Avoiding and treating hypos – low blood glucose

Avoiding and treating hypos Jelly Babies

Avoiding and treating hypos – low blood glucose (hypoglycemia)

It’s a question often asked in groups, what do you use to treat hypos? Here are some thoughts on avoiding and treating low blood glucose. Firstly I thought it would be a good idea to mention ways to try and limit hypos.

Think about:

Eating extra carbohydrate if you are more active than normal.

Frequently checking basals and bolus settings.  Reduce basals when required.

Don’t drink alcohol on an empty stomach and best not to drink too much!

The obvious way to cut down on hypos is frequent blood glucose testing, fingers can get very sore so take care to use a gentle pricker, if it’s for your child test some yourself first to find the most gentle, as not all prickers are created equally! For someone with type 1 diabetes trying to manage control as well as possible hypos will never be fully preventable or unavoidable.

The good news is technology has come a long way in the last few years and Continuous Glucose Monitoring (CGM) is improving greatly.  Although this won’t remove the need for finger prick testing completely, it may reduce it. There are various options available now, the most up-to-date device is the 640G system with SmartGuard, low glucose prediction and insulin suspend. Many people report a reduction of hypos, one study demonstrates over an 80% reduction. Patients frequently talk of improved quality of life, feeling of wellbeing, and better quality sleep. It is no longer like driving in the dark! The more advanced 670G should be available later this year (2018)

The bad news, is although CGM is becoming more common around the world it is not widely available on the NHS, and even less so in Scotland than England. It is certainly worth trying CGM if you can. Anyone who is unable to obtain funding should ensure the clinic is aware that it is something they would like, and contacting your MSP or elected representatives to make them aware of the lack of availability and advantages of CGM is a must for awareness.

The Freestyle Libre has been rolled out throughout much of Scotland now, it can be helpful in learning more about how carbs and exercise affect you, it can be a great education tool, however it is not the same as CGM.

Treating hypoglycaemia:

Treatment is usually 15 grams of fast acting carbohydrate, and sometimes followed by 10 grams of longer acting carbs (more so on injections than a pump)

Wait 10-15 minutes and check blood glucose has come up to normal range, if not, re-treat. Try and wait 10 minutes before re-testing to limit over-treatment swinging blood glucose up too high.

If, after 3 treatment cycles you are still not maintaining normal blood glucose, call your team or emergency contact for advice.

Please note, for a younger child or mild hypo, 10 grams of fast acting glucose may be sufficient.

After a gastro/tummy bug it can take the body a couple of weeks to fully recover and during this time there can be a considerable affect on absorption and we are more prone to hypos and may need much larger treatments too. Insulin sometimes also needs to be reduced until fully recovered.

People respond differently to treatments, and often it depends on what caused the low too, and if there is still insulin or food onboard.  So although these are commonly used treatments in the UK, you do need to find the best one for you. Liquid often works faster. It is often easier to drink through a straw to treat a bad hypo, or for a child during the night.  As many drinks now have reduced sugar content – always check the labels.

jellybeans diabetes hypo treatmentHere are some examples of more common treatments used:

Lucozade original –  170ml = 15 grams of carbohydrate. Always check the carbs on the bottle, as some flavours, and also the energy range are lower in carbs than original lucozade. *** Please read update below regarding changes made from April 2017

Full sugar drinks – mini cans (mixer cans) are a good size of hypo treatment. Always check carbs in drinks as so many manufactures are now making reduced sugar alternatives.

From January 2018 IRN-BRU will contain approximately 50% less sugar. The sugar content per 100ml will reduce from 10.3g to 4.7g. For a time old and new products may be on the shelf together so remember to check the label.

Sweets for example, 4 Jelly babies, 16 grams haribo, fruit pastels, skittles etc. Marshmallows, fluff, and candy floss are other examples for mild hypos.

Juice, e.g. apple, orange, grape, or Capri sun, Ribena

3-4 Gluco Tabs, 5-6 Dextro tablets (a friend uses 2 dextro tabs if her 5 year old is between 3.6-3.9, 3 for a between 2.5-3.5 and 4 tabs for under 2.5)

Glucojuice (60ml bottles – sometimes available on prescription – dependant on GP)

Glucogel – prescribed by your GP or it can be purchased over the counter

GSF-Syrup (previously Hypofit sachets) in orange, mint or tropical – sometimes available on prescription – dependant on GP

Pots of fruit in syrup – good for toddlers and younger children

Maxijul – mixed with water – good for babies – available in prescription

juice hypo treatment

Hypoglycaemia is a medical emergency, treatment should never be delayed.

While the focus is on avoiding and treating hypos, you should always have Glucagon, (orange box injection) available in case of a severe hypo when nothing can be given by mouth due to risk of choking and that you are unable to treat yourself.

Glucagon raises the blood glucose level by releasing glucose that is stored in the liver. It may not work if the patient has had recent hypoglycemia or been drinking alcohol.  There is no danger of overdose with glucagon, the most common complication is nausea.  It is designed to be administered by anyone, however it is sensible to familiarise friends and family members with the injection, you can practise on an orange with expired kits.

Glucagon can be injected into the arm, thigh or buttocks.  Always call emergency services too.

*** Lucozade changes from April 2017 after low sugar campaigns

Lucozade Energy Original:

* It was 17.2g/100ml – a mix of glucose and glucose-fructose syrup

* It will be changed to 9.2g/100ml and will be formulated as glucose and glucose polymer syrup (this reduces the sugar by 50%)

* Added Acesulfame-K & Aspartame – not suitable for anyone with PKU

The date of change is likely to be April 2017

* There will be very little discernible difference in packing other than the nutritional contents on the back and the kcal on the front, old and new bottles will be on the shelf at the same time during change-over.

* 10grams of carbs will be equal to 110ml

* 15 grams will be equal to 170ml

Lucozade Energy Orange:

* It was 15.2g/100ml – a mix of Glucose and glucose-fructose syrup (this parts counts as the sugar on the labelling)

* It will be changed to 8.4g/100ml and will be formulated as glucose and glucose syrup (this reduces the labelled sugar by 50%)

* Added Acesulfame-K & Aspartame – not suitable for anyone with PKU

The date of change is likely to be April 2017

* There will be very little discernible difference in packing other than the nutritional contents on the back and the kcal on the front

Caribbean Crush

* It was 9.6/100ml – a mix of Glucose and glucose-fructose syrup (this parts counts as the sugar on the labelling)

* It will be changed to approx. 4.5g/100ml and will be formulated as glucose and glucose syrup (this reduces the labelled sugar by 50%)

* Added sweeteners but unknown at this time

The date of change is likely to be July 2017

* There will be very little discernible difference in packing other than the nutritional contents on the back and the kcal on the front

Ribena Full Strength Cordial:

* It was 53g/100ml – a mix of Glucose and glucose-fructose syrup (this parts counts as the sugar on the labelling)

* It will be changed to approx. 22g/100ml and will be formulated as glucose and glucose syrup (this reduces the labelled sugar by 50%)

* Added sweeteners but unknown at this time

The date of change is likely to be October 

* There will be very little discernible difference in packing other than the nutritional contents on the back and the kcal on the front

Orangina

* Reducing sugar during 2017

Chocolate

Chocolate is not ideal to treat hypos due to the fat content, however, please be aware Nestle who make Kit Kats, Aeros, Yorkie etc have said their sugar content will be reduced by 10% by next year!

The sugar will be replaced with higher quantities of existing ingredients or other, non-artificial ingredients, and the amount of calories will be limited.

It means about 7,500 tonnes less sugar will be used to make the confectioner’s products by 2018.

Nestle said it could help to have a significant impact on public health.

From January 2018 IRN-BRU will contain approximately 50% less sugar. The sugar content per 100ml will reduce from 10.3g to 4.7g. For a time old and new products may be on the shelf together so remember to check the label.