and larger pharmacies, these are glucose tablets that you can chew to release energy, with 4g of glucose in each tablet. They now come in a handy little plastic tube carrying 10 ‘tabs’ which can be refilled from a bigger bottle. The small tube is around 80p, the bigger bottle under £3.00. New on the market is Gluco Juice - little bottles of 15g of carbohydrate in liquid form. 
• Hypo-fit: a syrup packed in foil sachets, each containing 13g of useful carbohydrate. As syrup, these are even easier than chewing a tab. The foil sachets are durable, light to carry and do not ‘go off’.

Top tips on handling a diabetic hypo

1. Make sure you have sugar sources stashed everywhere (a drawer next to your bed, in the glove-compartment of the car, in a desk drawer at work, in your briefcase, handbag or rucksack). Make sure no one feels they can help themselves to these – they are yours for emergencies. 
2. Tell those close to you what the symptoms are and how they can help you if you’re having a diabetic hypo. You should tell at least one colleague how you handle your diabetic hypos, just in case you have a diabetes-induced wobbler at work. 
3. Try to do a blood test if you can. I know that for me, feeling very anxious can feel very much like a diabetic hypo (there is a certain amount of interaction between adrenalin and insulin), but adding sugar to anxiety won’t help at all while adding sugar to a diabetic hypo will. So know what you’re dealing with. 
4. Try to treat the diabetic hypo with something very sugary (sweets, orange juice, cola or other soft drinks), as well as something more long-term (a biscuit or a slice of bread which will release its sugars over a longer period of time). But don’t overdo it.
5. Read the label on whatever you’re using to treat the diabetic hypo so you know how much energy you are putting in.
6. Wait 10 minutes and do another blood test and see if you need more anti-hypo action.
7. Test again about an hour later. By then, if you’ve overdone it, you might need a little insulin ‘chaser’ to bring down a high sugar, but be careful – you don’t want to end up having another diabetic hypo!
8. Try to keep note of when you have diabetic hypos – if there is a pattern (for example, you get lows at 10.30am every weekday) then it may indicate that you need to adjust your medication or change what or when you are eating.
9. Have a back-up blood test machine to keep in your bedroom in case you can’t sleep and are worrying it might be because your sugars are low, or if you actually wake up feeling diabetic hypo. Keep some sugar near you to deal with the diabetic hypo as soon as you can – going to another room, especially up or downstairs when you’re ‘wobbly’, can be more of a challenge than normal. Ask for one at your clinic or buy one – you can get them for less than £20 at a pharmacy. 

Remember to replace the sugar sources that you use up. Preparation is all! It’s bad enough having a diabetic hypo without having a panic attack too.

Extract taken from Diabetes - The Essential Guide. For more information on what a diabetic hypo is, take a look at the book - available now in eBook, printed book and large print formats. Buy the printed version and get the eBook free!