The Signs, Symptoms, and Causes of Hypoglycemia

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1 The Signs, Symptoms, and Causes of Hypoglycemia Tam Doan PharmD, CDE, BC-ADM Clinical Pharmacist, Diabetes Care Manager Santa Clara Valley Medical Center Fruitdale, CA

2 Agenda What is hypoglycemia? What are the signs and symptoms of hypoglycemia? What are the risk factors and causes of hypoglycemia? What are the consequences of hypoglycemia? Patient story

3 What is Hypoglycemia? Hypo(low)glycemia(sugar): Low blood sugar Blood sugar (glucose): Energy source Defined by blood sugar or glucose less than 70mg/dL Greatest immediate danger with diabetes Must be treated immediately

4 Stages of Hypoglycemia 140 mg/dl 70 mg/dl 55 mg/dl Mild hypoglycemia Normal range Early Symptoms Hunger, racing pulse, headaches Pale skin, sweating, trembling Dizziness, feeling shaky, irritability Confusion, anxiety, weakness Blurred vision 40 mg/dl 0 mg/dl Moderate hypoglycemia Severe hypoglycemia Later, More Severe Symptoms Poor coordination Poor concentration Numbness in mouth and tongue Passing out, seizures Nightmares or bad dreams Coma and death

5 Symptoms of Hypoglycemia Bodily Reactions Sweating Racing pulse Shaking Hunger Headaches Pale skin Cognitive/Behavioral Changes Confusion Behavioral changes Slurred speech Anxious Visual disturbances (blurred vision) Dizziness Seizures Poor coordination and concentration Coma and death

6 How can low blood sugar make you feel? What are the symptoms? SHAKING SWEATING FAST HEARTBEAT ANXIOUS or NERVOUS

7 How can low blood sugar make you feel? What are the symptoms? DIZZINESS HUNGRY HEADACHE IRRITABLE or IMPATIENT

8 What are symptoms of hypoglycemia that may happen when I am sleeping or wake me up? Damp sheets or clothes (sweating) Nightmares or crying out during sleep Tiredness, irritability, or confusion when waking up

9 What is severe hypoglycemia? Severely low blood sugar (<40 mg/dl) Diabetic emergency Require help from another person to treat your low blood sugar

VISION CHANGES DROWSINESS WEAKNESS FATIGUE HARD

10 What are the symptoms of severe hypoglycemia? LOSS OF CONSCIOUSNESS (PASSING OUT) MEMORY LOSS VISION CHANGES DROWSINESS WEAKNESS FATIGUE HARD TIME FOCUSING or PAYING ATTENTION CONFUSION SEIZURES

11 What is hypoglycemia unawareness? Who is at risk? When a person does not feel the symptoms of low blood sugar Blood sugar level falls below 70 mg/dl and feel no symptoms Do not know that treatment is needed Higher risk for hypoglycemia unawareness: Increased age Frequent episodes of hypoglycemia Type 1 diabetes Have had diabetes for a long time Complications with diabetes: Damage to nerves Taking medications, such as beta blockers, can hide the symptoms Must monitor blood glucose frequently Consider wearing a medical alert band

12 Medications What causes hypoglycemia? Sulfonylureas: glyburide (DiaBeta), glimepiride (Amaryl), glipizide (Glucotrol) Insulin: Dose, timing, and type Dosing inaccuracies Risk of hypoglycemia with different types of insulin: Insulin degludec (Tresiba) & insulin glargine U300 (Toujeo) Less than Insulin detemir (Levemir) & insulin glargine U100 (Lantus) Less than NPH (Humulin N) Others: meglitinides (Prandin, Starlix), beta blockers (Tenormin), ACEinhibitors (Lotensin, Vasotec), and more

13 What causes hypoglycemia? Continued Meals Not eating, eating less, delaying a meal, or skipping meals, not enough carbohydrates Illness Liver or kidney disease, hospitalization, anorexia, or cold/flu Alcohol use Exercise: intensity, duration, timing Excessive stress

14 What may put you at risk for hypoglycemia? Risk Factors Medications (insulin, sulfonylureas) Older age Number of years with diabetes Multiple health conditions History of coronary heart disease Kidney or liver disease Pregnancy Erratic eating habits (skipping or infrequent meals) Special conditions Gastric bypass Heart transplant

15 What are the consequences of hypoglycemia? What can happen if I do not treat my low blood sugar? Loss of consciousness, brain damage, or death Cardiac arrest, heart arrhythmia More difficult to control diabetes Hypoglycemia unawareness Poor quality of life Can make it harder to take your medications on schedule

16 Patient Story: Mrs. Jones 46-year-old with type 2 diabetes for 7 years History of high blood pressure and asthma Medications for diabetes Metformin 1000 mg twice daily Humulin 70/30, 30 units twice daily Experiencing low blood sugar at night Wakes up every night confused and with her sheets soaked in sweat How do you think she is feeling?

17 Patient Story What is happening? Low blood sugar during bedtime What could be the cause? Timing of insulin doses Injection 1: 6am when she wakes up Injection 2: 11pm when she goes to sleep

18 Patient Story Continued What can be done? Change the timing of the injection! Insulin Humulin 70/30 must be injected minutes before breakfast and minutes before dinner Change to a different insulin Risk of hypoglycemia with different types of insulin: Insulin degludec (Tresiba) & insulin glargine U300 (Toujeo) Less than Insulin detemir (Levemir) & insulin glargine U100 (Lantus) Less than NPH (Humulin N) No more low sugars during sleep!

19 Summary Hypoglycemia is the most immediate danger with diabetes Defined by blood sugar less than 70mg/dL Symptoms include: Shaking, sweating, fast heartbeat, anxiety, dizziness, hunger, irritability, headache, impaired vision, confusion, fatigue/weakness, confusion, and loss of consciousness There are multiple risk factors and causes, of which, many of the causes can be prevented. The consequences of hypoglycemia can be severe and even death. Knowing the symptoms and how to treat them is key!

20 Questions? This presentation is available online at: horizoncme.com Diabetes Family Health Fair

21 Copyright (c) 2018 by Horizon CME. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from Horizon CME.

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