Once you have recovered from a hypoglycaemic attack, whether mild or severe, work out why it happened so that you can avoid another one. Did you have too much insulin or too many tablets? Did you eat enough? Did you exercise more than you expected? Were you careless? Seek your diabetes adviser’s help if you cannot work out how to prevent another hypoglycaemic attack. If you have been hypoglycaemic on sulphonylurea pills, contact your diabetes adviser that day, as soon as you have eaten.A rare but distressing problem for a few people with insulin-treated diabetes is that of frequent hypoglycaemia, often without warning. Because hypoglycaemia causes amnesia, you may forget a bad hypoglycaemic attack. But it can worry your family. Listen to their concerns. If you are having frequent hypoglycaemia you must act. First, stop driving and do not do anything which might put you or others in danger. This may mean taking time off work. Next reduce all your insulin by at least one third. You are aiming to have all your blood glucose levels between about 8 and 12 mmol/1 (144-216 mg/dl) for a few days or weeks to make certain you cannot have a hypoglycaemic attack. Eat three meals and three snacks each day with a big pre-bedtime snack. Contact your diabetes adviser now to help regain the fine tuning of your glucose balance. This problem can be resolved – it is an emergency. Act now to restore your blood glucose balance and your peace of mind.Hypoglycaemic attacks are less common among people who take sulphonylurea pills than those treated with insulin. However, they do happen and people taking long-acting pills such as chlorpropamide can, very rarely, have an attack lasting several hours. More often, you simply feel very hungry before the next meal or perhaps a little light-headed. Older people should note that feeling a bit muddled or not quite yourself may be an effect of the hypoglycaemic pills and not of old age! The important thing is to realize that people taking pills to control diabetes can occasionally become hypoglycaemic, so if you feel unwell in any way, consider a low blood glucose level as a possible cause of your feeling.It goes without saying that anyone with diabetes on insulin or hypoglycaemic pills should carry glucose or some form of carbohydrate all the time. Eat glucose the instant you suspect you are hypoglycaemic. If you are unsure and feel well enough to test, check your blood glucose level. However, remember that the longer you delay treating hypoglycaemia, the harder you may find it to treat. Many people with diabetes have an illogical aversion to food when they are hypoglycaemic and refuse to eat, even though another part of your brain is telling you that you should. This split brain phenomenon is a feature of hypoglycaemia. I was made hypoglycaemic in a research experiment. At the end my colleagues gave me some food. Ugh! Part of my brain told me that the food looked horrible and that I didn’t want it and wasn’t going to eat it. Another part of my brain told me that I needed food because I was low. A third part said, ‘this is interesting, people with diabetes do this when they are hypo, will she overcome the aversion to food or not?’ I eventually ate the food with some firm persuasion from my colleagues and my three minds merged to my usual one!Your family or friends will feel more secure with a supply of glucagon to hand. This hormone reverses the effect of insulin and raises the blood glucose temporarily by releasing glucose from liver stores, awakening you so that you can take food. It can be injected subcutaneously, intramuscularly or intravenously and most people can be taught how to give it. Glucagon keeps for many years, but the expiry date should be checked.Someone unconscious from hypoglycaemia should be placed in the recovery position, that is, lying on his or her side with a clear airway. Sometimes, rubbing a glucose tablet or a small quantity of glucose gel inside the cheek and lips will wake someone up from a hypoglycaemic reaction, but do not allow him to choke on it, and be careful to avoid getting bitten.
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