Hypoglycemia

If I have a hypoglycemic event while driving, what should I do?

If you have a hypoglycemic event  whilst driving:

  • Stop the vehicle as soon as possible
  • Switch off the engine, remove the keys from the ignition and move from the driver’s seat
  • Take some fast-acting carbohydrate, such as glucose tablets or sweets, and some form of longer-acting carbohydrate.
  • Do not start driving until 45 minutes after blood glucose has returned normal.

If you have poor warning signs, or have frequent hypos, you should probably not be driving because of the risk to yourself and others. Discuss this with your doctor. If he advises you to notify the DVLA/DVA you must do so. If you fail to do this, your doctor has an obligation to do so on your behalf.

How to deal with my Diabetes during and after a pregnancy

During your pregnancy

You will be offered extra monitoring appointments and scans during your pregnancy to help you keep good control of your blood glucose and check your baby’s growth and development. You should have contact with your diabetes team every one or two weeks.

Your doctor will encourage you to do extra blood glucose tests and agree on personal target levels. Generally the aim is for before meal levels of 3.5–5.9mmol/l and less than 7.8mmol/l one hour after meals.

You may find you are more at risk of hypos due to tighter control. You should be given a glucagon kit: ensure that family/friends understand how to use this if you are unable to treat a hypo yourself.

Top tips for a healthy pregnancy

  • Stop smoking
  • Avoid alcohol
  • Eat a healthy balanced diet
  • Keep active

 

After the birth

Generally, your experience should be the same as anyone’s. But because you have diabetes, doctors will take some extra steps to make sure you and your baby are off to a healthy start.

  • Your baby: All babies’ blood glucose levels drop after separation from the mother. Breastfeeding soon after delivery and at regular intervals usually resolves this.
  • Your baby’s blood glucose will be regularly checked after birth and extra feeds may be given if needed. Your baby should stay with you unless there is a medical reason why he or she needs admitting to a neonatal unit for extra care.
  • After delivery, your insulin needs will significantly drop. You may need an intravenous insulin/glucose drip for a few hours after delivery and your insulin dose will be adjusted as needed.
  • Your blood glucose will be checked regularly, until your levels stabilize. When you resume your normal diet, you should also return to your pre-pregnancy insulin dose. If you were taking insulin for gestational diabetes, the insulin can usually be stopped immediately after delivery.
  • Most women who deliver by Caesarean section are given antibiotics after delivery in order to decrease the risk of infection at the wound site.

 

Breastfeeding and diabetes

Breast is best, and there’s no reason diabetes will change this. There’s no reason why women with diabetes cannot breastfeed. You may have some early difficulties – for example if your baby needs extra feeds, or if you were initially separated from your baby due to Caesarean section or your baby’s treatment in the neonatal unit – but with patience and practice you and your baby should be able to establish a good breastfeeding pattern.

  • Breastfeeding may lower your insulin needs by up to 25 per cent. Breast milk contains sugar called lactose. Every time you feed your baby, you will lose that sugar and your blood glucose will drop, which may cause a hypo. To help avoid hypos, you may need to eat 40–50g more starchy foods per day while you are breastfeeding.
  • Even though you will be eating more, breastfeeding will not make you gain weight. In fact, it may help you lose weight.
  • If you take Metformin or glibenclamide for Type 2 diabetes, you can usually resume or continue taking these while breastfeeding, if your doctor is in agreement.

How to drive a car safely

The licensing agencies are trying to ensure you are safe on the road. They will be concerned if you are unable to recognize or self-treat your hypos.

If you are on insulin, check your blood glucose within 2 hours before getting behind the wheel and every two hours whilst driving.

If you hold a Group 2 license and take non-insulin medication which may cause a hypo you should check your levels at least twice per day at times relevant to driving. The results should be recorded on the meter memory.

Safe driving tips

  • Avoid delaying or missing meals and snacks
  • Take breaks on long journeys
  • Always keep hypo treatments to hand in the car
  • Do not drink alcohol and drive
  • Many of the accidents caused by hypoglycemia are because drivers have continued to drive, ignoring their hypo warning signs (e.g., hunger, sweating, feeling faint).

If you have a hypo whilst driving:

  • Stop the vehicle as soon as possible
  • Switch off the engine, remove the keys from the ignition and move from the driver’s seat
  • Take some fast-acting carbohydrate, such as glucose tablets or sweets, and some form of longer-acting carbohydrate.
  • Do not start driving until 45 minutes after blood glucose has returned normal.

If you have poor warning signs, or have frequent hypos, you should probably not be driving because of the risk to yourself and others. Discuss this with your doctor. If he advises you to notify the DVLA/DVA you must do so. If you fail to do this, your doctor has an obligation to do so on your behalf.

Motor Vehicle Insurance

When applying for motor insurance you must declare you have diabetes even if you are not asked about this. You should also inform your insurance company of any changes to your condition or treatment. Failure to do so, or failure to notify DVLA/DVA where required, could mean you are not covered. If you feel your premium is too high it is worth challenging your insurer. Insurers can only refuse cover, or charge more if they have evidence of increased risk.

How to tell your colleagues at work about your diabetes

Some people are ill-informed about diabetes, and they may respond irrationally out of fear or ignorance.  A simple explanation about diabetes is all you need to give. If you do not treat your diabetes as a problem, it is less likely that your colleagues will.

  • Hypos at work: It’s important to tell colleagues how to recognize and treat a hypo (hypoglycemic episode) if you experience these. This will stop them from overreacting at the time and will help to make sure that any hypos you have are treated correctly. Talk to your first aider about your diabetes too and make sure they know what to do in an emergency. If you have had a hypo at work and needed help to treat it, talk to your employer and colleagues afterwards. If possible, explain why the hypo happened to show them that you can normally control the situation and it is unlikely to happen again.
  • Taking time off: Everybody takes time off work for sickness or hospital appointments, whether they have diabetes or not. Diabetes does not necessarily make you more prone to sickness. If possible, try to arrange several clinic appointments for the same morning and give your employer plenty of notice of when and why you will be absent. When you are ill, seek prompt medical attention and keep your employer informed of what is happening.
  • Sources of support and further information: If you feel discriminated against at work, or that you might have been turned down for a job or dismissed because of your diabetes you will probably need specialist advice initially, and in some cases legal advice, if you wish to challenge employment decisions.

What should I do if I experience hypoglycemia?

Everyone with diabetes should be prepared to treat hypoglycemia, but people with type 1 are at the highest risk for hypoglycemia. People with type 2 are less likely to have issues with hypoglycemia during or after exercise, unless they are on insulin or an insulin secretagogue.

If you experience hypoglycemia during or after exercise, treat it immediately. Use the same process as you would any other time of the day:

  1. Have at least 15-20 grams of fast-acting carbohydrate (sports drinks, regular soda, or glucose tabs are all good ideas).
  2. Wait 15-20 minutes and check your blood glucose again.
  3. If it is still low and your symptoms of hypoglycemia don’t go away, repeat the treatment.
  4. After you feel better, be sure to eat regular meals and snacks as planned to keep your blood glucose level up.

 

If you want to continue your workout, you will usually need to take a break to treat your low blood glucose, depending on what activity you are doing and how much insulin you have circulating in your bloodstream. If you do stop exercising, check to make sure your blood glucose has come back up above 100 mg/dl before starting to exercise again.

Keep in mind that low blood glucose can occur during or long after physical activity. It is more likely to occur if you:

  • Take insulin or an insulin secretagogue
  • Skip a meal or don’t eat something within 30 minutes to two hours after stopping
  • Exercise for a long time
  • Exercise strenuously

If hypoglycemia regularly interferes with your exercise routine, talk to your doctor about adjusting your treatment plan. Your provider may suggest eating a small snack before you exercise or they may make an adjustment to your medication(s).

Injury free exercising – 12 tips

Here are a few simple things you can do to help prevent injuries, dehydration, and hypoglycemia when exercising:

  1. Talk to your doctor about which activities are safest for you. Your doctor’s advice will depend on the condition of your heart, blood vessels, eyes, kidneys, feet, and nervous system. Still, many people with diabetes can do the same activities as someone without diabetes.
  2. Warm up for 5 minutes before starting to exercise and cool down for 5 minutes after. Your warm up or cool down should be a lower intensity than the rest of your time exercising. This helps get your blood flowing and warms up your joints.
  3. Avoid doing activity in extremely hot or cold temperatures. Choose indoor options when the weather is extreme.
  4. Drink plenty of water before, during, and after activity to stay hydrated.
  5. If you feel a low coming on, be ready to test for it and treat it. Always carry a source of carbohydrate with you so you’ll be ready to treat low blood glucose. This is especially important if you are on insulin and have type 1 diabetes.
  6. If exercising for an extended period (more than an hour or two), you may want to have a sports drink that provides carbohydrates. Be careful to check the nutrition facts though, you may need to water down the drink so that you don’t have too much, which can cause your blood glucose to spike.
  7. Wear a medical identification bracelet, necklace, or a medical ID tag that identifies you as someone with diabetes in case of emergency, and carry a cell phone with you in case you need to call someone for assistance.
  8. Activities should be energizing but not overly difficult. Use the “talk test” to make sure you are not pushing yourself too hard. If you become short of breath and you can’t talk, then slow down. This is most important when you are just starting to increase the activity in your routine. As you become fit, you’ll be able to exercise at a higher intensity and chat with others while you do it.
  9. Take care of your feet by wearing shoes and clean socks that fit you well.
  10. You should also check inside your shoes before wearing them. Socks that are made out of a material that reduces friction and pulls moisture away from your skin can also help protect your feet.
  11. Carefully inspect your feet before and after activity for blisters, redness, or other signs of irritation. Talk to your doctor if you have a foot injury or a non-healing blister, cut, or sore.
  12. Stop doing an activity if you feel any pain, shortness of breath, or light-headedness. Talk to your doctor about any unusual symptoms that you experience.

Worst Case Scenario: Diabetic Coma

Diabetic coma is an emergency. You cannot be prepared in advance. If you have the feeling of an extreme high or low blood sugar you should call your local emergency number. You need to ensure help before you pass out.

If there is a person with you instruct him/her about it. If this person is familiar with diabetes care he/she should:

  1. Test your blood sugar.
  2. If the blood sugar level is lower than 70 mg/dL (3.9 mmol/L), administer an injection of glucagon. If glucagon isn’t available, rub glucose gel, honey or non-sugar-free syrup on the inside of the unconscious person’s cheek. No insulin should be given!
  3. If the blood sugar level is above 70 mg/dL, wait for medical help to arrive. Don’t give sugar to someone whose blood sugar isn’t low.

Let the emergency care team know about the diabetes and what steps have been taken, if any.

Low blood sugar

Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar (shakiness, nervousness or anxiety, sweating chills and clamminess, irritability or impatience, confusion, rapid heartbeat, dizziness, hunger and nausea, sleepiness, blurred vision, tingling or numbness in the lips or tongue, headaches, weakness or fatigue, anger or sadness, lack of coordination, nightmares or crying out during sleep, seizures, unconsciousness).

Eat or drink something that will quickly raise your blood sugar level, fruit juice, etc.

  • Consume 15-20 grams of glucose or simple carbs.
  • Check your blood glucose level once again after 15 minutes
  • If hypoglycemia continues, repeat the actions from the beginning.

Once your blood glucose is normal eat a small snack if the next meal is more than one hour away.

Find more info on low blood sugar here.

During a hypoglycemic event

Treatment

  1. Consume 15-20 grams of glucose or simple carbohydrates
  2. Recheck your blood glucose after 15 minutes
  3. If hypoglycemia continues, repeat.
  4. Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.

15 grams of simple carbohydrates commonly used:

  • glucose tablets (follow package instructions)
  • gel tube (follow package instructions)
  • 2 tablespoons of raisins
  • 4 ounces (1/2 cup) of juice or regular soft drink (not diet)
  • 1 tablespoon sugar or honey
  • 8 ounces of nonfat or 1% milk
  • hard candies, jellybeans, or gumdrops (see package to determine how many to consume)

Glucagon

If untreated, hypoglycemia may lead to severe consequences, such as unconsciousness or even coma. In case of unconsciousness someone else should be ready to take over.

There is a hormone, glucagon, able to stimulate your liver to release stored glucose into the blood. In case your blood sugar level is too low, you may need injectable glucagon kits. These kits are used as a medication to treat somebody who has become unconscious. Your doctor is the one that can prescribe glucagon kits. You may ask him/her whether it would be useful for you to have one home, and if need be, how to use it properly.

If you possess a glucagon kit then you should instruct people with whom you are in frequent contact on how to use it in case it is ever needed.

If glucagon is needed:

  1. Inject glucagon into the individual’s buttock, arm, or thigh, following the manufacturer’s instructions.
  2. When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting.
  3. If you have needed glucagon, let your health care provider know, so they can discuss ways to prevent severe hypoglycemia in the future.

Do not:

  • Inject insulin (it will lower blood glucose even more)
  • Provide food or fluids (individual can choke)
  • Put hands in mouth (individual can choke)