American Diabetes Association Complete Guide to Diabetes. American Diabetes Association

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СКАЧАТЬ pregnant women and people who intensively manage their diabetes. There is some evidence that frequent episodes of low blood glucose can make someone have hypoglycemia unawareness.

      This is a dangerous condition, and if you think you have hypoglycemia unawareness, you should consult with your health care team. Sometimes, just avoiding mild hypoglycemia can help restore a person’s awareness of the symptoms of hypoglycemia. Other times, the solution will be to increase blood glucose goals to higher numbers.

      Some Safety Nets for Hypoglycemia Unawareness

      • Increase the number of times you check every day or check at different times

      • Always check before driving. If levels are under 100 mg/dl, eat and test again. If glucose levels are higher than that but falling, eat and test again before driving

      • Discuss your hypoglycemic episodes with your health care team so you can look for patterns to use as warning cues

      • Educate the people you’re with every day about hypoglycemia and how to help you

      • Wear an ID bracelet that identifies you as a person with diabetes

      • Ask for prescription glucagon, and be sure those around you know how to use it. (Find out more about glucagon later in this chapter.)

      • Attend a class on blood glucose awareness training offered at a specialty diabetes clinic

      Treatment of Hypoglycemia

      Check your blood glucose level if you think you have hypoglycemia. Talk to your health care team about the blood glucose level at which you should begin treating for hypoglycemia. Although it’s best to check before treating, this may not always be possible. What if you don’t have your monitor with you? Should you wait until you get home? No! Eat or drink something immediately. Never wait until you get home, especially if you have to drive.

      You need to eat or drink something that contains carbohydrate that can be rapidly absorbed from your digestive tract and into your blood. However, you shouldn’t go overboard. You’ll feel worse later on if you send your blood glucose levels soaring. There are many choices of fast-acting carbohydrates.

      You’re best prepared for low blood glucose if you carry around a measured amount (15 grams) of “pocket carbohydrate.” The easiest and most convenient fast-acting carbohydrate is found in glucose tablets or gel, which come in a variety of flavors. Check the annual Diabetes Forecast Consumer Guide for a list of current over-the-counter products for treating low blood glucose. Usually, two to five glucose tablets or one package of glucose gel will bring quick relief, but check the instructions and dosing on the package to make sure.

      Recheck your blood glucose 15 minutes after you’ve treated your low blood glucose. If you still have low blood glucose, you may need to take another dose of 10–15 grams. Check again in another hour. If blood glucose is low, you may need another 15 grams of carbohydrate.

      Fast-Acting Carbohydrates for Hypoglycemia

      Each has about 15 grams:

      • 2–5 glucose tablets

      • 1 gel tube

      • 2 tablespoons raisins

      • ½ cup regular soda (not diet)

      • 4 ounces orange juice

      • 5–7 Lifesavers

      • 6 jellybeans

      • 10 gumdrops

      • 3 teaspoons sugar, honey, or corn syrup

      • 6–8 ounces nonfat or 1% milk

      After an episode of severe low blood glucose, readings may run high for some hours afterward, as a result of your body fighting back against the low blood glucose. High blood glucose readings immediately following a low reading can lead to a misinterpretation of the pattern. Talk to your health care provider about these patterns, because if you treat for the high readings, you may begin a dangerous cycle of fluctuating blood glucose levels.

      Special Considerations for Hypoglycemia

      Physical Activity

      Exercise and other physical activity lowers blood glucose levels, so you have to be extra careful to avoid hypoglycemia during and sometimes after exercise (if you take insulin). When you first begin an exercise program, you will need to monitor your blood glucose levels after exercise to find out how your body responds. If you feel as though you are becoming hypoglycemic while you are working out, stop at once. Don’t say, “I’ll just do one more lap” or “Just 5 minutes won’t hurt.” Stop.

      Treating Hypoglycemia during Physical Activity

      • Check your blood glucose right away and treat hypoglycemia if you need to.

      • If you want to continue your workout, eat a snack, take a 15-minute break, and check to make sure your blood glucose has come back up above 100 mg/dl before starting back. If you start too soon, your blood glucose may drop again, quickly.

      • Studies show that hypoglycemia is even more likely to occur 4–10 hours after you exercise than during the activity or shortly after.

      Sexual Activity

      If you are prone to hypoglycemia when you work out or at night, you may also have a low blood glucose reaction following sexual activity. This can be especially true if you have sex at night. This is when your blood glucose levels typically dip, so you may need to adjust your insulin or have a snack before or after sexual activity. Be especially careful if you are combining sexual activity with alcohol.

      Avoiding Lows During and After Sex

      • If you use insulin, you need to be watchful for low blood glucose during or after sex.

      • Check your blood glucose first. This may slow you down a bit, but it’s better than having to deal with low blood glucose at an inopportune moment.

      • Eat just before or right after active sex, just as you would if you were exercising.

      • Consider having a snack before going to sleep for the night.

      • If you use an insulin pump, you may want to set a temporary basal or disconnect it during sex to avoid going low. See more about insulin pumps and plans in chapter 13. The length of time you can safely keep the pump off without an injection depends on how active you are. Ask your health care team for advice about this.

      Heart Disease

      Hypoglycemia can cause your heart to beat faster than normal. If you have heart disease, talk to your doctor about how hypoglycemia might affect you. You may need to keep your blood glucose levels a little higher to reduce the risk of developing hypoglycemia.

      Alcohol

      Alcohol lowers blood glucose levels. Normally, when your blood glucose levels begin to drop too low, your liver will convert stored glycogen to glucose. This helps protect you from a severe reaction temporarily and gives you time to recognize and treat hypoglycemia. But alcohol СКАЧАТЬ