Managing blood sugar levels is challenging no matter how dedicated you are to your treatment plan, but having a reputable resource to reference for guidance can help relieve some of the stress. The American Diabetes Association (ADA), the premier organization for diabetes research, education, and advocacy, recently updated its Standards of Medical Care in Diabetes. One of the many topics addressed in this 2023 update is hypoglycemia, which can be life threatening and have a devastating impact on you and your loved ones.
What is hypoglycemia?
A healthy, normal fasting blood glucose level is 70 to 99 mg/dL (3.9 to 5.5 mmol/L). Hypoglycemia is when your blood sugar levels fall below your target range (i.e., less than 70 mg/dL).
The ADA defines hypoglycemia according to 3 levels:
Levels 1 and 2 are characterized by measurable glucose numbers:
- Level 1: <70 mg/dL (3.9 mmol/L), but >54 mg/dL (3.0 mmol/L)
- Level 2: <54 mg/dL (3.0 mmol/L)
Level 3 is characterized by altered mental and/or physical functioning.
It’s important to note that Level 3 hypoglycemia is not mutually exclusive with level 1 or level 2. The Steering Committee considered it essential to classify “altered mental and/or physical status requiring assistance” as its own category of hypoglycemia given that there are individuals who are able to function independently at a blood glucose level <54 mg/dL (3.0 mmol/L) and therefore should not be grouped into the same category as those individuals who require third-party assistance.
Am I at risk for hypoglycemia?
Whether you have type 1 or type 2 diabetes, being prepared for the possible onset of hypoglycemia is important, and it should not be taken for granted.
According to the ADA, there are many factors that impact blood glucose levels and can increase your risk of hypoglycemia. Here are some of the most common ones:
- Use of insulin or insulin secretagogues (oral diabetes pills that help your pancreas produce more insulin)
- Impaired kidney or liver function
- Have had diabetes for a long time
- Use multiple types of medications
- Have a history of severe hypoglycemia
- Exercise or physical activity
- Are older
How do I know if I am experiencing hypoglycemia?
People experience a range of physical and neurological symptoms, such as dizziness, shakiness, confusion, combative behavior, and trouble answering questions.
People can and do react differently to hypoglycemia. You and your healthcare provider should create a plan, if you haven’t already, that outlines what you should do and when you should do it.
Also, make sure to talk to your healthcare provider about any symptoms you experience between your visits. It’s critical for your healthcare provider to understand what you are experiencing so that they can make changes to your diabetes management plan and/or run any necessary tests to determine and rectify the issue.
What can I do to reduce my risk of hypoglycemia?
The risk cannot be eliminated for certain patients because there are so many factors that can impact it: stress, erratic meal schedules, intense exercise, certain medications, etc. Hypoglycemia can come on without warning and happen to anyone, even if you’ve had diabetes for a while and haven’t had an event to date. Understanding this can help you craft a plan with your healthcare provider to ensure your diabetes tool kit is fully equipped to manage a severe blood sugar low should it ever occur.
How do I treat hypoglycemia?
Hypoglycemia requires immediate attention and can be managed, depending on its severity, through either ingestion of glucose, a glucagon injection, or intravenous glucose solution.
Generally, patients are told to follow the 15-15 rule: have 15 grams of carbohydrates to raiseblood glucose, if you’re able to safely swallow, and check it again after 15 minutes. If it’s still below 70 mg/dL, have another 15 grams of carbs. Repeat these steps until your blood glucose is at least 70 mg/dL. Once your blood glucose is back within normal range, eat a snack or meal to make sure it doesn’t go low again.
There are times, however, when you or your loved one may be unable or unwilling to consume carbohydrates by mouth. The ADA states that this is when glucagon can be used.
Should I have a glucagon prescription?
In a word, yes! Equipping your diabetes toolkit with glucagon is always a wise idea, as hypoglycemia can be reversed through the administration of glucagon.
The ADA says glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia so that it is readily available should it ever be needed.
If you fall into any of the categories below and don’t have a prescription for ready-to-use glucagon, be sure to talk to your healthcare provider right away:
- Use of insulin or insulin secretagogues (oral diabetes pills that help your pancreas produce more insulin)
- Impaired kidney or liver function
- Frailty and older age
- Have had diabetes for a long time
- Use multiple types of medications
- Have a history of severe hypoglycemia
- Exercise or physical activity
- Are older
What guidelines should I follow for my type 2 diabetes?
The ADA guidelines are a great place to start. They provide guidelines for both type 1 and type 2 diabetes. As part of the 2023 update, they now recommend that healthcare providers consider a prescription of glucagon for type 2 patients who are beginning treatment on basal insulin. If you fall into that category, make sure to speak with your healthcare provider about prescribing glucagon for you.
What brand of glucagon should I have?
This is a great conversation to have with your healthcare provider. There are several options. The ADA states that ready-to-use preparations may be beneficial in terms of safety, efficacy, and simple administration.
Because emergencies demand quick action, having a tool that’s intuitive and simple to administer is critical. One option is Gvoke HypoPen®, a ready-to-use rescue pen that anyone can administer the moment it’s needed, similar to rescue medication for severe allergic reactions.