Contributor: Sneha Baxi Srivastava, PharmD, BCACP, ADCES, DipACLM
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How many of you can relate to this? You wake up, and you’re ready to take on the day. You have got your calendar, thought about your to-do’s, and coordinated all aspects of your life – whether it’s work, working out, family, pets, and all the other amazing (or not so amazing), nonstop aspects of your life. Managing diabetes is probably not far from your mind either – whether it’s checking blood sugars, meal planning, taking meds, or all the other things related to giving yourself the best care possible. And then things get busy – an unexpected meeting, a fun chat with a friend, a project taking a little longer than expected – and the next thing you know, you start feeling a little off – maybe it’s a headache or shakiness or sweating or feeling irritable. And you realize, oh, how long has it been since I’ve eaten? Or maybe the scenario is that you’re trying out a new workout class or enjoying this beautiful summer weather by being more active, and those same symptoms show up. Or maybe it’s nothing you can pinpoint.
Whenever I hear my patients talk about the symptoms of low blood sugar, it's usually tied with being scared or feeling discomfort and wanting to make sure it doesn't happen again. Unfortunately, hypoglycemia is a side effect of some of the medications used to treat diabetes – and that makes sense considering the medicines are used to lower blood glucose. Sometimes they can lower your blood sugar too much or too quickly. Fortunately, many newer medications are less likely to cause hypoglycemia. But some, such as insulin and sulfonylureas (this class includes glipizide, glyburide, and glimepiride), can cause low blood sugar. Since these medications are often necessary, finding ways to prevent and treat hypoglycemia is especially important.
Here are my Top 5 Recommendations!
- Know what low blood sugar looks and feels like for you: There is a long list of symptoms seen in mild hypoglycemia, including hunger, sweating, nausea, headache, and blurry vision. As blood sugars continue to drop, symptoms can progress to confusion, changes in behavior, irregular heartbeat, seizures, and loss of consciousness. Sometimes you may only have one symptom, sometimes you may have multiple symptoms, and there are times when you may not have any symptoms. Being aware of exactly what your symptoms might be will allow you to treat low blood sugar right away! If you’re comfortable with it, let the people who know you well look out for you too – sometimes, they may notice before you do.
- Know how to treat low blood sugar:
- If you can, check your blood sugar, and if it’s less than 70, it’s time to treat with 15 grams of fast-acting carbohydrates to quickly bring your blood sugar up! This can be 1/2 cup of orange juice or regular soda, 1 tablespoon of sugar, or 4 glucose tablets. If you are often on the move, keeping glucose tablets in all sorts of places may be a good idea – in your bags, car, desk, purse, etc. Hopefully, you won’t need to use them, but they will be readily accessible if you do. Refer to this article on the 15-15 rule for the treatment of hypoglycemia.
- Ask your doctor if a glucagon prescription is right for you. Glucagon may be a good idea if you experience very low blood sugars, don’t have any symptoms, are taking multiple medications that can cause low blood sugar, and have someone who would be able to give it to you. Glucagon is used when your blood sugar drops so low that you need help to quickly bring up your sugar level.
- Know your goal blood sugar levels and how/when to check your blood sugar: Depending on the type of diabetes you have, the medications you are taking, and other circumstances like being ill or needing to adjust your treatment plan, you may need to check your blood sugar anywhere from one to several times a day. A continuous glucose monitor (CGM) can help monitor your blood sugar day and night. Using a CGM may be a good idea to get a picture of when low blood sugars occur and what might be causing them.
- Know what affects your blood sugar levels:
- Nutrition: What you eat can play an important role in your blood sugar levels. Working with a dietitian can be helpful to see the patterns of what types of food affect your blood sugar and how to plan your meals. Skipping meals can be a common reason for low blood sugar, and it’s understandable how this can happen. Try keeping easy snacks around that are a good mix of carbohydrates, protein, and fat. Alongside the glucose tablets, keep a protein bar, a nut mix, an apple with peanut butter, or your favorite foods as a go-to when your planned meal does not happen.
- Physical Activity: Exercise can affect your blood sugar levels. It is excellent for your mind, body, soul, and diabetes, but it’s important to know how exercise affects your blood sugar levels and plan accordingly. For lengthier or more high-intensity workouts, you may need a snack in the middle, or you may need to eat soon after working out to prevent your blood sugar from dropping.
- Alcohol: This can affect blood sugar both ways – it can lower your blood sugar or cause it to go higher because of the sugary mixers that may be used. In general, if you are going to drink, limiting it to no more than one drink is recommended, and make sure it’s not on an empty stomach.
- Medications: As mentioned, sometimes the medications meant to lower your blood sugar to your goal levels may cause the sugar to go too low. This may happen in combination with the reasons above, or sometimes your medication needs may change. Working closely with your health care provider to ensure you get the proper medications at the right doses is important.
- Know your patterns: You know your body the best! Check your blood sugar if you are feeling “off” or different than you typically do. It’s an easy first step to check to see if it’s low blood sugar that is causing you to feel this way. And if it is, then try to write down what may have contributed to the low blood sugar, so you know the patterns. The more you know and understand how your body responds to low blood sugar and what causes low blood sugar for you, the better you can talk about it with your healthcare provider and create a plan to prevent low blood sugar from occurring.
Sneha Baxi Srivastava, PharmD, BCACP, ADCES, DipACLM, is passionate about empowering people with knowledge and skills to prevent and treat chronic conditions, especially diabetes, and about lifelong learning. She is an Associate Professor and Associate Director of Skills Education at Rosalind Franklin University of Medicine and Science College of Pharmacy and a Clinical Pharmacist at Lake County Health Department. Dr. Srivastava earned her Doctor of Pharmacy degree at Rutgers University Ernest Mario School of Pharmacy and completed two years of postgraduate training in pharmacy practice and primary care at the University of Illinois College of Pharmacy. Dr. Srivastava is board certified in ambulatory care and lifestyle medicine and is a certified diabetes care and education specialist.