Hypoglycaemia

What is Hypoglycaemia?

Hypoglycaemia is a low blood glucose level of less than 4mmols/mol.

Signs and symptoms

Everyone has different symptoms, but the most common symptoms of hypoglycaemia are:

• feeling shaky
• dizzy
• feeling confused
• sweating
• being anxious or irritable
• going pale
• palpitations and/or a fast heart rate
• lips feeling tingly
• blurred vision
• being hungry
• feeling tearful
• tiredness
• headache
• lack of concentration
• night sweats

Treatment of Hypoglycaemia

If you feel unwell, always check your Blood Glucose level.

If you use a Flash Glucose Monitor or Continuous Glucose Monitor (Freestyle Libre/ Dexcom) and you have symptoms of hypoglycaemia which is not confirmed, check your Blood Glucose level using a Blood Glucose meter (Finger prick test).

Also be aware of downward trending arrows on your Flash Glucose Monitor or Continuous Glucose Monitor.

It is important to treat hypoglycaemia quickly and effectively.

• Confirm Hypoglycaemia – Blood Glucose level less than 4mmols.
• Have 15 – 20grams of rapid acting carbohydrate. For example: 5x Jelly Babies, 150 mls smooth fresh orange juice, 150mls Coca Cola, Glucojuice or GlucoGel.
• Recheck your Blood Glucose level – It is important to recheck your Blood Glucose level after 15 minutes. If your Blood Glucose Level is still less than 4 mmols, repeat the rapid acting carbohydrate step.
• Follow up snack. To prevent reoccurrence of hypoglycaemia, a slow release carbohydrate snack is advised. For example: Piece of fruit, 1x slice of toast, 2x digestive biscuits or a pot of yogurt.

It is important to follow all steps in order to successfully treat hypoglycaemia. Missing a step may lead to a further episode of hypoglycaemia.

Common causes of Hypoglycaemia

Understanding why you get hypoglycaemia can help you prevent them from happening as often.

We don’t always know why hypoglycaemia happen, but some things make them more likely. These include:

• missing or delaying a meal
• not having enough carbohydrate at your last meal 
• doing a lot of exercise without having extra carbohydrate or without reducing your insulin dose (if you take insulin) 
• taking more insulin than you need or over correction
• alcohol  
• changes in the weather, especially heat.
• poor injection technique
• breastfeeding
• stress
• illness

Insulin and some other diabetes medications can make you more likely to have a hypoglycaemic episode.

Prevention of Hypoglycaemia

• Monitor blood glucose levels closely
• Avoid skipping meals
• Plan ahead when exercising
• Closely monitor your blood glucose levels when drinking alcohol, and ensure you have a carbohydrate snack

Severe Hypoglycaemia

Severe hypoglycaemia can happen if you ignore the early warning signs of hypoglycaemia or if you have no awareness of hypoglycaemia. Severe hypoglycaemia is where third party assistance is required. This may be if the individual is unconscious or awake but not able to treat themselves.

• If the individual can swallow, assist with appropriate treat (as above).
• If the individual cannot swallow, put them in the recovery position and dial 999.
• Some people will have access to a GlucaGen injection to treat severe hypoglycaemia, this can be administered via a third party.

You can find more information about hypoglycaemia by reading the TREND Diabetes leaflet below.

What to do next

It is always important to reflect on episodes of hypoglycaemia. If you are aware of the cause of hypoglycaemia, consider what actions you would take in future to prevent hypoglycaemia. For example, reducing insulin doses, eating a snack.

If the cause of hypoglycaemia is unknown, it is advisable to reduce the dose of insulin prior to the episode of hypoglycaemia by 20%. This is to prevent any further episodes of hypoglycaemia reoccurring. 

Hypoglycaemia and Driving

It is your responsibility to make sure that you are safe to drive.

Group 1 drivers (car and motorcycle)

You need to tell the DVLA if:

• You have had more than one episode of severe hypoglycaemia while awake (needing the assistance of another person) within the last 12 months.
• You develop impaired awareness of hypoglycaemia (difficulty in recognising the warning symptoms of low blood glucose).

Group 2 drivers (bus and lorry)

You must stop driving Group 2 vehicles and tell DVLA if:

• You have a single episode of hypoglycaemia requiring the assistance of another person, even if this happened during sleep.
• You have any degree of impaired awareness of hypoglycaemia (difficulty in recognising the warning symptoms of low blood glucose).

All drivers (Group 1 and Group 2)

You must tell DVLA if:

• You suffer severe hypoglycaemia while driving
• You or your medical team feel you are at high risk of developing hypoglycaemia
• An existing medical condition gets worse or you develop any other condition that may affect your ability to drive safely.

Appropriate glucose monitoring systems

All drivers must have a blood glucose meter and test strips available when driving.

• Group 1 drivers can use finger prick glucose testing and continuous glucose monitoring systems (Freestyle Libre, Dexcom, and Guardian 4 sensors) for the purposes of driving.
• Group 2 drivers must continue to use finger prick testing for the purposes of driving. Continuous Glucose Monitoring systems are not legally permitted for the purposes of Group 2 driving.

Safe Driving

• You should check your glucose less than 2 hours before the start of the first journey and every 2 hours after driving has started.
• A maximum of 2 hours should pass between the pre-driving glucose check and the first glucose check after driving has started.

More frequent testing may be required if for any reason there is a greater risk of hypoglycaemia for example after physical activity or an altered meal routine.

Glucose level Recommendation

5.0mmol/L or less – Eat a snack.

Less than 4.0mmol/L or you feel hypoglycaemic – Do not drive Always keep a supply of fast-acting carbohydrate in your vehicle.

Hypoglycaemia occurs whilst driving

If hypoglycaemia develops while driving stop the vehicle safely as soon as possible. You should switch off the engine, remove the keys from the ignition and move from the driver’s seat. Check your blood glucose level and treat any hypoglycaemia. You should not start driving again until 45 minutes after finger prick glucose has returned to normal (at least 5.0mmol/L). It takes up to 45 minutes for the brain to recover fully.