Part 1: Low blood sugar

What counts as a hypo

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. A severe hypo is one where the person needs someone else's help, whatever the number.

How it feels

Shaking, sweating, a racing heart, hunger, anxiety or irritability, dizziness and tingling lips come first. Then confusion, blurred vision, clumsiness and odd behaviour. At night, a hypo can show up as nightmares, crying out in sleep, or waking in a sweat.

After many years of diabetes or many hypos, some people stop feeling the early signs. If that is you, tell your doctor: it changes how your treatment should be set.

The 15-15 rule

• 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.

If someone can'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.

Preventing the next one

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.