Hypoglycemia: understand it, prevent it, treat it

Hypoglycemia is the medical name for low blood glucose (low blood sugar)—specifically, a blood glucose level below 4 mmol/L. Frequent or severe hypoglycemia can have a very negative effect on your diabetes management and your overall quality of life, making it important to be able to recognize the warning signs, to have strategies in place for preventing it, and to know how to treat it if it does occur.

Causes

Hypoglycemia may result from a number of factors including:
• not eating on time
• not eating enough
• getting more physical activity than usual
• taking too much medication
• drinking alcoholic beverages

Warning signs

The warning signs of hypoglycemia can vary from person to person, and some people don’t experience any warning signs at all. When warning signs do occur, they may include feeling:
• lightheaded
• shaky
• sweaty
• headachy
• hungry
• nauseated
• nervous, irritable, or anxious
• weak or drowsy
• unable to concentrate
• numbness or tingling in your lips or tongue
• fast heart rate

Very low blood sugar can cause:
• confusion and disorientation
• loss of consciousness
• seizures

Hypoglycemia can happen rapidly. Knowing the signs to watch for will enable you to treat it quickly.

Preventing hypoglycemia

It’s always better to prevent a problem than it is to be faced with the need to treat it, and these tips will help you prevent hypoglycemia:
• Follow the blood glucose monitoring schedule your diabetes care team has created for you. Careful monitoring is critical to making sure your blood sugar level remains within your target range.
• Eat on schedule. Don’t skip meals or snacks.
• Take your diabetes medication or insulin on schedule.
• If you are going to be very physically active, adjust your medication or have additional snacks.
• If you chose to drink alcohol, don’t do it on an empty stomach.
• Keep a log of your low glucose readings so you will be able to identify patterns.

Treating hypoglycemia

Sometimes, even the best efforts to prevent a problem aren’t enough. If you think your blood sugar may be low, check it immediately. If you don’t have access to your meter, treat the symptoms anyway. Treat hypoglycemia by eating or drinking 15 grams of a fast-acting carbohydrate, such as:
• 15 g of glucose in the form of glucose tablets
• 15 mL (1 tablespoon) or 3 packets of sugar dissolved in water
• 15 mL (1 tablespoon) of honey (Do NOT give honey to a child younger than one year of age.)
• 150 mL (2/3cup) of juice or regular (not diet) soft drink
• 6 LifeSavers® candies

Wait 15 minutes, then check your blood sugar again. If it is still low, treat it again with another 15 grams of fast-acting carbohydrates. Wait another 15 minutes, and then check it again. Keep doing this until your blood glucose is above 4 mmol/L. Once your blood sugar reaches 4 mmol/L, if your next meal is more than an hour away or if you are going to be physically active, have a snack that contains 15 grams of carbohydrate plus a protein source—such as half of a sandwich or cheese and crackers. Be sure to wait at least 40 minutes after your blood sugar reaches at least 5 mmol/L before driving, because your brain may need that long to recover before you can drive safely again.

If your blood sugar remains below 4 mmol/L or if you become sleepy and less alert, call 911 or your local emergency number immediately.

Severe hypoglycemia

Severe hypoglycemia in a conscious person is treated with 20 grams of fast-acting carbohydrates, preferably in the form of glucose tablets. Blood glucose should be retested in 15 minutes and retreated with another 15 grams of fast-acting carbohydrates if blood glucose remains below 4 mmol/L. Severe hypoglycemia in an unconscious person is treated with an injection of glucagon administered either subcutaneously (under the skin) or intramuscularly (into a muscle). The effectiveness of glucagon will be reduced in people who have consumed more than two standard alcoholic drinks in the previous few hours, in those who have been fasting, and in those who have advanced liver disease. People with diabetes should wear medical identification jewelry. That way, if they lose consciousness and are unable to speak for themselves, emergency responders will know what to look for and what to do.

Hypoglycemia in a child

Even mild symptoms in a child require immediate attention. In a child under six years of age who has symptoms, a blood glucose level below 6 mmol/L with symptoms is enough to trigger treatment. In a child at least six years old who has symptoms, a blood glucose level less than 4 mmol/L is enough for treatment.

Treatment will depend on the child’s weight.
• A child weighing less than 15 kg (33 lbs.) should be given 5 grams of carbohydrates.
• A child weighing between 15 and 30 kg (33 to 66 lbs.) should be given 10 grams of carbohydrates.
• A child weighing more than 30 kg (66 lbs.) should be given 15 grams of carbohydrates, the same as an adult.

5 grams of carbohydrate:
• 11/2 oz. (45 mL) of fruit juice
• 1/2 cup (125 mL) of white milk
• 1/4 cup (60 mL) of chocolate milk
• 1/4 cup (60 mL) of regular (not diet) pop
• 1-11/2 teaspoons (4-6 g) of jelly or jam

10 grams of carbohydrate:
• 3 oz. (90 mL) of fruit juice
• 3/4 cup (185 mL) of white milk
• 1/3 cup (80 mL) of chocolate milk
• 1/4 cup (60 mL) of regular (not diet) pop
• 2-3 teaspoons (8-12 g) of jelly or jam

Tips for family, friends, and coworkers

If you have diabetes, it is important that the people around you know what to do if your blood sugar drops too low. These tips will help:

If you are unconscious:
• The person should prepare a shot of glucagon and administer the shot following the instructions that came with the medication.
• As soon as the injection has been administered, the person should call 911 or your local emergency number.

If you are conscious and able to swallow:
• The person should lift your head and give you ½ teaspoon (7.5 mL) of water to swallow.

If you swallow the water without coughing or choking:
• The person should give you 15 grams of glucose tablets or 15 grams of fast-acting carbohydrates, then wait 15 minutes and see if you need help testing your blood glucose level.
• If you are feeling better but your blood glucose is still low or you still have symptoms, the person should give you another 15 grams of glucose tablets or fast-acting carbohydrates then wait with you for another 15 minutes until you test your blood glucose again.
• If you become sleepy or lethargic, the person should call 911 or your local emergency number immediately and stay with you until help arrives.

If you cough or choke on the water:
• The person should turn you on your side and make sure your airway isn’t blocked.
• Then the person should prepare a shot of glucagon and administer the shot following the instructions that came with the medication.
• As soon as the injection has been administered, the person should call 911 or your local emergency number.
• If you are unconscious and emergency help hasn’t arrived within five minutes, the person should give you another glucagon shot and stay with you until the emergency help arrives.

Diabetes & Covid-19

COVID-19 is a virus that affects the respiratory system (the system that enables us to breathe). People with diabetes are not more likely than others to catch the COVID-19 virus, but if they do catch it, they are more likely to have a severe form of the infection and to suffer more complications. This makes it particularly important for people with diabetes to do everything they can to protect themselves from this virus. Here are some things you can do to help protect yourself.

• Wash your hands thoroughly and often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth.
• Regularly clean commonly used surfaces and devices you touch or handle.
• Don’t make unnecessary trips away from home.
• If you do have to leave your home, try to stay at least 2 metres away from anyone else.
• Avoid contact with people who appear to be sick with a respiratory illness.
• Watch carefully to see if you develop any symptoms.

Common symptoms of COVID-19 to watch for include fever, tiredness, dry cough, aches and pains, nasal congestion, runny nose, sore throat, and diarrhea. However, some people who become infected with the virus never develop symptoms. If you do develop any of the symptoms, continue following your diabetes management plan and call your doctor to see whether you should make an appointment to go in for a checkup and for advice on how to treat your symptoms. Research has shown that insulin and other treatments for blood sugar control do not increase the risk of severe COVID-19, and you should continue to take them. In fact, you should not make any changes to your diabetes management plan without checking first with your doctor. It is always better to be prepared than to be surprised by something unexpected. For people with diabetes, this includes having a sick day management plan in place before you get sick.

The article “Sick Day Management” below will help you prepare for COVID-19 or any other illness you may develop.

Sick Day Management

Even a minor illness can cause serious problems for people with diabetes. When we are sick, our body reacts by releasing hormones to fight infection, but this can raise blood glucose (blood sugar) levels and make it more difficult for insulin to lower blood glucose. A little planning can reduce the likelihood of developing dangerously high blood glucose levels if you get sick.

Plan ahead
While you are still healthy, you should talk to your doctor or diabetes care team to create a sick day management plan. Your plan should include your target blood glucose goal during an illness, how often to test your blood glucose and ketone levels, how your diabetes medication schedule or insulin might have to be adjusted, if you should stop taking any other medications, and what warning signs indicate it’s time to contact a doctor. Make sure you keep your sick day management plan where it will be handy when you need it. Prepare a sick day kit that includes:
• glucose tablets to treat hypoglycemia (low blood sugar)
• sugar-free beverages
• a thermometer
• enough blood glucose testing strips
• a ketone meter and strips

Managing your blood sugar
If you are on insulin, continue taking it even if you are vomiting or have trouble eating or drinking. If you are managing your diabetes with medications or if you are taking medicines for other conditions, you may need to stop taking them if you are at risk of becoming dehydrated as a result of vomiting or diarrhea.

Speak with your doctor if you take any of these types of medicines to make sure you know what to do if you get sick:
• blood pressure medications
• diuretics (“water pills”)
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• pain medicines
• sulfonylureas

Be careful about taking over-the-counter medicines. For example, if you have a cough or cold and you are looking for relief from your symptoms, you should be aware that some products contain sugar. Ask your London Drugs pharmacist for assistance in choosing a product that will help you feel better without affecting your blood glucose control.

Stay hydrated

If you are vomiting, have diarrhea, have a fever, or are exposed to excessive heat, you are at risk of dehydration. Be sure to drink plenty of fluids that contain minimal or no sugar. Try to drink at least one cup (250 mL/8 oz.) of sugar-free fluids periodically for a total of at least nine cups (2.2L/72 oz.) daily to prevent dehydration. Good choices of fluids include water, clear soup or broth, herbal tea, and caffeine-free diet pop (such as diet ginger ale). Limit the amount of caffeine-containing beverages you drink (e.g., coffee, some teas, and some types of carbonated soft drinks), because caffeine makes dehydration worse. You may want to consider electrolyte replacement solutions.

Eating while you are sick

If you can, try to stick with your meal plan. If you can’t eat the foods you usually eat, try to consume light foods or fluids that contain 15 grams of carbohydrates every hour. Options include:
• 1 slice of bread
• 7 soda crackers
• 1 medium-size piece of fruit
• 1 twin popsicle
• ¹/2 cup (125 mL) of unsweetened applesauce
• ¹/2 cup (125 mL) of 100% fruit juice
• 2/3 cup (165 mL) juice
• ¹/2 cup (125 mL) regular Jell-O®
• 2/3 cup (165 mL) regular soft drink that does not contain caffeine
• ¼ cup (60 mL) regular pudding or ½ cup (125 mL) sugar-free pudding

If you are not vomiting and don’t have diarrhea, you may also want to try:
• 1 cup (250 mL) of milk
• ¹/2 cup (125 mL) of flavoured yogurt
• ¹/2 cup (125 mL) of ice cream

If you are eating less than normal and the symptoms last for more than 24 hours, you may need to temporarily stop taking some medications, including certain diabetes pills, blood pressure and heart medications, and anti-inflammatory pain medicines, and you may need to stop taking all diuretics (water pills). Check with your healthcare professional before you get sick to find out if any of your medications should be stopped, and incorporate this into your sick day management plan.

Test, test, test
Your sick day management plan should include instructions for what tests you should perform and how often to do them, but the following are some general guidelines to consider:
• Check your blood glucose at least every two to four hours. If it is rising quickly, check it more often, even throughout the night.
• If you take insulin, test your blood or urine for ketones.
• If your blood glucose tests above 16 mmol/L twice in a row, test your blood or urine for ketones every four hours.
• Weigh yourself and check your temperature, breathing rate, and pulse frequently.

When to seek help
There are some warning signs that point to a more serious problem. You should contact your healthcare provider if:
• You are sick for more than 24 hours and aren’t getting better or if you start to feel worse
• You can’t drink enough liquids
• You take any medicines and aren’t sure if you should change your dosage or stop taking them when you are sick
• You take insulin and aren’t sure if or how you should change your dosage
• You have been told to check your ketones and they are moderate to high
• You are unable to keep your blood glucose level above 4 mmol/L

If you can’t reach your healthcare provider and are not getting better, consider going to the emergency
department of your local hospital.

Read all other articles in our Living with Diabetes Magazine here.

Health Tips Video: How to Manage Diabetes for a Long, Healthy Life

Tips to manage diabetes for a long and healthy life

Diabetes is a serious medical condition that affects over 2.1 million people in Canada. There are different types of diabetes, but all forms affect the body’s ability to manage blood sugar levels with insulin. Either the body has difficulty producing insulin in the pancreas (Type 1), or it cannot properly use the insulin it does produce (Type 2). There is also a temporary type of diabetes that can affect women during pregnancy. Gestational diabetes affects 2-4% of pregnancies and means that both mother and child have a higher risk of developing Type 2 diabetes later in life.

Thankfully, there are many ways to manage diabetes. According to London Drugs pharmacist Sangita Tumber, it is important for people with diabetes to:

  • Interpret blood sugar patterns
  • Eat well
  • Get physical activity
  • Safely inject insulin
  • Adjust dosage if needed

Track Your Blood Sugar

How to manage diabetes for a long and healthy life

Tracking your blood sugar can keep you on track. The Canadian Diabetes Association recommends that people using insulin test their blood sugar levels regularly. People with Type 2 diabetes who aren’t using insulin may also want to self-monitor their blood sugar levels. It’s easy to do this at home with a blood glucose monitor.

Eat Well and Exercise

You can manage diabetes and live a long, healthy life

Food choices, especially related to alcohol and sweets, can greatly affect blood sugar levels. This is why nutrition is so important for people with diabetes, especially Type 2. Exercise can also lower your blood sugar and help insulin work more effectively.

Work with Your Healthcare Professionals

The most important thing you can do to manage your diabetes is to form a partnership with your healthcare professionals, says Tumber. They can help you monitor your diabetes and teach you how to track sugar levels and inject insulin safely. Prevention is key when it comes to avoiding long-term complications.

It really is possible to live a long and healthy life with diabetes. It just takes some knowledge and care. The best weapon to managing this chronic condition is education. That’s why London Drugs has Certified Diabetes Educators at select locations to help you better understand this disease. These are pharmacists with national certification as diabetes experts.

These Certified Diabetes Educators can also assist you in a variety of languages, including Cantonese, Punjabi, Mandarin, and Korean, depending on location. Language shouldn’t be a barrier when it comes to understanding the steps you need to take to manage your health.

To learn more about diabetes and managing the condition, visit the London Drugs Health Library online or talk to a Certified Diabetes Educator at select London Drugs locations.

5 Reasons Your Pharmacist is Awesome

Everyone knows that your pharmacist is the expert in filling your prescriptions, but everyone may not know that they provide many other super helpful services as well. We’re celebrating World Pharmacists Day by shining a light on all of the ways your friendly, neighbourhood London Drugs pharmacist can help you maintain and improve your health.

1. They can give you your jabs

Getting immunized isn’t exactly fun, but pharmacists can take the sting out of it by making it easy and convenient. If you’re planning a trip overseas, your pharmacist can help you prepare by reviewing your immunization history, letting you know which vaccines you’ll need for your destination, administering them, and issuing you an International Certificate of Vaccination if you need it.

London Drugs’ Certified Injection Pharmacists are also able to administer influenza vaccinations, as well as the Zostavax vaccine for Shingles.

If you would like to get a vaccination at a London Drugs pharmacy, just ask for more information at the pharmacy counter.

2. They give great advice

Although sometimes necessary, getting in to see a doctor can be time-consuming and complicated. If you’re looking for quick advice about minor ailments or wellness, your pharmacist can be your first stop on the road to good health. You can meet with a London Drugs pharmacist one-on-one to get trusted health advice on anything from allergy relief, diabetes management, nutrition, cough and cold remedies, pain management, stomach health, and eye care. Here’s the best part–no appointment necessary!

3. They help with the kids

Becoming a new parent can be scary, especially if you think something is wrong with your precious little bundle. If you have questions about your child’s health, pharmacists are an accessible resource. They can recommend over-the-counter medications that are safe for your children and provide information on proper dosage to help you treat common baby health conditions such as diaper rash, eczema, cradle cap, constipation, pain and fever, rashes, teething and more. Pharmacists can also refer your child to a doctor or other health professional if they feel your little bundle of joy requires a closer look.

4. They can help you find out for sure

You can never be too careful with your health, and pharmacists make it easier to put your mind at ease. Health screenings are a great way to take control of your health, and London Drugs provides the following convenient screening services and clinics at most of our locations:

5. They care about the community

Pharmacists are not only healthcare professionals, they are caring members of the community that they serve.

For example, last year during the British Columbia wildfire crisis, they provided life-saving services in the affected communities. While London Drugs helped assemble essential supplies and support staff, London Drugs pharmacists assisted those affected by accessing medical histories and contacted insurance providers to ensure quick access to essential medications for people who had to evacuate their homes.

Do you have a great story about how your super-pharmacist saved the day? Share it with us in the comments or on Twitter! #ilovemypharmacist

Diabetes alert dogs to the rescue

Image_003Sophie Mullins of Paradise, Newfoundland, was diagnosed with type 1 diabetes when she became seriously ill at the age of 18 months. Her parents, Heidi Pavelka and Jamie Mullins, worried about her constantly, since her blood sugar can drop without warning, putting her at risk of hypoglycemia. “Sophie doesn’t feel her lows—she could have low blood sugar and be running around the house as if everything is normal,” says Pavelka. Their worries were alleviated thanks to a new addition to the family: a six-month-old black Labrador retriever named Peaches, a diabetes alert dog who has been trained over several years to detect Sophie’s low blood sugar levels and get help when she needs it. (Note: At six months the dog moves in with the patient’s family to begin the training process.)

READ MORE

Sight unseen: tips and techniques for coping with vision loss

Image_001Diabetes is the leading cause of blindness in Canada. Diabetic retinopathy, which results in vision loss, is caused by damage to the blood vessels of the retina. It affects 25% of people with type 1 diabetes and up to 14% of people with type 2 diabetes. Having diabetes also raises the risk of developing other eye problems, such as cataracts and glaucoma. While it can be frightening to lose part or all of your vision, there are plenty of strategies, tools, and resources available to help you stay as independent as possible. Here are some of them.

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Prescription for exercise

Image_001Physical activity is the best treatment for type 2 diabetes. Why not do it in the great outdoors?

Exercise is considered one of the cornerstones of treatment for people living with type 2 diabetes for a host of reasons: it improves the body’s use of insulin, burns excess body fat, improves muscle strength and heart health, increases bone density, lowers blood pressure, relieves stress, lifts one’s mood, and increases energy.

Exercise doesn’t just make you feel better, it also reduces disease, lessens hospitalizations, and can actually help you live longer. A 2012 study of 650,000 people from the U.S.-based Brigham and Women’s Hospital and the National Cancer Institute proved just that. It found that people over 40 who walked briskly for 75 minutes per week lived an extra 1.8 years. That increased to 3.4 years when they walked 150 to 299 minutes per week and to 4.5 years for 450 minutes per week.

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