HYPOS AND HYPERS

HYPO (HYPOGLYCAEMIA)

With a hypo (full stop: hypoglycemia), the blood sugar is too low. There is too little blood glucose in your blood. You have a hypo if your blood glucose is lower than 3.9 mmol/l. Also people without diabetes can have blood glucose values below 3.9 mmol/l, but their body is able to solve this itself. A hypo can occur when you eat too little, have too much active insulin in your body or exercise for too long without getting enough carbohydrates. This often gives a bad feeling. It is a signal from your body to take action.

Solve it as soon as possible

It is important to resolve a hypo as soon as possible, not only to get rid of the unpleasant feeling, but also to prevent a serious hypo, which could leave you unconscious. Measurements taken in the blood vessels show that during severe hypo's that can last longer than 30 minutes, all kinds of harmful substances are formed that are bad for the blood vessels, just as happens with high (hyper) values. Blood becomes locally more viscous and the risk of small clots (thrombosis) increases. 

Characteristics of a hypo:

Physical reactions:

• feeling hungry
• tiredness
• Shaking, sweating
• pale face
• palpitations / pounding heart
• tingling / numbness of lip / tongue / fingers
• muscle weakness (feeling of limpness)

Neurological reactions, caused by a shortage of glucose in the central nervous system:

• blurred vision, deviation from colour vision
• headache
• dizziness
• disturbance of concentration
• mood swings, sudden anger or aggression
• loss of control
• sleepiness
• loss of consciousness

These are general symptoms, but your body may show additional symptoms not included in the above list.

It is important to resolve a hypo as soon as possible. Not only to prevent fainting: If your body experiences hypo for a long time or regularly, you may no longer experience the symptoms. This is called hypo-unawareness. You no longer feel a hypo coming on. The physical reactions therefore disappear, but the neurological consequences for your brain remain.

Of course it is not safe to drive if you have a hypo. Therefore, measure your blood glucose level half an hour before you set off.  This way you know if it is safe to drive. On the road, make sure you have dextrose (fast-acting carbohydrates) within reach.

What do you do if you are hypoglycaemic?

You need glucose to make up the shortfall in the blood as quickly as possible. For this you need fast-acting carbohydrates. The amount depends on your body weight. For pen therapy (insulin injections) we recommend 0.5 grams of carbohydrate per kilo of body weight, with a maximum of 20 grams of carbohydrate, assuming a basal insulin level of 30 to 35%. If you have an insulin pump we recommend 0.3 grams of carbohydrate per kilo of body weight, with a maximum of 12 grams of carbohydrate, assuming a basal insulin level of 20 to 30%. On the latest insulin pumps such as the 780G we see that you need even less carbohydrate to resolve a hypo. In all cases, always follow the advice of your doctor or diabetes nurse. Usually you will see the line slowly increase on your FGM or CGM sensor. Afterwards, keep a close eye on how you feel. Try to avoid staying too long in a hypo.

Types of carbohydrates for hypo:

It is important to consume fast-acting carbohydrates. We know the following types:

Glucose: if you have a hypo you want the glucose values to rise FAST. Glucose gives a rapid rise with 10 to 20 minutes which makes you feel better, after 45 minutes you reach the peak of the rise. Glucose is available in tablets (e.g. Dextro) and as powder.

Fructose (fruit sugar) does not influence blood glucose directly and only gives a rise later. It is mainly absorbed in the liver cells (without the help of insulin), where it is converted into glucose. Fruit juices and most lemonade syrups contain fructose and give a slower rise to blood glucose. Therefore they are less suitable to treat a hypo, the fructose acts too slowly and there is a greater chance to shoot to high blood glucose levels. Normal sugar consists of both glucose and fructose. It will therefore not rise as quickly as the same amount of pure glucose.

Sucrose is a carbohydrate that consists of a glucose and a fructose part. Invert sugar, glucose-fructose syrup, honey are also largely made up of fructose. It does help, but you may need more of it to get the fast effect. The disadvantage of this is that hyperglycemia occurs later. You need more glucose to have the same effect as regular glucose in the beginning. Later on you get an increase because only then the fructose part is converted into glucose. There is a risk that you will get too high glucose levels.

What is the best thing to take when you have a hypo?

The most effective way to treat a hypo is dextrose or glucose. This fast carbohydrate is really preferable for us.

Grape sugar or glucose: brands

Glucoseproduct:	Shape:	Amount of glucose / tablet:
Dextro	1 tablet	3 gram glucose
Dextrose Kruidvat	1 tablet	2,2 gram glucose
Glucopep	1 tablet	2,2 gram glucose
Dex4	1 tablet	4 gram glucose
Glucosepowder Dextropur *)	1 spoon = 10 gram dissolve in water	10 gram glucose

*) Available at pharmacies or drugstores.

If you do not have any dextrose to hand, choose a sports drink with glucose or sucrose or a soft drink/fruit drink with sugar (cola, 7-up). The important thing is that the hypo is resolved so that you feel better again.

Check the label for information on the type and amount of carbohydrate. Do not choose a sports drink with isomaltose etc., this works too slowly. An example of a sports drink is 100ml AA High Energy, which is good for 16.5 carbohydrates. A glass of cola of 150ml is 15 carbohydrates. An alternative is a large spoonful or lump of sugar (through tea) or lemonade syrup with sugar. Attention; the assortment of lemonade syrups is very large, look carefully on the label for type and amount of carbohydrates, do NOT choose syrups with sweetener because they do not contain fast carbohydrates. Know that 10 ml of pure syrup often contains 7 grams of carbohydrates.

Exercise and the risk of hypoglycaemia

It's a common fear among diabetics: getting a hypo from exercising. We would like to give you the tips and support you need to exercise. Exercise and sport are important for feeling good and play an important role in your insulin sensitivity. At Diabeter, we therefore always advise you to continue exercising. If you have questions or doubts about diabetes and sport, discuss them with your medical team. Read more

Precision work

The doctors and diabetes nurses at Diabeter specialise in type 1 diabetes and help people with type 1 diabetes every day. If you often have hypo, we will work with you to find solutions to reduce your symptoms. Their advice is always tailored to you, your lifestyle and your wishes.

HYPER (HYPERGLYCAEMIA)

The opposite of a hypo is a hyper (in full: hyperglycemia). The blood sugar level is then too high, i.e. above 11.1 mmol/l.  A hyper indicates that you have too little or no insulin in your body. This can be caused by not putting enough insulin into your body in relation to the number of carbohydrates you have eaten, stress or illness.

Characteristics of a hyper:

With a hyper, several symptoms occur in the short term, which are not always immediately noticed with a higher value. Common symptoms are:

• thirst, dry tongue
• tiredness, sleepiness
• frequent urination
• possibly sudden moodiness, quick temper
• headache
• concentration problems
• redness
• cloudy vision

When ketones (acidification of the body) are present, nausea and/or vomiting may occur. Other symptoms can be a breath that smells like acetone and accelerated breathing. Sometimes a person may also have difficulty breathing. In the above cases, contact the emergency line of your healthcare team.

What should you do if you are hyper?

What to do in the event of a hyper depends on the glucose level. Sometimes, administering additional insulin according to the treatment schedule and an additional glucose measurement is sufficient. If you often have a hyper or your value is significantly elevated, consult with the treatment team or call the Diabeter emergency line for (parents of) patients with type 1 diabetes 088-2807277, option 1. You will then immediately (24 hours a day / 7 days a week) get one of our doctors or diabetes nurses specialised in type 1 diabetes on the line for advice.

What values are we talking about and what should you do?

20.0 mmol/l - high: impending keto-acidosis.

Consult our emergency line and state the daily insulin dosage. Give extra insulin via pump or pen according to the instructions of the doctor or diabetes nurse on duty and the guidelines in the Diabeter app. Check your glucose value after 30 minutes to 1 hour. Do not exert yourself or do any sport with these values.

15.0 - 19.9 mmol/l: impending dysregulation.

Give extra insulin via pump or pen according to the advice in our Diabeter App and call your medical team (office hours). If it happens again, call the emergency line and mention the daily total of insulin. Check glucose after 1 - 2 hours.  NO exercise / sport if glucose values are rising,

11.1 - 14.9 mmol/l: Hyper:

Give extra insulin via pump or pen according to the advice in our Diabeter App. Check the glucose value after two hours and call or email your healthcare team if necessary.

7.8 - 11.0 mmol/l: Increased:

If necessary, adjust the insulin dose the next day. Follow the advice as given in the Diabeter app.

A person with type 1 diabetes who has high glucose values for a long time can derail into a so-called diabetic ketoacidosis (DKA). A DKA is life-threatening and can lead to cerebral oedema or coma.  This is why early recognition of prolonged 'high sitting' is so important.

Consequences of a hyper or hypo

An occasional hypo or hyper is no big deal. But especially high glucose levels over a longer period of time (months) are not good for the body. They cause long-term damage to blood vessels. And this leads to a lot of diabetes complications later in life in for example the kidneys, heart and eyes. All the more reason to try to prevent serious hypo's. That is why at Diabeter we constantly monitor your blood glucose values remotely. We receive these values after an upload of your insulin pump, FGM or CGM. After such an upload, you will receive a clear advice in colour about the course of your blood glucose control in the past weeks. If you have a lot of high values (red) or low values (blue), you can make adjustments during consultation with your medical team. In this way, together we can keep our finger on the pulse.

Do you often suffer from hypo and/or hypers? Let us take a look at your situation and ask your questions to Katja or Grada, diabetes nurses.