Hypoglycemia: what is it and how to treat it

“Hypoglycemia is generally sustained by diseases such as adrenocortical insufficiency, sepsis, liver disease, insulin-secreting pancreatic tumors (Insulinoma), neoplasms. Hypoglycemia can also appear in case of alcohol abuse (especially in the morning on an empty stomach), following gastrointestinal surgery with modification of glucose absorption, in the course of serious debilitating diseases. We talk about 'reactive hypoglycemia' in people with eating disorders (obesity, insulin resistance), when hypoglycemia is detected 2-3 hours after a meal, especially if rich in carbohydrates or following prolonged fasting.”

“In the pharmacologically treated diabetic patients, hypoglycemia is the main acute complication. It causes malaise, fear and hospitalization; for this reason, diabetics are trained to recognize and manage it during visits or educational courses we organize.”

Hypoglycemia is frequently found in diabetics receiving insulin treatment (both type 1 and type 2), but it can also occur during therapy with oral drugs that stimulate insulin secretion, in particular sulfonylureas, especially those with long duration of action (glibenclamide).

It appears in particular between meals, at night or after physical activity. Favorable factors are:

• inadequate food intake, especially carbohydrates (high-protein diets or meals with total elimination of carbohydrates);
• incorrect administration of insulin;
• intense physical activity without appropriate introduction of carbohydrates before and / or after exercise;
• excessive consumption of alcohol.

Particular attention should be paid to "unnoticed" hypoglycemia related to long-lasting diabetic disease and the onset of complications (autonomic neuropathy).

How can hypoglycemia be recognized and distinguished? There are three degrees of Hypoglycemia, each with its own symptoms:

• mild hypoglycemia: it is accompanied by symptoms such as sweating, tremor, palpitations, intense hunger;
• moderate hypoglycemia: manifested by the appearance of neuroglycopenic symptoms such as ocular disturbances / blurred vision, headache, tingling, difficulty concentrating, drowsiness, irritability.

In both of these cases the patient is still able to manage himself independently.

• severe hypoglycemia: it is accompanied by loss of consciousness and the need for third party intervention to resolve the problem. Severe hypoglycemia in a frail patient with multiple comorbidities can be fatal. Hypoglycemia itself can promote cardiovascular problems such as heart attack and stroke. Nervous system, heart, nerve cells are the main ones to suffer in the case of the unavailability of sugars as it is essential for their functioning.

“The onset of symptoms is linked not only to the absolute value of blood glucose and the speed of hypoglycemia, but to individual tolerance and the degree of glycemic compensation of the patient,” explains Dr. Savulescu.

Dr. Savulescu replies: “Hypoglycemia is always manageable, but requires timely and structured intervention.”

Mild-moderate hypoglycemia: rule of 15

“The treatment of mild to moderate hypoglycemia requires the introduction of simple sugars, which are easily and quickly absorbed by the body. But beware, no to elaborate desserts, cakes, chocolate, briosches!

The correction is based on the '15 rule':

• intake of 15 g of glucose: 3 teaspoons / 3 sachets / 1 large table spoon of sugar dissolved in water or 125 ml of sweetened drink, coca-cola, sweetened fruit juice or 1 tablespoon of honey;
• re-evaluation of blood glucose after 15 minutes; repetition of the treatment until two blood sugar levels >100 mg / dl are reached 15 minutes apart. To maintain the glycemic rate, the subsequent intake of 50 g of complex sugars is recommended (50 g of bread, 1 packet of crackers / biscuits, 1 fruit).”

Severe hypoglycemia: glucagon rescue

“The treatment of severe hypoglycemia, with the patient in a state of unconsciousness, requires intervention of other people. People in close contact with diabetics (parents, spouses, friends) must be educated on the management of this eventuality. In the event of an altered state of consciousness, one must resort to the administration of glucagon, a hormone with an opposite action to insulin, capable of increasing blood sugar. If this solution is not available, an ambulance must be called immediately so that the medical staff can administer intravenous glucose,” continues Dr. Savulescu.

Pharmacological novelty this year, the availability of glucagon for nasal administration, which guarantees greater speed of intervention by simplifying the method of administration and is easier to store.

Up to now, the emergency kit was available in the pharmacy, represented by a vial of glucagon to be administered intramuscularly or subcutaneously after reconstitution of the solution and its’ storage in the refrigerator. The current availability of a spray to be administered with a single intranasal puff, characterized by passive absorption, without need for simultaneous inspiration, which can be stored at room temperature, with a single dosage 3mg for adults and children, represents a valid aid in the management of severe hypoglycemia.

In support of diabetics, there are also continuous monitoring systems for blood glucose using sensors applied to the skin. These are small devices in a size of a coin, which can be applied to the skin with an adhesive and which, through a small filament that passes through the skin, allows the detection of blood sugar in the interstitial fluid under the skin.

It is possible to connect the device to your mobile phone allowing you to see the glycemic trend. They are also equipped with acoustic alarms to signal hypo- and hyperglycemia.