Hypoglycemia and Type 1 Diabetes

Log all blood glucose readings and events to discuss with your healthcare team. Always try to identify the potential cause or trigger for the hypoglycaemia and note these down as well.

Severe hypoglycaemia occurs when the blood glucose levels drop so low that you become incapable of self-treatment. Symptoms can include confusion, seizures and loss of consciousness. 

In such cases, someone else will need to help you by calling995 immediately for medical assistance and an intravenous glucose infusion to revive you. They should not try to feed you when you are unconscious and unable to swallow.  

If your family is trained, they can administer an emergency glucagon injection to elevate your blood sugar before the ambulance arrives. Discuss keeping a glucagon kit at home with your healthcare team.  Glucagon should be stored in the fridge, and the expiry date regularly checked to ensure that it has not expired. Your caregiver or family should be taught how to inject it. 

If you have frequent and recurrent episodes of hypoglycaemia, a condition called impaired awareness of hypoglycaemia or hypoglycaemia unawareness may develop. This means that you either no longer experience warning symptoms of hypoglycaemia, or have diminished symptoms.

This condition will increase your risk of severe hypoglycaemia.

You should discuss with your healthcare team should you suspect that you have impaired awareness of hypoglycaemia. You should avoid driving, operating heavy machinery, and undertaking high-risk activities like rock-climbing or diving.

You can regain awareness of hypoglycaemia by avoiding further episodes of hypoglycaemia and quickly treating any episodes of hypoglycaemia that occur. Your healthcare team will be able to help you regain awareness of hypoglycaemia. 

Understanding the causes of hypoglycaemia is key to reducing its occurence.

Common causes include: 

• Meal-related issues: 
  • Delaying/skipping meals after insulin administration
  • Insufficient carbohydrates in the meal for the administered quick-acting insulin 

• Insulin-related factors: 
  • Excessive basal insulin
  • Excessive correction insulin  given for high blood glucose

   

• Exercise-related factors:
  • Prolonged aerobic physical activity  (such as such as running, walking, swimming, cycling) 
  • Increased sensitivity to insulin which occurs after exercise

   

• Other factors: 
  • Weight loss (which increases sensitivity to insulin)
  • Alcohol consumption
  • Rarely, there may be other medical conditions causing frequent hypoglycaemia such as hypoadrenalism 

   

Episodes of hypoglycaemia can be reduced without compromising overall glycaemic control with the following strategies. Many of these strategies are covered in our  online resource page for Type 1 Diabetes. 

1. Smart insulin usage 

• Be on the right dose of basal insulin 
• Give the right dose of quick-acting insulin to match the carbohydrates in your meal
• Safe correction of high blood glucose levels  

2. Learn to manage your blood glucose levels before, during and after physical activity 

3. Using  flash glucose monitoring (FGM) or continuous glucose monitoring sensor (CGMS)

If you have impaired awareness of hypoglycaemia or frequent hypoglycaemia, a real-time CGMS will enable you to set alarms when your glucose readings are either low or dropping, so that you can take action to prevent a hypoglycaemia attack.

4. Your healthcare team might recommend an insulin pump if you experience frequent hypoglycaemia.