What is hypoglycaemia?

In this article, we provide you with an overview of the side effects that the use of insulin can be associated with.

Hypoglycaemia

• What is hypoglycaemia and why does it happen?
• How do I know if I am having a hypo?
• How do I treat a hypo?
• Why did the hypo happen?
• How can I reduce my chance of having a hypo

What is hypoglycaemia?

Hypoglycaemia (sometimes called ‘hypo’) is a term used to describe low blood glucose levels, usually under 4 mmol/l.

Without diabetes, the body knows to stop releasing insulin from the pancreas if glucose levels are low.

Did you know? In type 1 diabetes, the level of injected insulin will not decrease in response to a low blood glucose level.

_{Figure: symptoms of hypoglycaemia}

How to know if you are having a hypo

Imagine a ‘potentially’ stressful situation, such as watching a scary film or sitting at the top of a rollercoaster, about to go down.

How would you feel?

How to treat a hypo

Why hypos happen

Medication-Related

• Insulin injection site problem (lipohypertrophy – lumpy site) can be associated with unpredictable insulin absorption which can build up subcutaneously and be released into the blood unpredictably.
• Use of insulin with quinine or excess alcohol consumption (alcohol delays the release of glucose from the liver).

Hypoglycaemia can occur as a consequence of reduced oral intake due to:

• Nausea and vomiting.
• Reduced appetite.
• Irregular, smaller, delayed or missed meals without reduction in insulin dose.
• Lack of access to usual between meal or pre-bedtime snacks.
• Having bowel disease can affect glucose absorption; e.g. coeliac disease.

Hypoglycaemia can occur as a consequence of increased glucose use due to:

• Being more physically active than expected to be.

Hypoglycaemia can occur as a result of relative insulin excess or increased insulin sensitivity due to:

• Administering fast-acting insulin without glucose based food.
• Incorrect insulin administered (e.g. fast insulin taken at bedtime instead of with a meal).
• Kidney impairment (reduced insulin clearance so works for longer than expected) or severe hepatic dysfunction (reduced hepatic glucose stores to respond to a falling blood glucose level).

It is very important after a hypo to think about why it happened and what can be done to reduce the risk of another.

How to reduce the chance of having a hypo

Sometimes after a hypo, the initial fast-acting glucose-containing snack is followed by a food item that contains slower acting glucose, such as a sandwich, cereal or a piece of fruit.

The blood glucose level should also be measured again to check it is rising. The insulin dose with the next planned meal may need reducing.

Medical advice should be sought if concerned or if recurrent unexpected episodes of hypoglycaemia occur. Try to take breaks for a glucose-based snack when physically busy and ensure that the insulin is administered carefully and correctly.

If you’d like to learn more about insulin, check out the full online course from the University of Southampton, below.