Hypoglycaemia is preventable. Indeed, most attacks severe enough to require medical attention could have been avoided with a little forethought. Most people with diabetes have good warning symptoms that their blood glucose is falling. Learn what yours are as soon as possible. They may be more subtle than you realize. One way of considering the symptoms of hypoglycaemia is to divide them into changes in emotions, changes in thinking, changes in movement, and adrenaline symptoms. You are unlikely to notice changes in conscious level yourself until glucose wakes you up.
Changes in emotion are often inappropriate for the situation. You may be irritable, sad, excited, giggly, withdrawn, angry, frustrated, cheerful or feel you can conquer anything.
Changes in thinking occur before most people realize what is happening. Slowness or difficulty in making decisions is a characteristic feature of a falling glucose. Time seems to slow down. Your ability to calculate, think logically and plan can be impaired. This is why it is so dangerous to drive or operate machinery when you are hypoglycaemic.
Changes in movement may be late symptoms. They include problems with coordinating movement, whether of the throat and mouth to produce coherent speech; coordination of hand movements to draw or do up buttons; or coordination of legs and feet to walk straight, for example. Muscles may become weak and rarely if you have a bad hypoglycaemic episode it can seem as if you have had a stroke. Glucose cures it straightaway. While you might expect lack of glucose to make people slow down, occasionally people seem to have superhuman strength and do things which they would normally find difficult – lifting heavy objects, running up hill, for example.
Adrenaline symptoms are what many people rely on to warn them of hypoglycaemia. Unfortunately these can be late features of a low glucose and it is important to learn all your warning symptoms so as to identify the onset of a hypoglycaemic attack as soon as possible. We all know that adrenaline is the fright, flight and fight hormone, hence the pounding rapid heartbeat, the trembling hands and the drenching sweat.
Changes in conscious level are uncommon. You may simple feel sleepy, or rarely become unconscious. Although it is rare and the vast majority of people with diabetes treat their minor hypoglycaemic episodes quickly and efficiently with glucose, hypoglycaemic coma is what many non-diabetics associate with diabetes. After all, from the film producer’s point of view, it is much more dramatic for the heroine to collapse unconscious in the hero’s arms, than for her to say, “I feel a bit hypo”, eat some glucose and carry on dancing.
If you have good warning of hypoglycaemia and can learn to recognize your symptoms of a falling glucose, you should have few problems with hypoglycaemia. As the years pass some people on insulin lose their warning symptoms of hypoglycaemia. This happened to Dr Lawrence, the co-founder of the BDA – his junior doctors used to feed him glucose when they noticed that he was hypoglycaemic. Other factors which may reduce your warning are treatment with beta blocker drugs such as propranolol and the level at which your blood glucose concentrations run. If you habitually have a glucose of 10 mmol (180 mg/dl) or more, you are likely to have more intense warning symptoms of hypoglycaemia than someone whose glucose levels are usually between 4 and 8 mmol/1 (72-144 mg/dl). This is one reason why people whose blood glucose is persistently high may resist returning it to normal – an understandable reaction. However, the fear of failing to recognize hypoglycaemia must be weighed against the risk of developing the diabetic complications which are linked with persistently high blood glucose.
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