Managing Hypos

David Mendosa | Apr 21st 2015 Apr 10th 2017

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If you use insulin or sulfonylurea medicine, you may be at risk for hypo episodes. When this happens while driving or during sleep, the consequences can be especially serious.

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What is a hypo?

A hypo is the familiar name for a hypoglycemic episode, low blood sugar. It’s familiar, but certainly not friendly. When the blood sugar level goes below 70 mg/dl, you run the risk of going hypo. This can lead to a seizure or a coma, which can be life-threatening.

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What causes a hypo?

Too much insulin is the most typical cause of a hypo, especially when you don’t balance it with the right amount of food. Vigorous exercise or drinking too much alcohol can have the same effect. But other diabetes drugs, especially one of the sulfonylureas, can lead to a hypo. The sulfonylureas include glipizide, glyburide, and glimepiride as well as combo drugs. And many drugs for other conditions can also cause hypos.

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What should you do when someone goes into a hypo coma?

When someone loses consciousness, never give that person anything to eat or drink. Instead, give him or her a glucagon injection and call an ambulance to immediately get them to the nearest emergency room. A glucagon kit is emergency medicine used to treat severe hypoglycemia when someone has passed out or can’t take any form of sugar by mouth. It requires a doctor’s prescription.

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What devices can tell if you are hypo?

Continuous Glucose Monitors, like those made by Animas, Dexcom, or Medtronic Diabetes, will tell you if they detect in you are going hypo. The Diabetes Sentry works for some people who go hypo in their sleep.

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What about glucose tabs?

Nothing helps recovering from a hypo better than glucose tabs. They look like candy, but they sure don’t taste as good, which is precisely the point. They work quickly to bring blood sugar level back to normal without then sending the level too high, which isn’t good either.

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How should I take glucose tabs?

Take just a few glucose tabs – three or four of them depending on the brand. You want to get a total of 15 grams of glucose when you go low. Then you wait 15 minutes and if necessary take 15 more grams of glucose. This is the easily remembered “The Rule of 15.”

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What glucose choices do I have?

At least four brands of glucose tabs are available over the counter, and they come in many flavors. You can also buy gels and liquids, which are generally less user friendly. Tabs are more convenient because you can always carry them with you, so you can get to them quickly.

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Why should I use glucose tabs instead of candy or orange juice?

Some people who don’t understand the glycemic index still recommend candy or juice. Glucose tabs are essentially pure glucose, which is high glycemic - the sugar that our bodies use the fastest. Other sugars don’t work fast enough when we go low. Drinking orange juice or eating table sugar is common advice, but they are mostly slower-acting sugars. For several more reasons see “Why Glucose Tabs Are Better.”

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