Updated  12 February 2013


Insights into Hypoglycaemia

Paul Dromgoole, RGN, RNMH, MSc Diabetes, PGCertED, a Clinical Lecturer in Diabetes writes:

Hypoglycaemia has been reported as the major limiting factor to achieving optimal glycaemic control in diabetes (1, 2).

The fear of hypoglycaemia (hypo) may be so intense that many patients deliberately maintain blood glucose levels above target in order to minimise the frequency and severity of hypo events (3).

Treatment for hypoglycaemia requires rapid acting (high Glycaemic Index or GI) carbohydrate (carbs) to promptly elevate blood glucose and longer acting (lower GI) carbohydrate to sustain blood glucose levels and prevent patients re-entering a hypoglycaemic state.

Evidence suggests that many patients are poorly prepared to treat hypoglycaemic episodes.  In one study, a significant proportion of those studied were unable to identify 4 mmol/L as the starting point of hypoglycaemia.  Only 24% correctly treated hypos with short and long acting carbohydrate.  57% exclusively ate short acting carbohydrate only to treat their hypo symptoms (4).

Hypoglycaemia is not confined to patients with Type 1 diabetes.  The frequency of hypoglycaemia in insulin-treated type 2 diabetes progressively rises with increasing duration of insulin treatment.  In insulin treated type 2 diabetes, the frequency of hypoglycaemia must not be underestimated, particularly in the elderly, in whom the morbidity of hypoglycaemia poses particular problems (5).

The significance of glycaemic index in treating hypos

For prompt treatment of hypoglycaemia, in the presence of falling blood glucose level, rapid acting carbohydrate (glucose, dextrose) must be used to arrest the fall in glucose and protect the patient with diabetes from harm.  Rapid acting carbohydrate (high Glycaemic Index or GI) works quickly but stops working quickly.  It is imperative the patients follows this up with longer acting (lower GI) carbohydrate to sustain blood glucose levels.

Five simple but vital tips to help prevent problem hypoglycaemia:

  • Carry hypoglycaemia treatment (rapid and longer acting carbs) at all times.
  • Be aware i.e. ‘in-tune’ with your own individual hypo symptoms and treat without delay.
  • Reduce insulin and / or increase carbohydrate intake prior to prolonged physical activity or exercise.
  • Test blood glucose before driving on every occasion.  Do not drive if under 5 (mmol/L) and break longer journeys every 2 hours with carbohydrate snack.
  • Discuss with your diabetes health professional, causes, treatment, and prevention of regular mild or any severe episode of hypoglycaemia or other concerns regarding hypos you may have.
  • It is recommended that hypoglycaemic episodes are treated with at least 10 - 20 grams of carbohydrate.6
  • Always back-up any hypoglycaemia treatment with carbohydrate snack or next meal if it is due.  Look for causes of hypoglycaemia in order to try to prevent future episodes.

GSF-SYRUP contains three types of carbohydrate in one sachet, which provide immediate hypo relief and more slowly released (lower GI) carbohydrate in order to maintain raised blood glucose levels.



  1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee.  Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada.  Can J Diabetes.  2003; 27(suppl 2):S1-152.
  2. Yale J-F, Begg I, Gerstein H, et al. 2001 Canadian Diabetes Association clinical practice guidelines for the prevention and management of hypoglycaemia in diabetes.  Can J Diabetes.  2002; 26:22-35
  3. Polonsky W, Davis A, Jacobson B, et al. Hyperglycaemia, hypoglycaemia, and blood glucose control in diabetes: Symptom perceptions and treatment strategies.  Diabetic Med. 1992; 9:120-125.
  4. What do patients with type 1 diabetes know about hypoglycaemia?  Practical Diabetes International September 2000 Vol. 17 No.
  5. Zammitt N, Frier B Diabetes Care December 2005 vol. 28 no. 12 2948-2961
  6. http://www.diabetes-healthnet.ac.uk/HandBook/Hypoglycaemia.aspx accessed 01/01/10

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