Frequent Hypoglycemia?

Self-Care at Home

A glucose monitor is available for people to check their own blood sugars in the comfort and privacy of their own home.

Usually this entails poking yourself in the finger to get a drop of blood.

The blood is transferred to a special strip of paper that is then placed into the glucose meter, or glucometer, which analyzes the blood. This gives a numeric reading that corresponds to the blood glucose.

If you find someone who has the symptoms of hypoglycemia, look for clues that explain the symptoms.

If the person still has his or her insulin and a recently disposed needle, you can presume that a change in their level of consciousness may be due to hypoglycemia (they have accidentally taken too much insulin).

If the person is awake enough to drink something, you can give them a cup of orange juice with sugar. If hypoglycemia was the cause of their confusion, they will improve after a few minutes.

For at home treatment.

Glucagon is a hormone produced by the pancreas that, along with insulin, controls the level of glucose in the blood. Glucagon has the opposite effect of insulin, that is, it increases the glucose level in blood. Glucagon, the drug, is a synthetic (man-made) version of human glucagon and is manufactured by genetic engineering using the bacteria Escherichia coli. Glucagon is used to increase the blood glucose level in severe hypoglycemia (low blood glucose). Glucagon is a glucose-elevating drug. Other glucose-elevating drugs are glucose itself and diazoxide (Proglycem). In diabetic patients, low blood glucose (hypoglycemia) may occur from an unintended excess of injected insulin or oral glucose-lowering medication, such as a sulfonylurea like glipizide (Glucotrol), that are being used to treat the diabetes. Hypoglycemia also may occur as a result of insufficient caloric intake or sudden, excessive physical exertion. Symptoms of hypoglycemia include nervousness, cool skin, headache, confusion, convulsions or coma. In any hypoglycemic situation, efforts should be made to raise the glucose level in the blood. Glucagon raises blood glucose levels by preventing the liver from storing glucose, increasing glucose formation in the liver from dietary proteins and fats, and increasing the release of glucose from the liver into blood. Glucagon transiently paralyzes the muscles of the intestines and occasionally is used during testing that requires the intestines to be flaccid, for example, endoscopic retrograde cholangiopancreatography and barium enema.

GENERIC: no

PRESCRIPTION: yes

PREPARATIONS: Glucagon is available as an emergency kit. The kit contains freeze-dried glucagon as a powder for injection with 1 mg (1 unit) of drug and a 1 ml syringe of glycerin. The glycerin is mixed with the glucagon powder prior to injection.

STORAGE: The glucagon emergency kit should be stored at room temperature, 20-25°C (68-77°F) prior to mixing with glycerin. Once mixed with glycerin, the prepared drug should be used immediately.

PRESCRIBED FOR: Glucagon is used to treat severe hypoglycemia in diabetic patients.

DOSING: Adults and children weighing 44 pounds or more should receive 1mg (1 unit) of glucagon either subcutaneously or intramuscularly. Children weighing less than 44 pounds should receive 0.5mg (0.5 units) of glucagon or an amount equal to 20-30 micrograms per kilogram or 0.009-0.014 milligrams per pound. Before injecting, the mixture should appear clear and free of any floating particles. It should not be used if it is discolored. Once glucagon is administered, blood glucose measurements should be obtained until the patient is no longer experiencing hypoglycemic symptoms. A physician should be notified immediately after a hypoglycemic episode to consider a change in the dose of drug being used to treat the diabetes in order to prevent further episodes of hypoglycemia.

DRUG INTERACTIONS: Glucagon may increase the anticoagulant effect of warfarin (Coumadin) causing an increase in the slow clotting of blood and a greater risk of developing an episode of bleeding. Careful monitoring is necessary when the two drugs are used together.

PREGNANCY: There are no studies of the safety of glucagons in pregnant women.

NURSING MOTHERS: It is not known if glucagon is secreted in breast milk.

SIDE EFFECTS: Nausea and vomiting may occur occasionally after injection of glucagon, but this may be a symptom of the hypoglycemia for which glucagons is being given. Rare allergic-type reactions may occur with glucagon including itching, respiratory distress or low blood pressure. Glucagon should not be administered to hypoglycemic patients who are also experiencing starvation, adrenal insufficiency or are suffering from chronic hypoglycemia. These medical conditions may be associated with an inability of the liver to produce glucose sufficiently in response to glucagon. For these patients, oral glucose is more effective if the patient is conscious. If the patient is not conscious, intravenous glucose should be given.

Also you did not say how much metformin he was taking. Perhaps lowering dose of metformin or Insulin might be the keys. You will have to work this out

Sounds like your husband needs to be taking a slow acting insulin once every 24 or 12 hours, and a fast acting insulin with each meal that contains carbohydrates (carbs).

Get him to discuss this with a diabetic consultant or diabetes specialist nurse. Also get him to discuss with them the "carb counting" diet, where the amount of fast acting insulin is balanced against the amount of carbs in the meal.

I take Lantus (slow acting) at 11 am and 11 pm - most people take it once a day, but twice a day works better for me.

I take Humalog (fast acting) with each carb containing meal.

This also has the advantage that if I test just before a meal and the result is too high or too low I can adjust the dose up or down to compensate. Having done this, if I then test a couple of hours later I almost always get a result in the "correct" range. Make sure he know by how much a unit of insulin will lower sugar levels - in the UK its 2-3 on the test result but as different measurements are used in USA this will also be different. Also make sure he know how much one portion of carbs will raise sugar levels, again here it is by 2-3 but will also be different in USA for above reason.

I have been on this regime for nearly two years, and it worked well at improving my sugar levels from the start. Although the proportion of insulin to amount of carbs has had to be tweaked a few times, and sometimes the mental maths defeats me so I need a calculator in the bathroom with me (lol) its been well worth the effort.

Can't comment on his sugar readings, I am in the UK and we use a totally different set of measurements here (normal is 4.0 - 10.00, hypo is below 3.0) although confusingly his A1c level corresponds to my HbA1c test.

I do not understand why the doctor gave Metformin. But I have several episodes of hypglycemia. My doctor suggested that I take my night time insulin shots later at night to forgo getting hypoglycemia while I am sleeping. She also lowered my units of insulin. By all means get a machine to test the blood.

I'm confused your husband is a type 1 diabetic but yet his doctor gave him Metformin, which is for patients with type 2 diabetics like myself!!!!! hmmm i would ask the doc why he would give a patient a drug for insulin resistant patients. i do see why you feel that way about the low sugar lvls because my lvl dropped to 32 yesterday and its very scary. yes high lvls of sugar like 300s to 400s can cause damage in long run but when lvls are low like mine where your brain starves itself instantly. i had a seizure yesterday when home with the kids and wife at work. i have also have had my sugar lvls over 1200 and still alive, with sugar lvls over 500s for months straight and damaged caused where cranial nerve IV which is a eye nerve. so please tell your husband that even tho his lvls get high its way better than being low.. not saying that high lvls are good but just better... also note that with my levemir pen i used 25 units in the morning when my lvls where over 400 and 6 units ar night,they kept them around high 100s , i also take amaryl 4mg in the morning and at night. to keep my lvls in safe range .just please be very carfull with low lvls. He can comatose and possibly die with lvls that low.... one more thing i no longer take humalog scince it is a fast acting insuling and levimer is a slow acting which usually last 12 hours

1

Try to balance amount of meds taken with food eaten.