Hypoglycaemia Unawareness

(Not being able to recognize the symptoms of the onset of hypoglycaemia)

Hypoglycaemia is the most common side effect of insulin treatment and usually presents itself with symptoms such as sweating, palpitation and hunger. These symptoms alert the person with diabetes to the condition of their glucose level so that they can take the necessary action. Some people, however, lose the ability to recognize these symptoms. This condition is not just an issue for the person with Type 1 Diabetes Mellitus, it also affects the whole family…their peace of mind and the quality of their lives.

Hypoglycaemia Unawareness is often accompanied by confusion, changed emotions and anger.
The patient might stubbornly refuse to test blood when asked to do so, be aggressive, quarrelsome, or unreasonable when offered help. In extreme cases they can get verbally or physically abusive.

Caregivers become afraid of their relative /partner after violent reactions. They tend to stay awake at nights   or get disturbed sleep because of worries in case of coma. They tend to get up regularly to check if the patient is all right. They are unwilling to leave them alone because they are worried and concerned as well as because the patient is so reliant on them. Some even give up their hobbies or do not go out at all.

From a study that explored the impact of Hypoglycaemia Unawareness on the whole family it was found that …

A person with diabetes and Hypoglycaemia Unawareness:

• Relies on the family members to help detect and manage Hypoglycaemia Unawareness
• Does not like this reliance
• Does not respond positively to help
• Worries that they have become a burden to others
• Loses confidence and in some extreme cases has to cope with an unhappy marriage.

A relative or partner who has to care for a patient with Hypoglycaemia Unawareness:

• Is angry about how Hypoglycaemia Unawareness has affected his/her life
• Is sometimes frightened of the patient
• Feels tired, alone and unsupported

So people who have Hypoglycaemia Unawareness should be taught to recognize symptoms and appreciate that the condition can be serious.

Hyperglycaemia - A Short term Complication of Diabetes Mellitus

There are various reasons for this and knowing the cause and the treatment can help.

When does a person with diabetes get hyperglycaemia? – 
When blood glucose levels are > 130 mg/dl fasting OR >180mg//dl after meals.

Symptoms of hyperglycaemia:   

Increased thirst, the need to urinate more often, feeling tired, blurred vision, headaches, hunger and muscle cramps.

These are temporary symptoms that disappear when blood glucose level comes back to normal levels. 

There are many reasons why a person with diabetes can have hyperglycaemia.

It can happen accidentally because of

• Forgotten or miscalculated medication or insulin dose 
• An unusually high  amount of carbs in a meal, 
• Over treating a hypo, or 
• Getting less physical activity than normal.

It can last for longer periods of time because of

• Illness or infection 
• Hormonal changes 
• Stress 
• Weight gain or
• It may be time to make corrections to medication or insulin doses 

Hyperglycaemia can also be a side effect of non-diabetes medication.

Treatment for Hyperglycaemia…

Treatment depends on cause of the hyperglycaemia and the current diabetes treatment.

• If it is insulin related, the dose has to be corrected.
• If the hyperglycaemia does not come down by changing medication dosage or if there is no illness, then check urine and blood for ketones and be aware of diabetic ketoacidosis and hyper osmolar hyperglycaemic state that requires emergency treatment.
• If you are treating your diabetes by diet or by using non- insulin medications, drink plenty of liquids that do not contain sugar and if possible, do some light activity such as walking.
• Keeping blood glucose levels on target is a difficult task. If the episodes of hyperglycaemia are happening very often or if they are increasing in duration or happening at a particular time of the day, go to your doctor as you may have to change your medication or require other treatment.

Keeping HbA1C levels as close to target as possible is the best way to reduce risk of complications.

Here are some tips for remembering to take medications-

• Make it a habit …

It is easier to remember to take your medications if you always take it before or after a particular routine task.

• Sort it:

Put the day’s requirement into a pill box to keep track of whether you have taken it or the time you have to take a medication.

• Stick a note

A note about your medication will act as a reminder. Carry an extra dose, keep an up-to-date list of medications with the dosage and how and when to take it.

• Make a note in your diary so that you can restock you medication early enough.

• Keep an alarm or reminder on your phone or computer to help you remember to take your medications. 

It is very important to pick up any kidney problems at an early stage…

Look for these signs…

• Swelling in the feet, ankles or hands due to water retention 

As the stages of nephropathy develop, in addition to water retention, symptoms include…

• Weight loss and poor appetite
• Shortness of breath
• Passing more or less urine than normal
• Itchy skin
• Muscle cramps
• Erectile dysfunction in men

Many of the symptoms   mentioned above can be avoided if kidney disease is diagnosed and treated at the early stages. 

Diabetes balance Nov-Dec , 2014