Ever overhear a conversation that included:

“Sorry I’m so cranky today. You know I’m hypoglycemic and my blood sugar must be a little low. Let’s go get a latte and a scone…”?

It’s usually followed by a hair flip and an application of shiny lip gloss.

That, my friends, is not hypoglycemia.*

People with diabetes know that insulin is not a cure. It’s what our bodies uses to bring glucose where it’s needed. (Remember the hot guy and the beautiful woman? That.) Too little insulin and we get sick. Too much insulin and we get sick. The very thing that keeps us alive can kill us. Not a pleasant thought, but one that needs to be understood when talking about hypoglycemia.

What is Hypoglycemia?

As simply as I can state it, it’s the lack of glucose in the blood. The brain (another really important organ to have) needs glucose to function, so if there isn’t enough of it floating around, the brain doesn’t work well. For people with diabetes, it’s easy to diagnose hypoglycemia - a blood glucose check does it. (Ahh… if only it were that simple, right?) Many medical professionals recommend the ingestion of some form of glucose when the blood glucose reading falls below 70 mg/dl, although some people with diabetes treat under 80 mg/dl.

What happens when blood sugars go lower than normal?

The body is an amazing machine. (Are you tired of me telling you this yet?) People with diabetes, despite having broken pancreases, still have other functioning bits. (Yes, bits is a medical term.) When there’s too much insulin and not enough glucose, two things happen.

• The brain has a quiet freak out. (Technically, it’s called neuroglyceopenia.)
• The body has a quiet freak out, releasing “counter-regulatory” hormones: adrenaline, glucagon, and epinephrine.

Symptoms are different for everyone - and they can change over time, but here are some of the more common ones:

• Impaired judgment. (This is my downfall. While I may feel my blood sugar dropping, I have thoughts that include: “It’ll go back up by itself,” or “I’ll take care of it in a few minutes.” A few minutes is often the difference between a mild - easily treatable - hypoglycemic reaction and a moderate one.)
• Difficulty speaking. 
• Inability to control emotions. (I’m giddy girl going down. I think everything is hysterically funny and I often talk about my sock status. “Look! I’m not wearing socks!” Unfortunately, when I drop below 50 mg/dl, things aren’t funny anymore and I get angry, frustrated, and begin to get emotional. Academy Award winning performance.)
• Sweating, shaking, pounding heartbeat (Thanks, hormones!), clamminess.
• Vision issues, including blurriness or “tunnel vision”. (If I’m tunneling, as I call it, I’m in dire straits. It’s happened a few times and those few times called for glucagon or syrup administered on the sides of my mouth.)
• Sleepiness. (I’ve caught myself tilting my head back and closing my eyes, thinking that I’ll just take a quick nap and I’ll feel better or rolling over in bed at night.)
• Not being able to focus on anything. That’s how John can tell before I can that something is not right. He’s my human CGM, because he’ll ask me to check my blood sugar if he recognizes that I’m not “right”.
• (A personal few symptoms that I have: my lips and the area around my mouth get numb and my hearing changes. When my hypo is horrible, I also can’t stop jerking my limbs and shaking uncontrollably because my body is trying to physically squeeze any glucose it can out of my muscles.)

I’m not a medical professional, so I can only tell you my own personal experiences with hypoglycemia. My “mild” lows are ones that I catch above 60 mg/dl. I usually bounce back quickly and the rest of my day isn’t impacted. “Moderate” hypoglycemia for me  hits around 50 mg/dl and if I can treat it immediately before it gets worse, while it will make me sluggish and one step behind for the rest of the day, I’m not down for the count. “Nasty” hypoglycemia for me is 40 mg/dl and under and it wipes me out for about 24 hours.

How Do You Treat Hypoglycemia?

How the experts say you should treat it:

Simple carbohydrates. Glucose. Rule of thumb is 15 grams of carbs, wait 15 minutes, then test. If you’re still below 70 mg/dl, then consume another 15g of glucose and wait another 15 minutes.

How I treat a mild low:

Glucose tabs. (I love Cherry Glucolift). Or juice. I wait 15 minutes, test, and then go on from there.

How I treat a low below 50 mg/dl:

Eat everything sweet that I can get my hands on because my brain is in full blown freak out mode. Wait what seems like 15 minutes (In reality, it’s about 45 seconds.) and then eat some more. Once I’m back above 70 mg/dl, I deal with the aftermath.

And when it’s low, low, low… this is how it happens. (It’s an oldie, but a goodie.)

Glucagon

Things can get dicey. If a person with diabetes can’t swallow anything, passes out, or is so ill that they can’t keep anything down and blood glucose is dropping to dangerous levels, it’s time to call in the big guns: external glucagon. Available by prescription, it’s a kit that uses a syringe to inject glucagon inter muscularly (IM) to force the liver to release sugar. (Again, that’s the non-medical explanation.)

I’ve had glucagon injected twice in thirty years and both times, I was conscious and consented for it to be done. My blood glucose levels were dangerously low and I was so nauseous that I knew I wouldn’t be able to ingest anything in time.

It’s not simple to use. Wish it was. You need to inject water into a vial of powder, shake it up, draw the liquid out, blah blah blah. The instructions and more information can be found here.

People can be freaked out when you talk about using it in the case of an emergency. I give a quick tutorial to coworkers and close friends and family (and refreshers) and let them know where I keep the kit in my purse. But I always tell them this: “Please make sure you call 911 immediately after you inject the glucagon. Please.” I hate the aftereffects of a glucagon injection (wicked nausea and gastrointestinal stress), but I hate the alternative more.

The Scary Thing I Don’t Want To Mention, But Will Because It’s Important

You can die from hypoglycemia.

The brain needs glucose to function. I don’t have to draw a picture for you. No glucose = no brain function.

I’d like to talk about it more, but I can’t. Not because I can’t find research or statistics, but because I…can’t.

It happens. It’s horrible. And it’s no one’s fault. We do everything we can and people with diabetes still die from insulin; the same drug that keeps us alive.

What Can You Do To Prevent Hypoglycemia?

I didn’t want to leave this post on a total downer, so here things you can do to prevent hypoglycemia:

Monitor:

• What you eat
• What you drink
• What your blood glucose levels are
• How much you exercise
• How much insulin/medication you take

Wait… this sounds like… what most people with diabetes already do?

Yes. It’s because this disease is sometimes often unpredictable.

I  wear a CGM, check my blood glucose levels often, stay vigilant… and it still happens.

So, latte and scone lady?  You don’t know hypoglycemia. You don’t know cranky. And you certainly don’t know my sock status.

“Look! I’m not wearing any socks!”

* Yo, before you all get your pitchforks, there are individuals who do not have diabetes, but are clinically diagnosed with hypoglycemia. I know that. I’m talking about those individuals who think that because they don’t eat properly (a latte and three bites of lettuce is not lunch) and self-diagnose hypoglycemia are…well, you got to eat something besides lip gloss. Work on that, will ya?