Every diabetes appointment should check for potential hypoglycemia, say US specialists

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Healthcare providers have been urged to do a hypoglycemia (low blood glucose) assessment every time they have an appointment with someone with diabetes. Debbie Hinnen, an advanced diabetes nurse and certified diabetes educator with the University of Colorado Health, and Diana Isaacs, an endocrine clinical pharmacy specialist with the Cleveland Clinic Diabetes Center, say there are several steps diabetes care and education specialists can take to help people avoid dangerously low blood glucose. Speaking during the annual meeting of the American Association of Diabetes Educators, Hinnen warned of the dangers of "pseudohypoglycemia" - when a person with diabetes experiences a rapid drop in glucose that is well above the hypoglycemic range. The physiologic responses to low blood glucose are vast, Hinnen said, so helping patients to assess hypo symptoms and patterns can help to prepare them for future incidences of low blood glucose. "It's frightening," she said. "Sometimes people will have a seizure, and that is what triggers the counterregulatory hormones. The care partners are terrified. We are probably the people that have some of the greatest impact in treating and hopefully preventing hypoglycemia." Isaacs noted that many people with diabetes underestimate their hypoglycemia, or do not connect their symptoms with episodes of very low blood glucose. "That is another reason why I really like people to check [blood glucose] when it is happening," Isaacs said. "I'm sure we have all had that patient who mistakes feeling very tired for a low blood sugar, and then treat it, and they were actually at 13.9 mmol/L (250 mg/dL)." Isaacs also highlighted the importance of preventing hypoglycemic episodes by reminding patients of the three types of medication that can cause low blood glucose: insulin, sulfonylureas and glinides "That is important as you are looking at someone's medication list and trying to identify causes and prevent hypoglycemia." The American Diabetes Association, working alongside the European Association for the Study of Diabetes, has issued new guidance dividing hypoglycemia into three levels, with level 3 the most severe and described as 'assistance required'. In cases such as these, the new guidelines state there is no specific glucose threshold. The person with diabetes will experience severe cognitive impairment and require third-party help to recover. Visit Diabetes Digital Media's Hypo Program for information on managing blood glucose levels, avoiding hypos and conversing with your doctor, nurse or dietitian about how they can help you to understand your hypo symptoms in greater detail.

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LooperCat

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They’d be doing more good long term by looking at persistent hyPERglycaemia tbh. That’s the one that does the real damage long term. A low might possibly harm you, but persistent high BG certainly will.
 

ickihun

Master
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Mine has done for years.
Hypos are the biggest threat to fatalities in diabetics! Scary, but true.
The disease's conditions need good management.
 

Lamont D

Oracle
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Type of diabetes
Reactive hypoglycemia
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I do not have diabetes
Testing insulin levels as well as glucose levels would prevent many prediabetic becoming type two!
 

LittleGreyCat

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Type of diabetes
Type 2
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Tablets (oral)
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Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
No information on how you would do this assessment, though.
Also no indication on types of diabetes or medication regimes.
Nor what defines a rapid drop in glucose.
I can see an insulin response via my Libre which is pretty rapid at times, but how would you know if you weren't continually monitoring?

Every diabetes appointment?
"Do you think you may have had a fake hypo with no symptoms?
At any time?
No, I don't know either but it is one of the mandatory questions!"
 

kitedoc

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Hyperglycaemia in TIDs can beget hypoglycaemia by overcorrection particularly on high carb diets.
US physicians have anecdotally said that they prefer to keep patients BSLs higher as they may be sued if a patient suffers from a hypo. The likelihood of being sued for the patient developing diabetes complications in the future is much less. \
Yesiree, watch for hypos you US docs 'cos they are going to happen with your typical dietary recommendations, insulin scripts and the BSL ranges you set.