Q: I often have patients that treat their hypoglycemia with candy bars. What's the best treatment for hypoglycemia? What should I be teaching them?
The treatment for hypoglycemia is 15 to 20 grams of a simple carbohydrate. Foods that are high in fat (like a candy bar) are not recommended, because they may delay absorption of the glucose and prevent the blood sugar from returning to normal quickly. Protein is also not recommended for treatment.
When a patient has symptoms of hypoglycemia (weakness/fatigue, shaking, sweating, confusion), check the blood glucose before treatment. A blood glucose lower than 70 mg/dL is considered hypoglycemia. After treatment, recheck the blood glucose in 15 minutes. If hypoglycemia continues, repeat with 15 to 20 grams of glucose. Once the blood glucose returns to normal, eat a small snack if the next meal is more than an hour or two away. Do not overtreat (such as adding sugar to orange juice) to avoid rebound hyperglycemia (American Diabetes Association [ADA], n.d.).
Examples of 15 grams of carbohydrates include:
* 4 ounces (1/2 cup) of juice or regular soda (not diet),
* 8 ounces of nonfat or 1% milk,
* hard candies, jellybeans, or gumdrops (see package to determine how many to consume),
* 2 tablespoons of raisins,
* 1 tablespoon sugar, honey, or corn syrup,
* glucose tablets (follow package instructions-typically 3 or 4), or
* gel tube (follow package instructions).
Understanding the cause of hypoglycemia is just as important as the treatment. Potential causes include increased activity, variation in food intake, or too much insulin. Patients need to have an understanding of the balance of food, activity, and medication on blood glucose levels. Physical activity may decrease blood glucose by decreasing insulin resistance. Meals and snacks that have less carbohydrate may also decrease blood glucose.
Blood glucose levels may become lower as patients initiate lifestyle changes such as an exercise program or nutritional improvements. In order to avoid hypoglycemic episodes, medication changes may be required. Typical medications that increase insulin production (such as sulfonylureas) and/or insulin injection doses will have to be decreased. Learning to analyze the cause and pattern of hypoglycemia by self-monitoring blood glucose may lead to adjustments in therapy that will prevent future episodes. In addition, frequent hypoglycemia and the need to treat with high-carbohydrate foods can lead to weight gain (ADA, 2014).
There is also a safety component to hypoglycemia. Patients at risk should test blood glucose prior to driving or operating machinery. The elderly are at particular risk, because falls due to hypoglycemia may cause injury.
The key to managing hypoglycemia is prevention. This can best be attained by individualizing target blood glucose goals and by practicing self-management strategies. For example, consuming additional carbohydrates prior to exercise, maintaining a consistent carbohydrate amount with meals, and monitoring blood glucose, especially with changes in medication treatment or lifestyle, are recommended.
REFERENCES