“If you have diabetes, you probably know the warning signs of hypoglycemia. The most graphic description of it,” says John Buse, MD, PhD, “is that it’s kind of like sitting in a car and skating on ice: panic, a racing heart, and a sense of doom.” He is a professor of medicine, chief of the Division of Endocrinology and executive associate director of the Clinical Research Program at the University of North Carolina School of Medicine in Chapel Hill.
Hypoglycemia can strike suddenly, and episodes must be treated immediately with sugar or carbohydrates. Other symptoms of hypoglycemia, as defined by the American Diabetes Association (ADA), include dizziness, tremors, difficulty concentrating, feelings of hunger, headache, clumsy or erratic movements, or sudden mood changes such as crying.
Hypoglycemic disorders of consciousness
Sometimes, however, people who experience hypoglycemia do not show or notice these warning signs. Instead, they can develop a dangerous condition called hypoglycemic dysarthria, which at worst can lead to loss of consciousness, coma, or even death (although it is rare). “Hypoglycemic disorders of consciousness are a race,” says Dr. John, “for patients to notice they are hypoglycemic before they lose consciousness.”
Dr. John said, “Hypoglycemic disorders of consciousness, which are most common in people with type 1 diabetes treated with insulin, can also occur in people with type 2 diabetes treated with insulin. According to the American Diabetes Association, hypoglycemic disorders of consciousness are more common in pregnant women and in people with a longer history of diabetes.”
“In addition, not eating or delaying meals, increasing exercise, or drinking alcohol can trigger hypoglycemia,” Dr. John said, “even with moderate alcohol consumption.”
Some medications that are meant to treat diabetes often cause hypoglycemia, which in turn can trigger hypoglycemic disorders of consciousness. Under normal circumstances, when the glycemic index plummets (a blood glucose level below 3.89 mmol/L is considered hypoglycemic), the body stops producing insulin and instead starts producing two other hormones: glucagon and epinephrine, to help stabilize blood sugar. Adrenaline causes the symptoms associated with hypoglycemia, and frequent episodes of hypoglycemia can suppress adrenaline production, blunting or eliminating the warning signs.
Treatment of hypoglycemia
Usually hypoglycemia is detected by others who are familiar with diabetes. They will notice that the person appears unconscious and will urge them to get a blood glucose test. People with diabetes may not take this advice seriously. “Some people are often resistant to the insight that ‘hypoglycemia is part of the symptoms of hypoglycemic disorders of consciousness,'” Dr. John explained.
Dr. John said that those with experience know that forcing a glass of orange juice or soda on a patient when he or she is hypoglycemic is a good idea. In fact, the recommended treatment is 15 grams of sugar or carbohydrate, such as half a sugary drink, like a regular soda (not a diet drink) or juice, one hard candy, three chewable glucose tablets, or glucose gel. This can be given repeatedly until blood sugar levels return to normal.
“If the patient is unconscious, don’t feed him anything, call 120 immediately. if you have glucagon (a hormone that prompts the release of stored sugar into the bloodstream) on hand, give it to the patient immediately, but the person doing this series must be trained to do so,” Dr. John said.
Prevention of hypoglycemia
To prevent hypoglycemia, the American Diabetes Association recommends: testing blood glucose levels more often (especially before driving); educating family members and friends of people with diabetes about hypoglycemia and how to help; wearing a wristband that identifies them as diabetic; and keeping glucagon on hand and making sure those around you know how to use it.
Most importantly, work with your doctor, who will recommend the use of a continuous glucose detection sensor, a device that measures blood glucose levels every few minutes. “The intention is to eliminate hypoglycemia over a period of weeks or months,” Dr. John said, “which is the equivalent of ‘resetting’ the body to recognize the symptoms of hypoglycemia itself the next time it happens.”