Treatment

Hypoglycemia: Being Prepared

Maine lobsterman Randy Brown was alone on his lobster boat, Rock Me Baby, when the seizure hit.

“It was horrible. My right leg started thrashing and going out from under me and I was going down – I didn’t have enough strength to hold myself up. It wasn’t even my body anymore,” says Brown, 53, who fishes off the island of North Haven. “My head was thrashing so much my face was driving into the steering wheel.”

Eventually, he was able to pull himself up and put the boat in neutral. He recovered enough to steer his boat to a safe mooring and get to land. Brown, who was diagnosed with Type 2 diabetes in 1997, then tested his blood sugar and found it had dropped to 45, low enough to cause a hypoglycemic seizure.

Hypoglycemia is a concern for people with Type 1 or Type 2 diabetes, but it is less well-known as a health risk among the Type 2 community. In a 2005 article for the American Diabetes Association, Dr. Nicola Zammitt and Dr. Brian Frier suggest that hypoglycemia awareness among people with Type 2 diabetes lags behind their Type 1 counterparts, but they warn that “with the increasing use of insulin to treat Type 2 diabetes, the actual prevalence of hypoglycemia is likely to escalate.” Hypoglycemia can lead to unconsciousness, cardiac arrhythmia and even death if not caught and corrected, so understanding its causes, symptoms and treatment is vital.

Sue Ferra, a nurse practitioner on North Haven, says hypoglycemia shows up frequently as a side effect of certain treatments for Type 2 diabetes. Type 2s often produce some insulin on their own, so if they take additional insulin or sulfonylureas (a class of insulin-mimicking drugs), they may end up metabolizing sugars too quickly, which can lead to hypoglycemia, she says.

Bridget Amundsen, a dietician at Pen Bay Diabetes and Nutrition Care Center in Rockport, Maine, says she sees cases of hypoglycemia most often in people with Type 2 diabetes who are treated with insulin, but she also sees it among those who take oral medications. “Usually the primary cause of hypoglycemia is when either they take too much medicine and forget to eat, they don’t eat enough carbohydrates, or they do extra physical activity,” she says.

Early symptoms of hypoglycemia can include confusion, dizziness and irritability, Ferra says. Because symptoms can be subtle or may be mistaken for intoxication, it’s important for people with Type 2 diabetes to inform friends, family and co-workers that hypoglycemia is a possibility. “Friends and family should definitely know how to check the finger stick for the patient if [the patient] is unable to, and, if they’re unsure what the blood sugar is, to give the patient some juice or something sweet,” she says.

Brown fishes with his daughter, April, who now knows his warning signs: “I think one of the things – and April will notice when it comes to me – is I get confused,” he says. Brown keeps soda or juice on his boat in case his blood sugar begins to drop.

Doug Stone, 73, also a resident of North Haven with Type 2 diabetes, describes his hypoglycemic symptoms as shakiness and blurred vision: “You know how you get a drop of water on your glasses and you try to look through it – that’s the only way I can describe it when I have low blood sugar,” he says.

Although hypoglycemic symptoms can be dramatic, hypoglycemia also can be asymptomatic. According to a 2012 report by Dr. Jeff Unger, a researcher at the Catalina Research Institute, asymptomatic hypoglycemic episodes most often strike at night for a majority of people with Type 2 diabetes treated with insulin. Brown says his regimen of both slow-acting and fast-acting insulin led to his bouts of nighttime hypoglycemia, which did include some symptoms. His dosage of Lantus, a long-acting insulin, was lowered, which decreased the times he experienced the condition at night.

“Three o’ clock nighttime hypoglycemia – it will wake you up. It will make you sweat unbelievably,” he says.

Equally serious, the body and the patient can both become accustomed to low-grade hypoglycemic symptoms, leading to hypoglycemia unawareness, a potentially fatal condition in which patients can’t recognize even the most severe hypoglycemia symptoms. “I think the safest way to manage patients who have Type 2 diabetes, if you’re going to prescribe something that is potentially going to lower their blood sugar, is to have them do a finger stick twice a day when you’re introducing new medications,” Ferra says.

Hypoglycemia_Distressed_woman_car_Thinkstk_78740447Medication for Type 2 diabetes sometimes has to be tweaked, as the condition can be affected by physiological changes, and changes in schedule, emotional well-being and activity level. Ferra cited a patient who experienced increased bouts of hypoglycemia prior to a long road trip. “He was getting hypoglycemic episodes with a medication he had been on for a while, so we decreased his medication before the trip,” she says. “It’s something they would want to discuss with their provider on a case by case basis.”

Maintaining as much consistency in daily routine as possible is key to managing hypoglycemia, says Amundsen. People with Type 2 diabetes should take their meds as ordered, eat a consistent diet with the right balance of carbohydrates at every meal and test their blood sugar levels, she says.

After his first seizure, Brown worried about scaring his three daughters with the news, but he felt it wouldn’t be fair to not tell them. Informing his family members was vital during his second seizure, which occurred when April was onboard. “I just spoke to April and I said to take the boat,” he says. A volunteer EMT, April was able to seat him on a bucket and keep him in place with her leg while she drove the boat back to shore.

Brown says he now monitors his blood glucose each time he eats to try to stave off further severe hypoglycemic episodes. He also stresses the importance of having small snacks, like crackers and peanut butter or oranges. He recalls his seizures with horror, and says he hopes others follow his advice.

Researchers and caregivers agree that the more that can be done to build awareness of hypoglycemia, the better.  As more people with Type 2 diabetes begin insulin treatment, that awareness could become a matter of life and death for many Americans.

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