Hypo vs Hyper

Because a diabetic's body can no longer regulate insulin production we must now do that for ourselves by injecting insulin. The body is an amazing machine designed to automatically react to slight changes in carbohydrate levels, emotional stress, physical activity, temperature and a load of other factors that can impact on our blood sugar levels. We are not as accurate as the human body normally is at detecting these changes so sometimes we get the dosage a little bit wrong. The result is either a blood sugar that is too low or sometimes too high. 

Low blood sugars or Hypos are correctly known as Hypoglycemia. This is where there is too much insulin in the body and the blood sugar drops below 4.0 mmol/l. The body's best operating level is around 6.0 mmol/l but for good control you are meant to try to stay between 4.0 mmol/l and 7.0 mmol/l as much as possible, as this mimics the body of a person who has a pancreas that works. This is very hard to achieve. I have found specialist will allow a little leeway especially for young diabetics. I think this is where I first learnt the importance of setting my goals high. It is better to have a high goal and fall a little short than set an easy goal and achieve it. I use this philosophy in my diabetes and everyday life.

I have been diabetic for over 20 years and the worst part about diabetes is dealing with the hypos. To explain a hypo I think it is easiest to say the body basically goes into shock. Early symptoms may include hunger, sudden change in mood, feeling a little bit sick in the stomach then the next set of symptoms begin if not treated you get cold and clammy, you sweat, your face and skin may go pale, you get confused and dizzy, sometimes you may get very emotional. If left untreated you may begin to loose muscle control, the body may fit or you may pass out. These are all symptoms I have experienced throughout my lifetime. Lately I have noticed the first symptom I get is it becomes hard to speak or put my words together when I go hypo as I do not get the early symptoms I would previously get. I think this is common when you have had diabetes for a long time like I have. (If anyone has any advice about this please let me know I'm here to learn from others experiences too)

 

To treat hypos we basically need to get sugar into the body. The first and most important thing is to consume something full of sugar like normal soft drink (not diet), jelly babies, jelly beans, sugar packets. After 10mins - 15mins you should test your blood sugars and check your levels have risen above 4 mmo/l. If they are not above 4 mmo/l simply eat some more sugar, if they are above 4 mmo/l eat 15g - 30g of Carbohydrates. This will prevent the fast acting sugar being used up by the body this is the best thing to stop you going hypo again.

 When you treat a hypo you must remember not to over-treat as you may send yourself into a hyper this is the part I find hard when training for marathons. When doing long runs hypos are almost always going to happen so as a diabetic I must make sure I am prepared. Sometimes it is very hard for me to get my sugars up while doing my marathons.

High blood sugars or Hypers are correctly known as Hyperglycemia. This is where there is not enough insulin in the body's and because the 'energy door' is closed the blood sugar rises. Below 14.0 mmo/l physical activity or exercise could be used to lower blood sugars however when your levels get above 14.0 mmo/l exercise seems to send your sugars higher. The reason for this is exercise causes stored sugar called glycogen to be released into the body and it can not be used because the 'energy door' is shut. This is something we will look at in a later post. When your sugars are above 14.0 mmo/l you need to administer extra insulin this is best done in consultation with your doctor as everyones body react differently to the insulin they are on. I am on the short acting insulin Novorapid and I find for every 3.0 mmo/l i can administer 2 units of insulin to reduce my blood sugars. I have a friend who uses the same insulin and she would end up Hypo if she used the same regime.

Highs are not as noticeable as hypos you can be high and not realise it but when you have been high for a while you really notice the symptoms. If you have ever done a hard work out and know the feeling of extreme levels of lactic acid building up in your muscles that is the best way I can describe what a high feels like.  

Your muscles ache and burn, your mouth is dry, you can get confused and your vision goes blurry. It is not pleasant. But highs are a slow reaction therefore your treatment can be slow where as hypos are a fast reaction and require fast treatment. So as you can work out Hypos are the most dangerous and can be a life threatening condition if not treated with importance.

IF YOU DO NOT KNOW WHAT IS WRONG NEVER ADMINISTER INSULIN TO A DIABETIC ALWAYS GIVE THEM SUGAR AND CALL AN AMBULANCE. SUGAR WILL NOT KILL THEM QUICKLY - INSULIN WILL.

I have experienced this as I was hypo and unconscious once and a friend of mine administered a full syringe of short acting insulin, lucky for me this was a few years ago when the short acting insulins took between 30mins to an hour to begin working and the ambulance was able to get me to hospital in time to load me up with Glucagon. So please never inject a diabetic unless they can do it them selves.

Below is some further information about Hypos and Hypers taken from the Diabetes Australia website.  These conditions are explored in more accurate detail. Click on the link to visit their website and find out more information about Type 1 Diabetes.
       


Hypoglycaemia

Hypoglycaemia (also called a ‘hypo’, low blood glucose or insulin reaction), is when your blood glucose level has dropped too low. This occurs when your level falls below 4 mmol/L, although this can vary. Some people may feel symptoms when their level is greater than 4 mmol/L and sometimes it just depends on the situation.

While hypoglycaemia can be experienced by people taking certain tablets for their diabetes, it is more common in people who inject insulin. It is generally not a problem for people with type 2 diabetes who can manage their diabetes through a healthy eating plan and physical activity alone, however, it is possible.

It is important to treat a ‘hypo’ immediately to stop your blood glucose level from dropping lower.

Talk to your Credentialled Diabetes Educator about preventing, managing and treating hypos that is unique to you and your lifestyle. The information covered in this Topic is a general guideline only.

Causes of Hypoglycaemia

Hypoglycaemia can be caused by one or a number of events, such as:

• Delaying or missing a meal 
• Not eating enough carbohydrate 
• Unplanned physical activity 
• More strenuous exercise than usual 
• Drinking alcohol - the risk of hypoglycaemia increases, the more alcohol you drink 
• Too much insulin or diabetes tablets. 
• While these are known causes of hypoglycaemia, in many cases, no specific cause can be identified. Symptoms of Hypoglycaemia

Symptoms of hypoglycaemia vary from person to person, however common feelings are:

• Weakness, trembling or shaking 
• Sweating 
• Light headedness 
• Headache 
• Dizziness 
• Lack of concentration/behaviour change. 
• Tearful/crying 
• Irritability 
• Hunger 
• Numbness around the lips and fingers. 

If you feel any of these symptoms, test your blood glucose level if time and circumstances permit. If you are unable to do so, treat as hypoglycaemia. Treat low or dropping glucose levels even if you feel fine. If you have low blood glucose levels without any symptoms you should discuss this with your doctor or Credentialled Diabetes Educator.

No Symptoms or Changing Symptoms

Some people have no symptoms of hypoglycaemia. They may lose consciousness without ever knowing their blood glucose levels were dropping. This is called hypoglycaemia unawareness and tends to happen to people who have had diabetes for many years.

Symptoms can also change over time, which may make it harder to recognise.

If you have hypos without symptoms or your symptoms change, you may need to check your blood glucose more often and alert your friends and family to watch out for changes. Treat low or dropping sugar levels even if you feel fine. If you have low blood glucose levels without any symptoms should discuss this with your doctor or Credentialled Diabetes Educator.

Treating Hypoglycaemia

Firstly, make sure you’re safe. For example, if you’re driving a vehicle, pull over to the side of the road.

Then have some quick acting carbohydrate that is easy to consume. For example:

• 1/2 can of regular soft drink (not ‘diet’) OR 
• 1/2 glass of fruit juice OR 
• 3 teaspoons of sugar or honey OR 
• 6-7 jellybeans OR 
• Glucose tablets equivalent to 15 grams carbohydrate. 

Wait 10-15 minutes. If it isn't rising, eat another quick acting carbohydrate from the above list. If your next meal is more than 20 minutes away, eat some longer acting carbohydrate. This could be one of the following:

• A sandwich OR 
• 1 glass of milk or soy milk OR 
• 1 piece of fruit OR 
• 2-3 pieces of dried apricots, figs or other dried fruit OR 
• 1 tub of natural low fat yoghurt OR 
• 6 small dry biscuits and cheese. 

Not Treating Hypoglycaemia

If hypoglycaemia is not treated quickly, the blood glucose level can continue to drop, which may progress to:

• Loss of coordination 
• Slurred speech 
• Confusion 
• Loss of consciousness 
• Fitting. Unconscious, Drowsy or Unable to Swallow

If a person with diabetes is unconscious, drowsy or unable to swallow THIS IS AN EMERGENCY.

Do not give them any food or drink by mouth.

Here’s what needs to be done:

• Place them on their side making sure their airway is clear 
• Give an injection of Glucagon if available and you are trained to give it 
• Phone for an ambulance (dial 000) stating a ‘diabetic emergency’ 
• Wait with them until the ambulance arrives 
• When they regain consciousness, given them carbohydrate to maintain their blood glucose level. 

Glucagon

Glucagon is a hormone which raises the blood glucose level and is injected in a similar way to insulin. Glucagon is recommended to reverse severe hypoglycaemia in people with diabetes. If you are able to treat your own 'hypo', you do not need Glucagon which is always given by another person. Your doctor or Credentialled Diabetes Educator will recommend you have Glucagon on hand in case of a severe ‘hypo’ and will show you, your family and friends how to use it.

Avoiding & Managing Hypoglycaemia

There are a number of things that you can do to manage and avoid hypoglycaemia including:

• Carry a ‘Hypo’-pack. 
• Wear an identification band that says you have diabetes, that way people will know that you need urgent medical help if you have one 
• Make a note in your monitoring book of any ‘hypos’ you have and discuss it with your doctor or Credentialled Diabetes Educator at your next visit 
• Make sure your family, friends, co-workers, school staff and carers know how to recognise and treat hypoglycaemia 
• Look for the cause of your ‘hypo’ so you can try to prevent the situation from occurring again 
• Contact your doctor or Credentialled Diabetes Educator if you are having ‘hypos’ often 
• If you are on insulin or certain types of diabetes medication, always carry quick acting ‘hypo’ treatment with you 
• If you’re taking medication called Acarbose (Glucobay®) carry pure glucose with you such as glucose tablets, glucose gel or Lucozade 
• Eat carbohydrates if you are drinking alcohol 
• Test your blood glucose level and ensure it is above 4 mmol/L before driving a motor vehicle. ‘Hypo’ Pack

A 'Hypo' pack is a pack for treating episodes of hypoglycaemia. Contents of a hypo pack may include:

• Name of the person it belongs to 
• List of contents 
• Written descriptions of hypo symptoms 
• Instructions for how to treat a hypo (in case friends and family need to treat) 
• Fast—acting carbohydrate such as juice boxes or jelly beans 
• Slow—acting carbohydrate such as muesli bars, fruit bars and biscuits 
• Doctors and hospital contact numbers 
• Emergency contact details, such as nearest relative. 

Hyperglycaemia 

Hyperglycaemia means high blood sugar level. This can develop over many hours or days.
It is possible for your blood sugar level to be high and you not even be aware of it. Many people do not experience the symptoms of hyperglycaemia until their blood sugar levels are extremely high. Although their blood contains too much sugar, they cannot tell unless they do a finger prick test.

Symptoms of Hyperglycaemia

• Feeling excessively thirsty 
• Frequently passing large volumes of urine 
• Feeling tired 
• Blurred vision 
• Infections (e.g. thrush, cystitis, wound infections) 
• Weight loss. 

Common Causes of Hyperglycaemia 

• Sickness 
• Infection 
• Stress 
• Too much carbohydrate food at once 
• Not enough insulin 
• Other tablets or medicines. 

Treatment of Hyperglycaemia

For Type 1 diabetes

• Contact your doctor or Credentialled Diabetes Educator for advice about increasing your dose of short acting insulin. You may also need extra doses of this insulin (e.g. 2-4 units every 2 hours). 
• Test your blood glucose levels frequently, as well as your urine for ketones every time you pass urine. 
• Drink extra water or low calorie fluids to keep up with fluid lost by passing more urine.

Contact your doctor or go to hospital if:

• Vomiting stops you from drinking and makes eating difficult 
• Blood glucose levels remain high 
• Moderate to large ketones are present in the urine. 

In type 1 diabetes, high blood glucose levels can progress to a serious condition called Ketoacidosis.