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
- 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.