Part 1: Low blood sugar
Rasheed sahib's hands are shaking at the counter. His niece Sana has about a minute to work out why.
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Three o'clock in Rasheed sahib's shop. His lunch is still in its tiffin. A customer came, then another.
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“Two hundred… two hundred and — hold on.”
“Why is it so hot today?”
His hands are trembling. A bead of sweat runs down his forehead.
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“Chachu? You're shaking. And you're sweating.”
“I'm fine! I'm just suddenly so hungry. Don't fuss.”
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“Did you eat lunch? You started a new diabetes tablet last month.”
Shaking, sweating, a racing heart, hunger, anxiety or irritability, dizziness and tingling lips come first.
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Sana has seen enough: shaking, sweat, sudden hunger, a short temper.
What should Sana do first?
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ASit him in the shade with a glass of water.
What happens instead
Ten minutes later he is worse. He can't count the change at all.
“This isn't the heat.”
BCheck his sugar, and treat it if it's low.
✓ The right step
“Let me check your sugar first. If it's low, we treat it now.”
Check if you can. Below 70 mg/dL means treat — and if you can't check but feel a hypo, treat anyway.
COpen his tiffin: rice and salan.
What happens instead
Twenty minutes later he is still shaking.
Rice is too slow to lift a low.
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Sana's meter beeps: 62 mg/dL.
A hypo is a blood glucose below 70 mg/dL (3.9 mmol/L). Below 54 mg/dL (3.0 mmol/L) is serious and needs action at once.
“Fifteen grams of fast sugar. What have we got?”
“There's a whole shelf of biscuits right behind me!”
“Not biscuits, Chachu. Sugar in water.”
- Take 15 g of fast sugar: 3 teaspoons of sugar in water, or half a glass of juice or a regular cold drink.
- Not chocolate, mithai or biscuits: their fat slows the sugar down.
Fifteen minutes on the shop clock. Sana checks again: 64 mg/dL.
“Sixty-four. Still low. One more glass.”
Check again after 15 minutes. Still below 70? Take another 15 g.
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Fifteen minutes later the meter reads 96 mg/dL. His hands are steady on the notes again.
“Two hundred and fifty. There. I can count again.”
Once you are above 70, eat a snack with carbohydrate and protein if your next meal is a while away.
“So the tiffin wasn't wrong. It was just late.”
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“Next time, eat at one o'clock, customers or no customers. And tell Dr. Sahib about today.”
Hypos come almost only with insulin or sulphonylureas such as gliclazide, glimepiride and glibenclamide. The usual triggers are a late or missed meal, less roti than usual, extra exercise, a dose taken twice, kidney disease, and fasting without a plan.
If hypos keep happening, happen at night, or need someone else's help, book a review. Your doses may need to change.
And if a hypo ever goes further — if he were confused and couldn't swallow:
Nothing by mouth — they can choke. Lay them on their side, and call Rescue 1122 or get them to hospital. If glucagon has been prescribed, family members can give it, so make sure they know where it is and how to use it.
What to remember
- Check if you can. Below 70 mg/dL means treat — and if you can't check but feel a hypo, treat anyway.
- Take 15 g of fast sugar: 3 teaspoons of sugar in water, or half a glass of juice or a regular cold drink.
- Check again after 15 minutes. Still below 70? Take another 15 g.
- Once you are above 70, eat a snack with carbohydrate and protein if your next meal is a while away.
- Not chocolate, mithai or biscuits: their fat slows the sugar down.