By Dr Vishal Gupta MD, MRCP (UK)

Dr Vishal GuptaHypoglycemia means low blood sugars usually below 80mg%. It becomes troublesome to the persons who experience them when it goes below 70mg% because important organs like the brain which are dependent on blood sugar for normal functioning start to fail (irritable, nervousness, lightheaded in the milder form of hypoglycemia, mental clouding, coma and death in the severest form). Hypoglycemia must therefore be avoided as far as possible as it is linked to impaired quality of life and increased patient mortality.

The commonest cause of hypoglycemia is anti-diabetes therapy in patients suffering from Diabetes. Patient should understand their hypoglycemic symptoms, learn to recognize them early and resolve them in time in order to avoid a fatal outcome. The most effective way to deal with a hypoglycemic attack is to consume natural sugars (fruits etc) or else artificial sugars (e.g. sugar crystals, chocolate) in case natural sugars aren’t available. The patients must try to reach out to their healthcare physicians as early as possible and iron out their diabetes therapy and diet which is often the culprit. Such maneuvers are usually successful in 95% of the times. It is also important that both the patient and physician recognize the ability or lack of ability of the patient in picking up the symptoms of hypoglycemia. In case the patient lacks the ability from a condition call “hypoglycemia un-awareness” every attempt must be made by the patient and physician in maintaining a safe blood sugar target goal and avoiding further hypoglycemic episodes.
Situations that endanger both the patient and others should be avoided as far as possible (e.g. self- driving) more so if the patient has hypoglycemia unawareness. Hypoglycemia is particularly dangerous in patients with heart disease, kidney disease and liver disease. They are often unpredictable in onset but usually occur in the early morning hours. A simple way to prevent such attacks is to introduce a bedtime snack till appropriate help from a specialist is sought. It is very important to ensure that the drugs that the patients are using are safe as most drugs do not have licensing in patients with heart, kidney or liver failure.

In the past oral anti-diabetes treatments were synonymously classified as oral-hypoglycemics. It was not till recently (2007) that the advent of newer medications influenced the way we healthcare physicians think, as being anti-hyperglycemic rather than hypoglycemic. A study called the ACCORD published in 2008 showed a significant increase in number deaths when an attempt was made to achieve very strict blood sugar control. Tight blood sugar control is required to decrease diabetes related complications. The main contributing factor to the increased mortality in the study was weight gain and hypoglycemia.

Just imagine a situation where tight blood sugar is achieved without increasing the risk of weight gain or hypoglycemia. It sounds too good to be true doesn’t it? This dream probably became a reality with the introduction of a new class of anti-diabetes drugs. They have found a unique place in the United Kingdom Diabetes treatment guidelines. The main indication for its usage exploits these very advantages (i.e. being weight neutral and anti-hyperglycemic rather than hypoglycemic) for which they are becoming popular in the healthcare circuit. The future of all diabetics holds a lot of promise with drugs being researched whose primary goal is safety (little or no hypoglycemia) and efficiacy.

For more details contact:
Dr Vishal Gupta MD, MRCP (UK)
Consulting Endocrine, Diabetes and Metabolic Physician, Jaslok Hospital
Tel No: 22065162, 22065262 (2.30 – 7.30pm)
Appointments: 9769327322