Information on Hypoglycemia

The technical term for low blood glucose (or as most writers say – low blood sugar) is hypoglycemia. Many people that have type 2 diabetes seldom experience hypoglycemia. It all depends on the medication they are using to manage diabetes. Example – metformin taken by itself generally will not cause hypoglycemia. On the other end, insulin is very apt to cause hypoglycemia if the person using it is not careful.

People with type 2 diabetes that use exercise and diet to manage their diabetes are not at risk for hypoglycemia. The type 2 people taking the oral medications below are at risk for hypoglycemia -

1. D-Phenylalanine Derivative There is only one drug in this class, Starlix or nateglinede.
2. Sulfonylureas This is a multi-drug class. The medications are Amaryl or glimepiride, DiaBeta or glyburide, Diabinese or chlorpamide, Glucotrol or glipizide, Glucogtrol XL or glipizide long acting, Glynase or glyburide, and Micronase or glyburide. The two generic only are tolazamide and tolbutamide.
3. Meglitinide This has one drug in its class, Prandin or repaglinide.

Note of concern – several of the sulfonylureas are combined with other oral medications, but this does not mean they will not cause hypoglycemia.

Then there is insulin which affects everyone using this medication. More care needs to be used with insulin. Don't get me wrong, care needs to be used for all diabetes medications, but insulin creates it own special care.

The causes of hypoglycemia include:

1. Too much injected insulin
2. Too much or too strong a dose of an oral medication
3. Improper period of time between medication and meals
4. Skipped or delayed meals
5. Not eating enough carbohydrates
6. More exercise than usual
7. Drinking alcohol on an empty stomach

#1. Be sure you are reasonably accurate in your carbohydrate count. Until you understand the correction ratio, be careful in not over injecting insulin.

#2. Too strong a dose of an oral medication can be dangerous. Always ask the doctor how much food is required for the prescribed dose. Always ask the doctor what to do if you only eat two meals per day. Don't forget to ask the doctor what to do if you don't feel good and may not eat a meal.

#3. This is an important point and you should not inject insulin or take an oral medication if you will not be eating within the necessary time frame. Accidents do happen and what do you do when someone arrives as you are ready to eat,

#4. Skipping or delaying meals and taking medication is a dangerous way to bring on hypoglycemia.

#5. This is important. The oral medication dose size can determine the amount of carbohydrates you must eat. This is why you must discuss this with your doctor to decrease or increase the size of your oral medication. Those using insulin can adjust the units of insulin injected based on the number of carbohydrates you will be consuming or even wait until you have finished eating to know how many carbohydrates you consumed.

#6. Not testing before exercise can create problems if you over exercise and do not have high enough blood glucose levels. Yes, over exercising can cause hypoglycemia.

#7. If you insist on having your alcohol, be aware that this can cause hypoglycemia, especially if you drink on an empty stomach. Make sure that you have an adequate amount of carbohydrates on board. Drinking excessive amounts of alcohol can result can result oh hypoglycemia problems.

As a person using insulin as a type 2, hypoglycemia needs to be taken seriously. I can speak from experience and while one doctor of mine keeps telling me to let my A1c rise, I have found that if I am more careful and eat less carbohydrates, I don't need as much insulin and my concern about hypoglycemia also has become less of a concern. My problem lately has been making sure that before I test, I have properly washed my hands and paying attention the finger I would be testing on.

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