Hypoglycaemia is a condition, in which blood sugar level falls below 70mg%. When blood sugar levels fall, there is an increase in counter-regulatory hormone levels to maintain the optimum blood glucose levels. In diabetics, hypoglycaemia is very common among the
•Elderly,
•Debilitated patients,
•Patients with infections,
•Patients with impaired kidney function,
•Patients on insulin therapy,
•After alcohol abuse (or) vigorous exercise
•Psychological illness.
•Diabetics who fast for religious reasons or those with continuous vomiting are prone to hypoglycaemia.
1) It is more common in insulin-dependent diabetes than maturity onset diabetes (type II diabetes). Hypoglycaemia is more common and pronounced if one aims for intense blood sugar control. Hypoglycaemia can result in ECG changes with or without any symptom (silent ischemia). It also can trigger angina, heart attacks, acute heart failure and/or cardiac rhythm disturbances. Some of the recent studies have shown that hypoglycaemic episodes increase cardiovascular events and mortality. Studies have also shown that adverse cardiovascular events are three times more common among those with intense glucose control compared with optimal control. Swings in blood sugar levels are equally hazardous.
Symptoms of hypoglycaemia
With the onset of hypoglycaemia, heart rate and systolic blood pressure increase with vigorous heart pumping activity owing to adrenaline release. This may result in such symptoms as sweating, palpitations, giddiness, restlessness and confusion. Some patients may experience intense hunger and lack of concentration. Rarely can hypoglycaemia be silent without any symptoms.
2) The exact incidence of hypoglycaemia is not known because these episodes may be mild, moderate or severe. Mild symptoms may even be undetected. Mild hypoglycaemic events are more common but less reported. Patients, who experience frequent hypoglycaemic episodes, may take corrective steps with the onset of premonitory symptoms. Dead in the bed syndrome due to nocturnal hypoglycaemia resulting in cardiac rhythm disturbances has been thought to be due to extreme hypoglycaemia, and fortunately this is very rare.
The challenge of physicians is to adjust blood glucose levels to near normal range and reduce complications of diabetes, while at the same time minimise or prevent hypoglycaemic events. One must particularly be more cautious in diabetics with underlying heart disease. Blood HbA1c level is a biochemical parameter to assess long-term glucose control. Hypoglycaemic episodes are more common if HbA1c level is < 7%. “Lower the better is no longer the rule.”
(Dr. I. Sathyamurthy is an interventional cardiologist and director of the Department of Cardiology, Apollo Hospitals, Chennai. He is the recipient of the Padma Shri Award for 2000 and the Dr. B.C. Roy National Award for 2001).
Keywords: Hypoglycaemia, diabetes awareness
Some diabetics suffer from low blood sugar because of administering excessive insulin. My mother who was a severe diabetic was on an excessive insulin dosage. Consequently she would often suffer from low blood sugar, then we would give her sugar which would raise her blood sugar levels and the cycle of sugar-insulin-low blood sugar-sugar-insulin would continue, this continued till we discussed with the physician and the insulin dosage was revised. In case a patient suffers frequently from low blood sugar it would be correct to refer immediately to the doctor and get the insulin dosage revised, if necessary.
I am not so sure as to what the optimal blood sugar level should be. Different studies resulted in contradictory conclusions. On the other hand high blood sugar is a slow killer like God's wrath. Low blood sugar or hypoglycemia may cause its effects acutely like king's wrath even permanently destroying the brain with no point of return. And then there is a curious phenomenon known as Somogyi phenomenon. Accordingly low blood sugar may trigger the release of counter regulatory hormones which in turn may raise the sugar above normal or optimal level. Since 1980s the phrase Somogyi effect or phenomenon has become a dirty phrase with pundits claiming that there is no such a thing as Somogyi effect in this day and age and it was all only before the days of long acting insulin.
A wonderful narration of the Hypo conditions and diabetics like me must note Dr. Sathyamurthy's warning that the swings in sugar values is hazardous. This fact is not normally realised and we tend to foloow that when you have Hypo, pl take glucose and it rises fast sugar and causes swings as well as when we tend to overexercise.
Pl publish more articles like this by the specialists which are highly informatory and extremely useful
"Hypoglycaemic episodes are more common if HbA1c level is < 7%. “Lower
the better is no longer the rule.”"
The above is so misleading and contradicting. Everywhere one reads -
right from American Diabetes Association, the Endocrinologists
Directives, All Medical advises - it is suggested that maintaining the
A1C from 4.5 to 5.5 is the right approach. 5 is the target set by many
a doctors. Even the PP numbers are suggested to be 120 instead of 180.
Now this doctor (and your article) just scares the people and probably
leads them to be lax in their control. The hypoglycemic episodes can
be controlled by proper amount of insulin or drug adjustments. Not by
being lax and let the long term effects on kidneys and heart take
effect.
It is the knowledge and being aware of identifying the symptoms and
controlling it. A healthy snack before bed, never taking insulin (fast
acting) without a food planned - these are simple steps
Not going back to > 7 ! That is plainly crazy and wrong!
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