How to have a hypo

This is an article with advice about avoiding the lows of hypos. This is a practical approach to one of the real low-points of having diabetes. At the end of the article there are some Top Tips on Handling a Hypo and a list of likely hypo-treatments. The first thing to say about hypos is that they are pretty much inevitable – perhaps even more so if you are well-controlled. But if you’re well-controlled then you should have hypo symptoms and you may also have good hypo strategies and can handle a hypo in the best possible manner.

Hypos: definition and terminology
Normal blood sugars should be between 4-8mmols. A hypo can be defined as being under 4mmols. A mild hypo might be a reading of 3.3, while a more severe hypo would be so low that the blood test meter you are using may just say ‘low’, meaning that you’re off the scale when it comes to reading a glucose result.

As with much to do with diabetes management, how we refer to hypos can be very individual, we call them ‘feeling a little bit wobbly’, or talk about ‘being a bit dizzy’, ‘feeling shaky’ and so on. For the sake of this article I will be talking about “hypos”, in the assumption that everyone reading it will know that hypo is short for hypoglyceamia, or a low blood sugar. Think low, think ‘hypo’.

Your hypo and how to treat it, will be very specific to yourself and your needs – how your hypo was induced, where you are, what you last ate, what your activity levels are (or have been) and what you have to hand when the hypo strikes.

Hypo symptoms
Some people get good hypo symptoms — and by ‘good’ I mean that it is good that you have symptoms, not that it’s good that you’re having a ‘good hypo’ – I’m sure there’s no such thing! It’s my belief that hypos should be avoided like the plague, for the obvious reasons that they feel bad and because they tend to lead to at least a few hours of ‘up and down’ blood test results.

Any diabetic can tell you what they feel when having a hypo — in the main, we get shaky, irritable, maybe a bit sweaty and find it hard to concentrate. Often the diabetic also has a very strong urge to eat anything that you can lay your hands on.

Hypo handling
It’s very easy to ‘over do it’ when it comes to treating a hypo and that’s one thing that, over time, you need to get used to handling. Some hypos are worse than others – in as much as they can come on more suddenly or you get to be very low – with a reading of 3.0 or lower.

You may be able to get to the point when you know that if you’re at 3.5 you need 1 glass of orange juice (or 15g of sugar) to sort yourself out. Or if you’re at 2.5 you need 1 glass of orange juice and a mini-Mars Bar.

The thing than non-diabetics can fail to understand is that you are deeply addled when having a hypo. You are confused, annoyed and perhaps not able to make good decision or explain yourself well when in the throes of a hypo.

Advice for parents & guardians
You are really up against it when dealing with young children and hypos. It’s hard enough with them having all the various ‘phases’ of discovering their personalities and place in the universe, but you have to keep an eye out and decide when a temper tantrum is in fact a hypo. There are signs you can watch for. Sudden snaps of temper might be part and parcel of any child’s day (they’re still part of mine) but signs to watch for are if they are looking pale (or ‘peaky’) and being more than normally irrational. Another tip is to ask them to hold their hand out and see if it shakes when they do so. If a few of these signs are present you can assume your child is going hypo. Try to do a blood test to confirm but otherwise, treat the hypo.

Hypo treatments
Also known simply as a ‘sugar source’, as any sugar can be a hypo treatment, but some might be better (faster or more effective) than others.

A hypo is a blood sugar reading of less than 3.8mmols. The lower the reading, the more sugar you will need to take to ‘pull yourself out of it’.

Nothing can legitimately be claimed to be a hypo treatment until it has been clinically tested, which is true of very few products indeed. Neither sugar, Coca-Cola, orange juice or chocolate have had clinical trials, but as any diabetic can tell you, they work when it comes to pulling you out of a hypo.

A liquid will work faster in your system than a solid – so smoothies, fruit juice or one of the gluco gel products are a good bet for an initial reaction to a hypo. With solids, they need a bit of digestion before the sugars are released. They will work, they’ll just take a bit longer to do so.

Likewise, a boiled sweet will take longer to deliver its load than say a chewy toffee or a crunchable tablet.

(See full list of hypo treatments below the top tips).

Top Tips on Handling a Hypo.

1. Make sure you have sugar sources stashed everywhere (a drawer next to your bed, in the glove-compartment of the car, in a desk drawer at work). Make sure no one feels they can help themselves to these – they are yours for ‘emergencies’. Many people joke about ‘needing’ chocolate; they should try having a hypo and see how that compares.

2. Tell those close to you what the symptoms are, and how to help you if you’re having a hypo. You should tell at least one colleague how you handle your hypos too, in case you have a diabetes-induced wobbler at work.

3. Try to do a blood test if you can. I know that for me, feeling very anxious can feel very much like a hypo (there is a certain amount of interaction between adrenalin and insulin) but adding sugar to anxiety won’t help at all, while adding sugar to a hypo will. So know what you’re dealing with.

4. Try to treat the hypo with something very sugary (sweets, orange juice, Coke or other soft drinks) as well as something more long-term (a biscuit or a slice of bread). But don’t over do it. Don’t blow your socks off.

5. Read the label on whatever you’re using to treat the hypo so you know how much energy you are putting in.

6. Wait 10 minutes and do another blood test and see if you need more anti-hypo action.

7. Test again about an hour later. By then, if you’ve over done it, you might need a little insulin ‘chaser’ to bring down a high sugar, but be careful — you don’t want to end up having another hypo!

8. Try to keep note of when you have hypos – if there is a pattern (say for example you get lows at half-past ten every weekday) then it may indicate that you need to adjust your medication.

9. See if you can get a back-up blood test machine so you can have one in your bedroom in case you can’t sleep and are worrying it might be because your sugars are low, or if you actually wake up feeling hypo. Keep some sugar near you too to address the hypo as soon as you can – going to another room, especially up or downstairs when you’re ‘wobbly’ can be more of a challenge than normal.

10. Remember to replace the sugar sources than you use up. Preparation is all!

Post-hypo analysis
See if you can rationalize why the hypo happened – why then? For me, I check “What did I eat – and when, did I do any unexpected exercise, did I give myself too much insulin or not eat enough carbs, or the wrong sort of carbs.” Keeping a diary of what you ate, when, what your blood sugar was and what insulin you gave yourself can be helpful (see our diary page too).

Hypo treatments and sugar sources
I’m listing these as a sort of scale, with the most dramatic hypo-stoppers at the top, and the weaker ones at the bottom. The amount of response would be indicated by the severity of the hypo.

Glucagon injection: This is for someone in a bad hypo, possibly past the point of being able to help themselves. It’s an injection that contains glucagons – a pure form of energy that gets straight into the system without having to be digested (as anything going in the mouth will have to be). You can get these on prescription from your GP. They should be kept refrigerated when not in use. Not for use when any other hypo treatments are available.

Fruit juices and ‘smoothies’: astonishingly sugary (as sugary as a coke — read the labels), but there’s a sense that they’re healthier than a fizzy drink.

Soft drinks: fizzy ones can be quite harsh on the throat if you need to drink them quickly.

Sugar cubes: old-fashioned but easy; keep a box handy for emergencies.

Gluco-tabs: available from Boots and larger pharmacies, these are glucose tablets that you can chew to release energy, with 4g of glucose in each tablet. They now come in a handy little plastic tube carrying ten ‘tabs’ which can be refilled from a bigger bottle. The small tube is around 80p, the bigger bottle under £3.00.

Hypo-fit: A syrup packed in foil sachets, with 13g of useful carbohydrate, this might be even easier than chewing a tab, and the foil sachets are durable. The product also does not ‘go off.’ We sell these on our site.

Other useful items
Gluco-carries have been designed by Scott Saunders, who is a diabetic. His simple vice holds enough glucotabs to stave off a moderate hypo and come in a handy key-ring form or can hang on a band that can go around your neck. He uses his for keeping with him when in the gym. We sell these on our site.

The sweetie draw
Yes, I have one…In my home I have a sweetie drawer that contains all the things I shouldn’t eat – most of them chocolates or sweets. Shouldn’t eat when I’m not having a hypo, and generally chowing down on chocolate won’t keep weight-gain at bay, which you might want to take into account. However, I keep it filled up and ready for when I need something to up my sugars. I almost see it as a ‘treat’ to be able to eat these things, even though it’s due to the fact that I’m having a hypo.

In my handbag I always have a blood test machine and I carry a 200ml carton of orange juice in a sealed plastic bag. There are more cartons of OJ in the car, and in my office desk drawer. In my bedroom I keep a carton of orange juice near my spare blood test machine so that if I get a nighttime hypo I can treat it there and then (see news item on Cold Sweat Alarm).

If I’m near any other source of sugar (like if I can walk into a news agent and buy some sweets) then I won’t use up my carton. That’s because I hate the idea of using it up and then not having something ready in case I need it later.

It’s bad enough having a hypo without having a panic attack too about how you’re going to handle it when you’ve nothing useful to hand, so the Boy Scout rule “be prepared” is standard ops for me.

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