Low blood glucose (hypoglycaemia)

Hypoglycaemia happens mainly to people with diabetes who inject insulin, but it can also happen to those who control their diabetes with tablets.

You can get hypoglycaemia if you have:

• not eaten for a long time
• given yourself too much insulin
• exercised hard without having any extra food.

If you are having a hypo, you are likely to have some or all of these symptoms:

• pins and needles in your mouth and tongue
• sweating
• pale skin
• shaking hands or legs
• a headache
• blurred vision
• a fluttering heart (palpitations).

You may also feel:

• dizzy
• nervous
• sleepy
• hungry
• confused
• unable to concentrate.

You might have symptoms similar to a hypo when your blood glucose level is not below 4 if:

• your blood glucose level is regularly high, and it quickly drops to normal
• you are anxious.

If you have symptoms but are unable to test your blood glucose, you should treat this as a hypo.

You can reduce your risk of having a hypo by avoiding what causes them. These include:

• missing or delaying a meal
• not having enough starchy food (carbohydrates) with your meal or snack
• being more physically active than usual and not having extra food to fuel it
• having too much insulin or taking too many diabetes tablets
• drinking too much alcohol or drinking alcohol on an empty stomach
• leaving too much time between your injection and your meal
• changing the time when you have your insulin or tablets.

You should always carry a hypo treatment with you. If you do not treat a hypo, you may lose consciousness or have a fit or seizure. This is rare and usually only happens if you have type 1 diabetes, but it is important to treat all episodes of hypoglycaemia correctly.

If you think there is a danger you might be having a hypo, even without symptoms, test your blood glucose level. If you cannot test, treat it as a hypo.

If your blood glucose is less than 4, you should immediately have:

• 30g of carbohydrate if you weigh over 70kg
• 15 g carbohydrate if you weigh less than 70kg.

You can get 30 grams of fast acting carbohydrate by having one of the items in the list below. Halve the amount if you only need 15 grams.

• 8 Lift fast acting glucose chews
• 10 Dextro Energy glucose tablets
• 2 tablespoons of sugar or glucose powder dissolved in water
• 1 glass (300 ml) of fruit juice or sugar-sweetened soft drink
• 18 small jellybeans
• 2 tablespoons of honey
• 3 tablespoons of jam
• 2 sachets Hypo-Fit Direct Energy Gel

Wait 15 minutes then test your blood glucose again. If your blood glucose is still below 4, have a repeat helping from the above list.

Once your blood glucose is above 4, have either:

• a meal if it is due
• insulin just before or straight after your meal if it is due

a snack such as one of — a sandwich made with one piece of wholegrain bread, 3 to 4 crackers, one piece of fruit, one glass (250 ml) of milk.

Tell your healthcare provider if you keep having hypos as they may need to adjust your medication.

These guidelines are for whānau, friends and colleagues of a person with diabetes, who may have to recognise and treat severe hypoglycaemia with glucagon. 

Glucagon is a hormone that raises blood glucose (sugar) levels by making the liver release its store of glucose. It is not glucose.

You give it by injection to help a person recover from very low blood glucose. In Aotearoa New Zealand it is available as GlucaGen HypoKit.

People with diabetes get glucagon through a prescription from their healthcare provider. It is usually stored in the fridge, so everyone knows where it is.

 

A glucagon kit

 

When to give glucagon 

Glucagon should be injected when the person with diabetes:

• has very low blood glucose (severe hypoglycaemia or having a hypo)
• cannot swallow
• cannot respond when you speak to the
• cannot squeeze your hand when asked.

Steps before giving a glucagon injection 

• Roll the person onto their side. Make sure they are breathing easily.
• Call for an ambulance (phone 111).
• Do not leave the person alone.
• Do not try to feed the person anything through their mouth if they are unconscious or having seizures.
• Inject the glucagon into the skin on their outer thigh, upper arm, back of hip, or abdomen.

It takes around 10 to 15 minutes for the glucagon to work. If the person is still not responding, give them another injection.

How to give the glucagon injection 

Follow the instructions inside the lid. Even if the glucagon has expired, you can still inject it and it will probably work.

1. Take the orange cap off the vial.
2. Take the grey needle cover off.
3. Insert the needle through the rubber stopper of the vial.
4. Inject all the liquid from the syringe into the vial.
5. Without removing the needle, gently shake the vial until the powder has dissolved and the solution is clear.
6. Turn the vial upside down and pull back the plunger until all of the solution is in the syringe. Be careful not to pull the plunger out of the syringe.
7. Take the needle out of the vial.
8. Inject the glucagon into the person's outer thigh, upper arm, back of hip, or abdomen.
9. Put the syringe back into its box to be thrown away — do not put the needle cap back on.
10. If you know how to, test the person's blood glucose level to check it is rising.

Recovery

• The person should wake up in around 10 to 15 minutes. If they are still not responding, give them another injection.
• When they are awake, give them sips of ordinary (non-diet) soft drink or another sweet drink.
• About 60 to 90 minutes later, they may feel sick and even throw up. They may also have a headache.
• Every 15 to 30 minutes, check their blood glucose level or get them to check. After they begin to feel better, they should eat a snack that includes protein and carbohydrate such as a sandwich or crackers and cheese.
• The person should have their usual insulin injection after a severe hypo, but they should contact a healthcare provider for medical advice on how much insulin to give.
• After a severe hypo, a person's blood glucose level is often higher than normal. Do not treat this with extra insulin.
• For 2 to 3 days after a severe hypo, the person might find it difficult to recognise symptoms of low blood glucose (hypoglycaemia) and their body might be less able than usual to cope with low blood glucose.

You can watch a video demonstrating how to give a glycagon injection. This is an American video that tells you to call 911 if the person does not respond. The emergency number in New Zealand is 111.

How to give glycagon — Mayo Clinic on YouTubeexternal link