Managing low blood sugar in diabetics
Most important goal in the management of diabetes mellitus is to prevent or slow down the progress of complications.
If diabetes has progressed to an advanced stage or complications start, insulin therapy is usually required. Any patient taking anti-diabetic agents, may experience hypoglycaemia in their lifetime.
Hypoglycaemia means low sugar level in blood circulation. Two of three vital criteria may confirm a patient in a state of hypoglycaemia. Symptoms of hypo-glycaemia arise when blood sugar reduced to 45 mg/dl (2.5 mmol/L) or below.
Any diabetic patient in a state of confusion, altered consciousness, coma, irritating or uncontrollable altered behaviour or mood-somnolence to violence may be considered as hypoglycaemia.
Hypoglycemia may be mild, moderate where patient can manage himself/herself. In severe hypoglycaemia, patients may need some assistance to recover.
Most important causes are mismatched anti-diabetic agents and life-style components. Overdose of insulin are very common. Failure to maintain discipline in taking meals is also a cause of hypoglycaemia. Lack of patient's education and motivations are considered as avoidable pitfall of diabetic management programme.
Preventing a hypo-glycaemic coma
Most patients should be taught to prevent hypoglycaemia by following a few simple rules. These include: Following a set meal plan: eating snacks and meals at regular and schedule times and amount throughout the day. Keeping an eye on their blood sugar level at home: Frequent blood sugar tests can tell the patient whether they are keeping their glucose levels in their target range. They can also alert them regarding their most dangerous hypoglycaemic time points throughout the day. Frequent blood sugar level monitoring is especially important when a patient's blood glucose is likely to be more variable than normal (i.e. when they have an infection, trauma, excessive stress or during pregnancy). Assessing when to seek medical attention: Patients should be told that if they experience any unusual signs or symptoms such as state of altered mood and behaviour and consciousness or confusion in sick conditions like anorexia, vomiting or enteritis with low blood sugars, they should seek medical attention immediately. Preventing further hypoglycemia: After recovery from hypoglycaemia, we should take the proper history and investigations to know the exact cause. Accordingly education and readjustment of overall management including anti-diabetic drugs. Using modern insulins to control blood glucose
Modern insulins provide flexibility in dosing in relation to meals, improved glycaemic control without risk of hypoglycaemia. These are not possible by previous conventional human insulins. Approaching good glycemic control can be achieved by previous insulin but with the expense of hypoglycemia. Newer insulins have great advantage in this regard. They are also associated with less weight gain than traditional insulins and offer easy, painless injections with a convenient device. Rigid lifestyle in meals and physical activities are overthrown by flexible life styles with these insulin analogues. Modern insulins are manufactured by modifying the chemical structure of human insulin to produce insulins that are better at mimicking the insulins produced naturally by the body. Modern strategy is to replace insulin exactly what normally required. There are three main types of modern insulin: Long-acting (basal) modern insulins: The long-acting modern insulins help to reduce incidence of hypoglycaemia especially at night. As an initiation strategy for insulin in type-2 diabetes, once-daily basal insulin also offers potential advantages of simplicity and acceptability over a twice-daily starting regimen. Rapid-acting modern insulins: The rapid-acting modern insulins synchronize insulin delivery and reduce post meal blood glucose greatly. It acts rapidly and for a shorter duration. Dual-acting (biphasic) modern insulins: It reduces the risk of major and nocturnal hypoglycaemic events compared to previous biphasic human insulin. It has rapid onset of action that means a convenient approach to mealtime dosing and a simple way to keep pace with patients' changing needs. Hypoglycaemia can be avoided by following several simple steps described above. Modern insulins can alleviate the risk of hypoglycaemia as part of a treatment regimen, which is tailored to fit the needs of the patient's hyperglycemia. The writer is an Associate Professor of Department of Endocrinology, BIRDEM
Most patients should be taught to prevent hypoglycaemia by following a few simple rules. These include: Following a set meal plan: eating snacks and meals at regular and schedule times and amount throughout the day. Keeping an eye on their blood sugar level at home: Frequent blood sugar tests can tell the patient whether they are keeping their glucose levels in their target range. They can also alert them regarding their most dangerous hypoglycaemic time points throughout the day. Frequent blood sugar level monitoring is especially important when a patient's blood glucose is likely to be more variable than normal (i.e. when they have an infection, trauma, excessive stress or during pregnancy). Assessing when to seek medical attention: Patients should be told that if they experience any unusual signs or symptoms such as state of altered mood and behaviour and consciousness or confusion in sick conditions like anorexia, vomiting or enteritis with low blood sugars, they should seek medical attention immediately. Preventing further hypoglycemia: After recovery from hypoglycaemia, we should take the proper history and investigations to know the exact cause. Accordingly education and readjustment of overall management including anti-diabetic drugs. Using modern insulins to control blood glucose
Modern insulins provide flexibility in dosing in relation to meals, improved glycaemic control without risk of hypoglycaemia. These are not possible by previous conventional human insulins. Approaching good glycemic control can be achieved by previous insulin but with the expense of hypoglycemia. Newer insulins have great advantage in this regard. They are also associated with less weight gain than traditional insulins and offer easy, painless injections with a convenient device. Rigid lifestyle in meals and physical activities are overthrown by flexible life styles with these insulin analogues. Modern insulins are manufactured by modifying the chemical structure of human insulin to produce insulins that are better at mimicking the insulins produced naturally by the body. Modern strategy is to replace insulin exactly what normally required. There are three main types of modern insulin: Long-acting (basal) modern insulins: The long-acting modern insulins help to reduce incidence of hypoglycaemia especially at night. As an initiation strategy for insulin in type-2 diabetes, once-daily basal insulin also offers potential advantages of simplicity and acceptability over a twice-daily starting regimen. Rapid-acting modern insulins: The rapid-acting modern insulins synchronize insulin delivery and reduce post meal blood glucose greatly. It acts rapidly and for a shorter duration. Dual-acting (biphasic) modern insulins: It reduces the risk of major and nocturnal hypoglycaemic events compared to previous biphasic human insulin. It has rapid onset of action that means a convenient approach to mealtime dosing and a simple way to keep pace with patients' changing needs. Hypoglycaemia can be avoided by following several simple steps described above. Modern insulins can alleviate the risk of hypoglycaemia as part of a treatment regimen, which is tailored to fit the needs of the patient's hyperglycemia. The writer is an Associate Professor of Department of Endocrinology, BIRDEM
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