I have always felt that people with diabetes have to work a little harder each day to preserve their good health while being forced to walk a narrow path between 2 devils . The Devils of high and the Devils of low blood sugars .The devil of high high glucose comes with known long term risk and the devil of low glucose levels , on the other side of the path , comes with immediate often severe consequences. This is the beginning of a 4 part discussion of hypoglycemia. Today, I will lay the ground work with a few definitions and a little physiology .
The American Diabetes Association's discussion of hypoglycemia. Position statement 2012
"Hypoglycemia is the leading limiting factor in the glycemic management of type 1 and type 2 diabetes.
Mild hypoglycemia - plasma glucose below 70 mg/dl
Severe hypoglycemia -
( where the individual requires the assistance of another person and cannot be treated with oral
carbohydrate due to confusion or unconsciousness) should be treated using emergency glucagon kits)
(In type 1 diabetes and severely insulin deficient type 2 )
These people of lost their awareness of the early warning signals of hypoglycemia
Joslin's Diabetes Mellitus thirteenth edition has a good chart on page 495 . It matches our bodies response and symptoms to decreasing blood glucose levels. I have adjusted the medical terminology slightly to meet the needs of this discussion.
Counter regulatory hormones .
These are hormones our body releases in an attempt to correct a falling blood glucose level. Some of these hormones produce the early warning symptoms that we associate with hypoglycemia.
Glucose level Increase counter regulatory hormone Effects and symptoms
< 70 mg/dl increase glucagon increase in glucose from liver
< 70 mg/d/ increase Epinephrine increase glucose, feeling of
anxiety, sweating , shaking,
< 65 mg/dl increase cortisol and growth hormone increase glucose levels
< 60 mg/dl neurological symptoms
irritability , sleepy
< 40 lethargy , Coma
Take home message
Epinephrine produces the early warning symptoms of a dropping blood sugar. The loss of the
epinephrine response to a falling glucose results in " hypoglycemia unawareness " and the
progression to the more severe stages of hypoglycemia.
Have Fun , Be Smart and avoid hypoglycemia
Does lowering A1c result in increased risk of hypoglycemia in type 1 and type 2 diabetes ?
Does age effect a persons awareness of hypoglycemia ?
74% of unrecognized hypoglycemia occurs at night . True or false