Emergencies
If you have been around someone and know them well, any sign that they are confused, displaying strange or bizarre behaviour, are shaking, having fits( seizures) or not walking up( coma), chances are you could be dealing with hypoglycaemia. Some people might start with complaining of hunger, sweating, heart beating fast, being weak, feeling anxious, faint or complaining of headache. If these symptoms started after they missed a meal or haven ' t eaten, you should be worried. In an ideal situation, you should check their sugar with a glucometer( sugarreading portable machine) then take action.
Mild Hypoglycaemia
The patient is still awake, aware of what they are feeling, symptoms( hunger, headache, sweating etc.). They should take a sugary drink immediately( 2 to 4 teaspoons of sugar with water). This should be followed by bread and milk. These are what we call slowly digestible foods and will maintain the glucose within normal ranges.
Severe Hypoglycaemia
In this case, another person is needed to assist with immediate treatment. The above measures can be tried starting, with a sugary drink. If you have a relative or loved one that experiences these severe bouts of hypoglycaemia, speak to your family doctor about getting a glucagon kit that is used to increase glucose in someone that is either unconscious or unable to take oral feeds for any other reasons. In instances where calling the ambulance will take too long and the patient is unconscious and unable to swallow a sugary drink, try rubbing honey or syrup on the patient ' s gums.
Any patient that gets a severe hypoglycaemic episode should be admitted for further care and management at the hospital. This will also include identification of risk factors, medication adjustment if necessary, collection of bloods for renal( kidney) and hepatic( liver) functions and more education for the patient and family.
What if someone keeps having hypoglycaemic episodes? It should not be considered ' normal ' having a relative that always gets these episodes. Inappropriate dosages, alcohol intake and patient ' s understanding and medication usage should be investigated. This will include a detailed dietary history by ideally a dietician. Some patients may be suffering from renal impairment. The kidneys may not be excreting the medication well, causing a build-up in the body. Hepatic impairment affects the glucose storage and processing to maintain an average blood glucose. Some patients may be victims of abuse, whereby the caregiver injects them more insulin( used to lower glucose) to get attention from hospital personnel. Sometimes this is done as a form of punishment to the patient. Some patients may also inject themselves to lower their glucose, either for attention seeking behaviour or as a cry for help. Such cases will need psychological review. One cannot easily say, without professional assistance, why these odd behaviours occur.
Hypoglycaemia is a preventable, silent killer. Please speak to your GP and dietician about how you can keep your glucose controlled or help a loved one deal with this complication. Please visit www. diabetessa. org. za for more, reliable and relevant information on living with diabetes in South Africa.
Dr T. G. Matoro MBChB, UCT Clinical Advisor
Reference 1. The 2012 SEMDSA Guideline for the Management of Type 2 Diabetes. www. diabetessa. org. za 2. Retrieved 12 September 2016.
BDM TALENT ISSUE # 04 12