How do I know when my relative with diabetes is having a low blood sugar reaction? What should I do to help?

How do I know when my relative with diabetes is having a low blood sugar reaction? What should I do to help?

The signs of a low blood sugar reaction can range from fairly obvious to quite subtle and hard to detect. The very young and the elderly are less likely to spontaneously complain of symptoms, but more often just slip into hypoglycemia. Those who have had diabetes for a long time, generally more than 10 years, may lose
their ability to perceive hypoglycemia and fail to make complaints or take action to prevent seriously low blood sugar from occurring. This is much more common in longstanding type 1 diabetes than it is in type 2 diabetes.

Those who are aware that something is wrong and who are able to voice their concerns will complain of a combination of hunger, headache, shakiness, sweating, palpitations (a sensation of fluttering in the chest), blurred vision, and inability to think straight or coordinate their actions, especially fine motor actions such as writing, typing, or dialing phone numbers. The very young, the elderly, or those with unawareness of low blood sugar will often exhibit confusion or bizarre behavior, shakiness, sweating, drowsiness, or restlessness in the earlier stages. Bizarre behavior can take many forms, from inappropriate laughing or crying, aggression, staring blankly, to making repetitive movements or inappropriate verbal responses to questions. Most people with diabetes will have their own individual pattern of behavior that tends to repeat itself each time their blood sugar is low. Therefore, familiarity is very helpful for recognition of low blood sugar in loved ones or colleagues.

If the low blood sugar is severe, loss of consciousness and seizures will occur. This is of course very worrisome to the observer and necessitates prompt action. Loss of consciousness can result from both very high and very low blood sugar. It comes on much more rapidlywith low blood sugar than with high blood sugar and is usually more rapidly reversible if treated promptly and effectively. However, unless the circumstances unmistakably indicate high blood sugar, or a fingerstick glucose reading is available, the safest treatment is to administer sugar or glucose or use a glucagon injection kit.

Additional glucose is unlikely to worsen in the short term the already serious situation of a coma due to high blood sugar, but could be lifesaving to a person with coma due to a very low blood sugar. Therefore, when in doubt, glucose or household sugar administration is the best route to take. Fortunately, the body has powerful mechanisms to prevent the blood sugar from becoming fatally low and these are generally intact in those with diabetes. For this reason, severely low blood sugar, while it is an emergency, is seldom fatal, considering how often it occurs.