If you drink alcohol, you may have a severe hypoglycemic reaction with little warning. Read more about alcohol and your meal plan in chapter 10.
Dawn Phenomenon
Your body has a normal mechanism that wakes you up and gives you energy to start the day. Your body responds to this wake-up call of hormones. These hormones depress the activity of insulin, allowing blood glucose to rise between around 4 and 8 a.m. This is called the dawn phenomenon. The dawn phenomenon can be one reason for blood glucose readings and ketone levels that are high when you wake up.
If high morning blood glucose levels seem to occur mysteriously, discuss the problem with your health care team and talk about the best way to treat it.
Severe Hypoglycemia
You could develop severe hypoglycemia if your symptoms of low blood glucose go unnoticed or are ignored. People who are elderly or who take diabetes pills, such as sulfonylureas, are more likely to develop severe hypoglycemia. You may lose consciousness if your brain has been deprived of blood glucose for too long. This is a real emergency. The best way to deal with severe hypoglycemia is to take precautions so that it doesn’t happen in the first place. Be alert to your symptoms and treat yourself right away. Don’t wait to see if it gets worse or put off treatment until a more convenient time.
You may become so confused and irritable that you refuse help during a hypoglycemic reaction. Those around you may have to be persistent to get you the help you need. They can save you from a coma and a trip to the hospital by insisting that you take some form of glucose quickly. Your life will be easier and safer if those with whom you spend the most time can spot a low glucose reaction and know what to do about it.
Someone else must take over if you become unconscious. You will not be able to eat or drink anything, but your blood glucose levels need to go up immediately. The safest remedy is to get a glucagon injection. Your helper should call for emergency help at once if he or she does not know how to inject glucagon. Glucagon will not work in someone who does not have enough glucose in the liver, which can occur with starvation, or in those whose liver does not effectively release stored glucose, which can occur with excessive alcohol intake.
Severe Hypoglycemia and Sleep
If you live alone, you may be concerned about having a severe hypoglycemic reaction while you are sleeping. Your best bet is to monitor your blood glucose levels before you go to sleep and occasionally during the night. If your blood glucose level is dropping, eat a small snack before going to sleep. Try mixing uncooked cornstarch into the snack or eat a product that contains slow-digesting carbohydrates. Many people who take insulin are able to reduce their risk of nighttime lows by switching to an insulin pump.
If you are prone to hypoglycemia, you’ll need to train someone you trust to inject glucagon. Talk to your provider about whether you should buy a glucagon kit, which is available by prescription. Ask your family members or friends to learn how to use glucagon, so they know what to do.
How to Inject Glucagon
1. Typically, glucagon kits are brightly colored and include step-by-step instructions.
2. A glucagon kit has a syringe filled with diluting fluid and a bottle of powdered glucagon. You must mix the diluting fluid with the powder immediately before it is injected. The instructions for mixing and injecting glucagon are included in the kit.
3. Inject glucagon into the buttock, arm, or thigh.
4. Turn the person on his or her side so if there is vomiting, he or she will not choke.
5. Feed the person with appropriate carbohydrate immediately when he or she wakes up and is able to swallow. Start with nondiet soda, juice, glucose tablets or gels, and then additional carbohydrate.
6. Check blood glucose. If the person does not wake up within 15 minutes, call for an ambulance. The dose may be repeated after 20 minutes.
7. Always call your provider and emergency personnel when a severe reaction occurs in order for help to arrive and appropriate care to be administered. Ask for instructions on emergency procedures when you get the prescription. Read the instructions that come with the glucagon and share them with friends, family, and coworkers.
8. Kits usually last a year before expiring (check the date on the box). However, premixing the glucagon and diluting solution will make the mixture last only 48 hours in the refrigerator.
Always let your health care providers know if you have taken glucagon and had a severe hypoglycemia episode. Also, tell them if you are having frequent bouts of even mild hypoglycemia. By working together, you might find a pattern in your insulin, meals, or activity routine that may be causing the hypoglycemia. With clues, you and your health care team can do some problem solving and decide on changes to prevent severe hypoglycemia.
Tell a Friend
Either you or a member of your health care team should instruct family, friends, or coworkers about the signs of severe hypoglycemia—and what to do if it develops.
Pregnancy and Severe Hypoglycemia
Many pregnant women, who have intensive blood glucose goals, may experience hypoglycemia unawareness. Thus, they are more likely to have mild and moderate bouts of hypoglycemia. Pregnant women should keep up a consistent blood glucose monitoring routine and check their blood glucose when hypoglycemia is most likely (between meals and in the middle of the night). You need to treat any blood glucose level below 70 mg/dl. You’ll have to take special precautions if you are pregnant and become unconscious.
Treating Severe Hypoglycemia during Pregnancy
• You may need only half the normal dose of glucagon at the beginning of a severe episode of hypoglycemia.
• After 15 minutes, if you do not regain consciousness or your blood glucose levels do not rise, you need another shot and someone should call 911 for emergency help.
• Make sure that those with whom you spend time know that you are pregnant and know what to do if you have a low blood glucose episode.
• Ask your health care provider about the dose of glucagon you need.
Hyperglycemia
High levels of glucose in your blood over time may lead to long-term complications. But blood glucose levels can also become dangerously high in the short term and cause a life-threatening situation that could result in coma or death. It is important to know the warning signs and treatments for hyperglycemia, which are different for people with type 1 and type 2 diabetes.
Type 1 Diabetes and Diabetic Ketoacidosis
Too little insulin in your body leads to too much glucose in your blood. A rare and serious—but often preventable—emergency can arise when blood glucose levels rise. Diabetic ketoacidosis, also called DKA, occurs when you don’t have enough insulin. It is mostly a problem for people with type 1 diabetes. A person with diabetes may have such low levels of insulin that his or her liver may produce unchecked levels of glucose and ketones, especially during illness or stress. It can occur in people with type 1 diabetes who have not yet been diagnosed.
Diabetic ketoacidosis can start innocently enough; you miss a dose of insulin, the insulin you’ve been using has gone bad, or your insulin pump tubing gets blocked. The lack of insulin leads to
