Hypoglycemia and Diabetes – Part 1

Part 1 of 2 parts.

Hypoglycemia can be caused by diet, some medications and conditions, and exercise. This is one reason for testing as often as many of us do. If we don't have enough sugar (glucose) available in our bodies, low blood glucose or hypoglycemia can happen for those of us with diabetes.

If you develop hypoglycemia, please record the date and time when it happened and what you did. Share your record with your doctor, so he or she can look for a pattern and adjust your medications, if necessary. Call your doctor if you have more than one episode of unexplained hypoglycemia in a week.

While it is true that most people feel the symptoms of hypoglycemia when their blood glucose level falls below 70 milligrams per deciliter (mg/dl), you will need to learn what your symptoms are and act on them.

Most of the early symptoms include:

• Confusion
• Dizziness
• Feeling shaky
• Hunger
• Headaches
• Irritability
• Pounding heart; racing pulse
• Pale skin
• Sweating
• Trembling
• Weakness
• Anxiety

Without treatment, you might develop more severe symptoms, including:

• Poor coordination
• Poor concentration
• Numbness in mouth and tongue
• Passing out
• Nightmares or bad dreams
• Coma

If you have any doubts about the diabetes medications you are taking, be sure to ask your doctor if any of your medicines can cause hypoglycemia.

Insulin treatment can cause low blood sugar, and so can a type of diabetes medications called "sulfonylureas." Commonly used sulfonylureas include:

• Glimepiride (Amaryl)
• Glipizide (Glucotrol)
• Glibenclamide (Glyburide, Micronase)
• Gliclazide

Older, less common sulfonylureas tend to cause low blood sugar more often than some of the newer ones. Examples of older drugs include:

• chlorpropamide (Diabinese)
• nateglinide (Starlix)
• repaglinide (Prandin)
• tolazamide (Tolinase)
• tolbutamide (Orinase)

You can also get low blood glucose if you drink alcohol or take allopurinol (Zyloprim), aspirin, Benemid, probenecid (Probalan), or warfarin (Coumadin) with diabetes medications.

You shouldn't get hypoglycemia if you take alpha-glucosidase inhibitors, biguanides (such as metformin), and thiazolidinediones alone, but it can happen when you take them with sulfonylureas or insulin.

You can get low blood glucose if you take too much insulin for the amount of carbohydrates you eat or drink.

For instance, it can happen:

• After you eat a meal that has a lot of simple sugars
• If you miss a snack or don't eat a full meal
• If you eat later than usual
• If you drink alcohol without eating any food

Don't skip meals if you have diabetes, particularly if you're taking diabetes medications.

If you have diabetes and think you have hypoglycemia, check your blood sugar level. Do your levels often drop after meals that include a lot of sugars? Change your diet. Avoid sugary foods, and eat frequent small meals during the day.

If you get low blood sugar when you haven't eaten, have a snack before bedtime, such as a protein or a more complex carbohydrate.

Your doctor may find that you take too much insulin that peaks toward the evening-to-morning hours. In that case, she may lower your insulin dose or change the time when you get your last dose of it.