London Medical Diabetes 

London Diabetes works to ensure that each individual patient controls their diabetes rather than letting diabetes control their lives through providing accessible and high quality health care.

We strive to provide the physical and psychological health of patients through a team approach to diabetes, lipid disorders, heart disease prevention, obesity, endocrinology and women's health by the promotion of education and care. Our values are confidentiality, the endorsement of wellbeing and the building of relationships amongst health professionals, patients and the medical community through fostering loyalty and interest within the Clinic and one another.



Laila King - Her Tip for this month

Hypoglycaemia (Low Blood Glucose)  

What is hypoglycaemia?

Hypoglycaemia or a ‘hypo’ happens when your blood glucose levels go too low - below 4mmol/l.

Hypoglycaemia occurs in those treated with insulin or diabetes tablets that help your body make more insulin like gliclazide, glimepride, repaglinide or nateglinide. Hypoglycaemia does not occur when your diabetes treatment does not involve drugs. Metformin (Glucophage and Glucophage SR) tablets or Byetta (Exenatide) on their own or together do not usually lower the level to hypoglycaemia. A hypo occurs quickly and requires immediate treatment.

Causes of Hypoglycaemia: 

  • Missed or delayed meals when taking premixed insulins (NovoMix 30, Humalog Mix 25 or 50)
  • Increased physically activity e.g. housework, gardening, running to catch a bus, or sport
  • Consumed alcohol on an empty stomach
  • Hot, humid weather
  • Hot bath or shower soon after a rapid-acting insulin injection – making insulin absorb more quickly
  • Too big a dose of insulin or insulin-secreting tablets (see above)
  • Changed your insulin injection site from a lumpy (lipohypertrophy) to a new site skin
 The symptoms of hypos vary from person to person and some people have no warnings. The longer the hypo is left untreated the more severe the symptoms. It is important to take action at the first warning symptoms – otherwise you risk losing control of your actions and also the awareness of these warnings. You will usually be able to recognize your own warning signs, which may include one or more of the following symptoms:   

 

You Might Notice Others Might Notice
Shaky or dizzy Mood change
SweatyIrritability or aggression
HungryIrrational or unusual behaviour
Anxious or bad-tempered Confusion and drowsiness
Palpitations (pounding heart beat)Lack of concentration
Tingling around the lipsLack of co-ordination and clumsiness
Headache or Migraine Pale skin
Double visionSlurred speech

  How to Treat Hypoglycaemia: 

  • Stop what you are doing and act quickly
  • Take quick-acting glucose – approximately 15grams:  100 ml (small glassful) of Lucozade, Coca Cola, or Lemonade (NOT DIET VERSION)- 3-4 glucose tablets (GlucoTabs4 or Dextrosol) - 5 soft sweets, such as jelly beans or marshmallows
  • DO NOT TAKE CHOCOLATE OR BISCUITS AS TREATMENT: their fat content slows down the glucose absorption which you need instantly!
  • Recheck your blood glucose level in 15 minutes
    • If the blood glucose is above 4mmol/l, take a slow acting carbohydrate like a biscuit, sandwich, glass of milk, piece of fruit, or your next meal if due to prevent your glucose from falling again
    • If you blood glucose is still below 4mmol/l, take another 15g of quick-acting glucose. 

 Treating a severe hypo (BG < 2mmol/L)

  • If you do not treat your symptoms quickly, you may need help from a friend, relative, or colleague.  
  • They may have to give you glucose in liquid form, such as: HypoFit syrup (14g in a foil sachet) or GlucoGel formerly known as Hypostop (1 tube = 10g, can be rubbed in to the side of your mouth or your gums provided you are fully conscious), a small glass of Ribena, Lucozade, or any sweet fizzy drink (not diet).  
  • If you are unconscious or unable to swallow properly, nothing should be out into your mouth as this may causes you to choke and the fluid could enter your lungs causing aspiration pneumonia, which can be life-threatening.
  • If you are unconscious or very confused and you cannot swallow, an injection of Glucogen or Glucagen (which is the hormone glucagon) can be administered. Glucagon is a hormone that is made naturally in your pancreas, which raises your blood glucose within 5-15 minutes by releasing stored glucose from your liver. Glucagon may cause you to feel sick afterwards so avoid solid foods for at least an hour. Instead, sip small amounts of sugary fluids until you are ready to eat a carbohydrate snack. 
  • Ensure your friends and/or family know how to administer Glucogen in case of such an emergency. This would save you from having to be taken to an A&E Department.

Remember to:

  • Let your friends, relatives and colleagues know you have diabetes and how they can help you if you have a hypo.
  • Always carry some form of glucose.
  • Always carry an identity card or wear an ID pendant or bracelet (MedicAlert or MediTag) informing others that you have diabetes.
  • Inform your diabetes team of unexplained or frequent hypos.
  • Try to identify the cause.
  • Remember to adjust your medication to account for exercise – if you know how and when.
  • Review your treatment with the diabetes team.
  • If drinking alcohol, eat carbohydrate food.
  • Remember: every low is followed by a high! Your blood glucose will rise because [a] your body’s counter-regulatory hormones – adrenaline, growth hormone, and cortisol – will make a lot of glucose come out of your liver, and [b] you tend to wolf down as much as you can once alerted by your hypo warning symptoms.

Driving and Hypoglycaemia

As some of the medications used to treat diabetes (insulin, sulphonylureas, repaglinide, and nateglinide) can cause hypos, and, as long-term complications of diabetes (vision problems, neuropathy in feet and hands) also affect fitness to drive, it is natural that the Department of Vehicles and Licensing Agency (DVLA) has set out regulations which people with diabetes need to abide by. Everyone who needs to start on insulin treatment will only be granted a provisional1-year, 2-year, or 3-year license. This can be renewed without any cost but requires a medical statement indicating the level of fitness to drive.  However, there are groups of vehicles that people with diabetes and treated with insulin cannot drive or operate:

  •  Buses
  •  Trains
  •  Planes
  •  Fire engines or police cars
  •  Heavy vehicles or equipment

Special rules for safe driving include:

  • Check your blood glucose immediately before driving.
  • Keep your glucose meter and fast-acting carbohydrate foods/drinks in the car.
  • If you feel you glucose levels going low, pull over, remove the ignition key, and test your glucose level.  Get out of your car, as otherwise you will be considered to still be in charge of your vehicle.  Treat your hypo, retest again in 15 minutes’ time.
  • If you have had a hypo (<4mmol/L), you must stay stationary a minimum of 45 minutes after treating your hypo before you can drive away.
  • Drive safe and enjoy your travels.



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