Dietary advice for hypoglycaemia

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What is hypoglycaemia?

Hypoglycaemia means low blood glucose. It is sometimes known as ‘having a hypo’. Any blood glucose reading less than 4 mmol/l is hypoglycaemia. It needs to be treated quickly, whether or not you are having symptoms.

Who experiences hypoglycaemia?

People who manage their diabetes with insulin or with certain tablets can experience hypoglycaemia. If you are not sure if this affects you, you can ask your diabetes specialist nurse or dietitian.

Symptoms of hypoglycaemia

• Intense hunger.
• Vagueness, confusion.
• Sweating.
• Difficulty concentrating.
• Going pale.
• Blurred vision.
• Irritability or irrational behavior.
• Trembling or tingling lips.

Dealing with a hypo

What to do if you are having hypoglycaemia

1. If you are not sure whether it is hypoglycaemia then check your blood glucose level. If it is below 4 mmol/l move on to step 2.

2. Fast acting carbohydrate (sugar). You need 15 to 20g of fast acting carbohydrate. Take 1 option from the following list:
• 4 jelly babies.
• 4 to 5 Lift Gluco Chews.
• 1 Lift glucose shot.
• 2 x 25ml tubes GlucoGel.
• 150ml cola or other non-diet fizzy drink.
• 5 to 6 Dextrose Energy tablets.
• 1 Dextrose drink.
• 3 heaped teaspoons sugar.
• 4 to 5 Maynards wine gums.
• 6 to 7 Swizzels Squashies.
• 220ml Lucozade energy original.

3. Wait 5 to 10 minutes and then re-check your blood glucose level. If it is still below 4mmol/l repeat step 2. If it is 4mmol/l or above go to step 4.

4. Slow acting carbohydrate. Take 15 to 20g slow release carbohydrate to keep your blood glucose level steady. If your next meal is due, have the meal. Make sure the meal contains bread, rice, pasta, potato or another starchy food. Here are some 15 to 20g slow release carbohydrate snack ideas.
• 1 slice of medium cut bread / toast.
• 2 sweetened oat biscuits or digestives.
• 1 small to medium banana.
• 1 cereal bar.
• 300ml milk.
• 4 dried apricots.

5. Learn from the hypo. Hypoglycaemia happens for a reason. It is dangerous to have regular hypos. Try to avoid it in future. Causes of hypoglycaemia include:
• Alcohol.
• Missing a meal.
• Not including starchy carbohydrate with a meal (bread, rice, potato, pasta or cereal).
• More activity than usual.
• Taking too much insulin.

If you are having regular hypos you may need to adjust your medications, insulin or eating patterns. You can discuss this with your diabetes specialist nurse or dietitian.
Sometimes a hypo may be so severe that you need help. It is useful if friends and family know how to help you. If you are confused friends and family should encourage you to have something from the list above.
Sometimes more help is needed. Someone can place 2 teaspoons of jam, or 1 to 2 tubes of glucose gel inside your cheek. They can massage the outside of your cheek to support absorption.

If you are unconscious someone should put you in the recovery position, call 999 and explain that you are having a severe hypo. The paramedic will give you a glucagon injection.

Top tips to manage and avoid hypoglycaemia

• A regular meal pattern with some starchy carbohydrate at each meal is generally recommended. The amount of starchy carbohydrate that is required depends on your medication or insulin regime. You can discuss this further with your diabetes specialist nurse or specialist dietitian.
• Stick to recommended units of alcohol (max 14 units per week)and don’t drink alcohol on an empty stomach.
• Keep a fast acting carbohydrate with you at all times and a slow acting carbohydrate somewhere handy. For example,keep glucose tablets and a cereal bar beside your bed,
in the car and in a handbag / pocket.
• Carry identification that says you have diabetes. You can obtain identification cards from the hospital diabetes centre and usually at your GP surgery or chemist. Some people find Medical Alert bracelets or necklaces useful.
• If you exercise, adjust your insulin/ diabetes medication as required or take extra carbohydrate (without insulin) to prevent hypoglycaemia. You can discuss this further with your diabetes specialist nurse or specialist dietitian.

To be prepared for hypos check that you:

• Know how to avoid a hypo (see above).
• Know the symptoms to recognise a hypo (see above).
• Know the steps to treat a hypo (see above).
• Tell friends or family about hypo symptoms and how to help you if needed.
• Organise supplies of fast acting and slow acting carbohydrate in handy places.

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