12/03/2021 / Endocrinology & Diabetes

How to manage Hypoglycemia with Medicine

Understand how managing hypoglycemic medication can help you lead a normal life. Hypoglycemia is the condition when blood sugar is depleted and falls to dangerously low levels such that it impairs your daily routine.

How to manage Hypoglycemia with Medicine
Mazia Ahmed Mazia Ahmed

Mazia Ahmed

MSc Nutrition Science, Ph.D. Scholar

Introduction 

Understand how managing hypoglycemic medication can help you lead a normal life. Hypoglycemia is the condition when blood sugar is depleted and falls to dangerously low levels such that it impairs your daily routine.

What is Hypoglycemia? 

The human body is fueled by sugar/glucose present for normal functioning. Hypoglycemia is the condition when blood sugar is depleted and falls to dangerously low levels such that it impairs a person’s daily routine. In terms of numbers, the sugar in our blood would ideally be in the range of 80 - 120 mg/dL. But in a hypoglycemic patient, it dips to less than 70 milligrams per deciliter (mg/dL).[1] 

A Hypoglycaemic Attack 

Our body, when it experiences Hypoglycemia will exhibit some symptoms. This can be classified as a mild hypoglycaemic episode with short-term ramifications or as a severe attack that can cause life-threatening complications. During the onset of a symptom, we need to try and normalize blood sugar by consuming easily absorbable sugary substances or also by considering a Glucose Intravenous Infusion. 

In a mild Hypoglycemic attack, the symptoms exhibited are:

  • Lowered cognitive capability

  • Blurred vision

  • Tremors

  • Irritable behavior

  • Raised heartbeat

  • Hunger pangs

  • Headaches

  • Ataxia(lack in coordination)

  • Confusion

  • Automatism(Automatic behavior, a person functions like they are on autopilot)

For severe cases, the symptoms include:

  • Blackouts

  • Seizure

  • Coma

How to manage Hypoglycemia with Medicine 1

How to cope with Hypoglycemia

There are several steps you can keep in mind to cope with a diagnosis of Hypoglycemia. These include keeping track of symptoms. If you recognize that your body is exhibiting any of the symptoms, make sure to ingest oral hypoglycemic drugs and follow the next stated crucial rules [3].

Be always prepared

The fastest way to beat the onset of a Hypoglycemic episode is to follow the rule of 15 [6]. It refers to consuming 15 grams of easily absorbable sugar/glucose consumed in the first 15 minutes and repeating if need be. Also, the individual needs to be precariously monitored for changes.

Checking blood sugar levels periodically

We need to check that the blood sugar has gone back to normal and if it has not, get professional help.

Know when to get hospitalized

In case things turn dire and if there is a chance that you will become unresponsive, always carry around a tag to help people identify that you live with Hypoglycemia and get hospitalized if conditions do not change.

How to manage Hypoglycemia with Medicine 2

Hypoglycemic drugs  

In the normal course to adjust our blood sugar, oral hypoglycemic drugs are prescribed along with lifestyle adjustments. Prescriptions always involve individual body types and glycemic goals. Drugs used are classified into four categories. They are:

  • Sulfonylureas:

These are the most common drugs used in the treatment of type 2 diabetes and they are employed to increase the responsiveness of the ß cells (located in the islets of Langerhans in the pancreas) which in turn improves insulin secretion. They are also important in improving tissue sensitivity to insulin by producing an extra-pancreatic effect. 

Use

Sulfonylureas can be distinguished by a generational divide; they are classified further into glipizide, glyburide (glibenclamide), and glimepiride. In terms of pharmacokinetics, sulfonylureas are equipped with a certain potency that makes them ideal to be ingested in low doses. 

Some sulfonylureas (like chlorpropamide, glyburide, and glimepiride) have longer half-lives and as such can be prescribed once daily and this is highly beneficial to counter any impending risk of a hypoglycemic episode.

Side effects

Side effects can manifest if the drug is taken in certain circumstances. These scenarios may be: 

  1. After a missed meal

  2. Following rigorous exercise 

  3. If the dose is too high

  4. Taken in tandem with alcohol

  5. When you are undernourished 

  6. When you take it with blood thinners like warfarin, fibric acid derivatives, sulfonamides, or salicylates

  • Metformin:

This is primarily the first-line treatment for type 2 diabetes. It is specially prescribed for overweight patients and female patients who suffer from PCOS (Polycystic Ovary Syndrome).

Use

Metformin action is completely different from sulfonylureas, instead of directly affecting insulin secretion it affects the action of insulin in our body. It also has the added advantage of suppressing glucose output from the liver thus stalling fluctuating blood sugar. It is often prescribed for overweight patients as it promotes modest weight loss and in other cases makes your weight stable. In combination with sulfonylurea, it lowers blood sugar drastically rather than each drug's action alone. The main advantage of metformin is that it is less suspected to cause a hypoglycemic episode and in promoting lipid-lowering activity, it produces a reduction in bad cholesterol LDL (low-density lipoprotein) and elevation in HDL (high-density lipoprotein) cholesterol concentration.

Side effects

These are related to the gastrointestinal part of the body and include the following:

  1. Mild anorexia

  2. Metallic taste in the mouth

  3. Abdominal discomfort

  4. Diarrhea

The symptoms are mild and transient and will stop when the patients stop taking them. But the main risk factor is lactic acidosis which in tandem with certain predisposing conditions can prove to be fatal.

In pharmacokinetics, the drug should be ingested with meals and in low doses so as not to induce any gastrointestinal side effects and dosage can be gradually increased as needed to an upper limit of 2550 mg/day.

  • Thiazolidinediones: Main types include Rosiglitazone and Pioglitazone. 

Use

They mainly act in reversing insulin resistance in our body with a specific action to the muscle, fat, and a lower extent the liver. They mainly function in increasing utilization and diminishing the production of glucose in our body.

Side effects

An early derivative, Rezulin, a specific Thiazolidinediones drug was involved in inducing severe liver damage in several patients but it has since been removed from the market. Newer drugs such as Actos and Avandia have exhibited a low incidence of these symptoms.

  • Alpha-glucosidase inhibitors: They include two market-ready drugs namely acarbose (Precose) & Miglitol (Glycet). 

Use

Their main function is to inhibit the body’s upper gastrointestinal enzymes. This in turn helps the body in digesting dietary starch and any complex carbohydrates to simple sugars and results in low and slow absorption of glucose after meals.

Side effects

Side effects are mild and transient; they include:

  1. Flatulence

  2. Diarrhea

Living with Hypoglycaemia is difficult and currently, it does not have a cure. Lifestyle changes, dietary control, and corrective hypoglycemic drugs are a patient’s only choices

Word of Wisdom:

Hypoglycemia can be very dangerous and lead to several complications, but if you follow a strict routine and your food, then it can be managed easily, and you can do your day-to-day activities normally.

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