Know the Signs of Hypoglycemia | Diabetes Center

Hypoglycemia can be a very serious condition, with extreme cases causing seizures, coma, and even death. It occurs when blood sugar levels drop too low, and it is most often experienced by people with diabetes.

As you learn about diabetes management, being well versed in low blood sugar symptoms will enable you to detect the signs of impending hypoglycemia and act quickly to head it off or minimize its impact.

Diabetes Type and Hypoglycemia Risk

Hypoglycemia risk varies across the three different types of diabetes:

Type 1 Diabetes People with type 1 diabetes experience hypoglycemia most often, as their diabetes management often requires a lot of attention and careful planning. The average person with type 1 diabetes who is attempting aggressive disease control may still experience low blood sugar symptoms frequently, and a full-blown case of hypoglycemia will require close medical attention.

“When it comes to type 1 diabetes, the body can’t make insulin on its own, so it must be administered,” notes Erin Palinski-Wade, RD, CDE, Everyday Health contributor and author of Belly Fat for Dummies. Paying close attention to your diet is important, too. “If the correct amount of insulin is given based on the amount of carbohydrates consumed, blood sugar levels can remain in a healthy range.”

Type 2 Diabetes These patients experience hypoglycemia less frequently than people with type 1 diabetes; the rate of hypoglycemia for type 2 diabetes patients taking insulin is about one-third that of type 1 diabetes patients. But research shows that the frequency of hypoglycemia in people with type 2 diabetes increases as the disease becomes more advanced.

“In people with type 2 diabetes, the body may produce adequate insulin, yet the cells are resistant to it, making the insulin ineffective at transferring blood glucose into the cells to be used as energy,” says Palinski-Wade.

People with both types of diabetes should aim to eat complex carbohydrates. “Avoiding refined carbohydrates and simple sugars is key in reducing insulin resistance, so that the body can better process blood glucose levels,” she says.

Gestational Diabetes This type of diabetes only happens during pregnancy, and occurs when your pancreas can’t make enough insulin, often due to changes in hormones. Gestational diabetes patients may experience hypolgycemia even if they take insulin during their pregnancy. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), your chances of getting this type of diabetes is higher if you’re overweight, though there are other factors, too.

Low Blood Sugar Symptoms

The warning signs of hypoglycemia may vary from person to person, but it’s important to know about and be alert to all of them, including:

• Feeling very shaky or trembling
• Weakness or dizziness
• Sweating or feeling cold and clammy
• Extreme hunger pangs
• Trouble keeping your balance or staggering when you walk
• Pale or gray skin
• A bad headache
• Becoming confused and unable to think or concentrate
• Feeling uncharacteristically moody or cranky
• A tingling sensation around your mouth
• Double vision or vision that has grown blurry
• A quickening heartbeat

Some people will experience an episode of hypoglycemia in their sleep. Signs of nocturnal hypoglycemia include:

• Waking up with your pajamas or sheets soaked with sweat
• Feeling cranky, irritable, tired, or confused after waking up
• Having nightmares or crying out in your sleep

People with extreme hypoglycemia may pass out or experience seizures as a result of low blood sugar. These people are in danger of lapsing into a coma and could die if not treated.

What You Should Do

Still, there are steps you can take to help prevent your blood sugar from dropping too low. “Take the time to schedule frequent meals and snacks,” advises Palinski-Wade. “Going long periods of time without eating, especially after physical activity, is one of the main reasons for drops in blood sugar levels. If you’re prone to frequent lows, testing blood sugar levels often is also an effective way to prevent this.”

If you have diabetes and think you’re experiencing hypoglycemia, you should test your blood sugar levels as soon as possible using a glucose meter. Levels below 70 milligrams per deciliter will require immediate treatment.

The best way to treat hypoglycemia is to eat some form of sugar. The American Diabetes Association (ADA) recommends getting between 15 and 20 grams (g) of sugars or carbohydrates with each snack, and between 40 and 65 g at each meal.

Although the ADA recommendation can offer a helpful framework, Palinski-Wade notes that counting and restricting carbs isn’t a one-size-fits-all approach. “Someone who is more prone to hypoglycemia may have different per-meal carbohydrate goals than another individual,” she says. “Getting 15 to 30 g of carbs per snack and 45 to 60 g per meal is a good starting point, but you should work together with your diabetes treatment team to see what carbohydrate goals work best for your own individual needs.”

If your blood sugar drops drastically, you can take a few immediate steps to address the situation. “Once you know your blood sugar is low, use the 15/15 rule,” Palinski-Wade says. “Consume 15g of quick acting carbs (such as orange juice), wait 15 minutes, and retest your blood sugar. Continue to repeat this until your blood sugar levels are within a healthy range.” By following this advice, Palinski-Wade says you may be better able to prevent yourself from eating too many carbs at once, which may spike blood sugar levels. Some other quick-acting sources of carbs include:

• Fruit juice, 1/2 cup
• Regular (non-diet) soda, 1/2 cup
• Milk, 1 cup
• Hard candy, 5 or 6 pieces
• Saltine crackers, 4 or 5
• Raisins, 2 tablespoons (tbsp)
• Sugar or honey, 1 tbsp
• Glucose tablets, 3 or 4
• Glucose gel, 1 serving

If you pass out or experience seizures, you need to see your doctor or call 911 to get to an emergency room for treatment.

To help manage diabetes and keep hypoglycemia from occurring, Palinski-Wade recommends staying focused on eating a diet high in fiber, vegetables, fruits, whole grains, lean proteins, and healthy fats, and limiting large amounts of added sugars and saturated fats. Also, “frequently testing blood glucose levels and tracking carbohydrate intake, exercise, stress levels, and sleep patterns — and sharing this data with your diabetes care team — is the most effective way to help you best manage diabetes and prevent spikes and crashes in blood glucose levels,” she says.

Symptoms, Causes, Treatment & Safety Tips

Overview

What is hypoglycemia?

Hypoglycemia is when the level of sugar in the blood drops below a healthy range. It’s also called low blood sugar or low blood glucose.

Everyone has different levels of blood sugar at different times. But for most people, low blood sugar is defined as below 70 mg/dL (milligrams per deciliter). Severe hypoglycemia usually happens at lower levels and is generally defined as a low blood sugar event that requires the assistance of someone else in order to correct the low blood sugar. Severe hypoglycemia is dangerous and needs treatment right away.

Symptoms and Causes

What causes hypoglycemia?

Hypoglycemia comes from too much insulin in the body. Insulin is a hormone that controls certain functions in your body. It helps your body use glucose for energy.

What’s the link between diabetes and hypoglycemia?

Hypoglycemia is most common, by far, in people with diabetes. Treatment for the disease often involves taking medication to increase insulin. Hypoglycemia can develop if things like food, exercise and diabetes medications are out of balance.

Common pitfalls for people with diabetes include:

• Being more active than usual.
• Drinking alcohol without eating.
• Eating late or skipping meals.
• Not balancing meals by including fat, protein and fiber.
• Not eating enough carbohydrates.
• Not timing insulin and carb intake correctly (for example, waiting too long to eat a meal after taking insulin for the meal).

Also, if someone with diabetes uses the wrong insulin, takes too much or injects it incorrectly, that can cause hypoglycemia.

Can someone have hypoglycemia without diabetes?

Very rarely, someone has hypoglycemia without diabetes. Scientists are still trying to understand the cause.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia can start quickly, with people experiencing them in different ways. The signs of hypoglycemia are unpleasant. But they provide good warnings that you should take action before blood sugar drops more. The signs include:

• Shaking or trembling.
• Sweating and chills.
• Dizziness or lightheadedness.
• Faster heart rate.
• Headaches.
• Hunger.
• Nausea.
• Nervousness or irritability.
• Pale skin.
• Restless sleep.
• Weakness.

You may also experience symptoms while sleeping:

• Crying out loud.
• Feeling tired or confused after waking up.
• Having nightmares.
• Sweating through pajamas or sheets.

When a hypoglycemic episode gets worse, the brain doesn’t get enough sugar, so you may experience:

• Blurry vision.
• Confusion or trouble concentrating.
• Sleepiness.
• Slurred speech.
• Tingling or numbness in the face or mouth.

During a severe hypoglycemic event, a person may:

• Be unable to eat or drink.
• Have a seizure or convulsions (out-of-control body jerks).
• Lose consciousness.
• Slip into a coma or die (very rarely).

Does everyone have symptoms from hypoglycemia?

Some people don’t have symptoms or don’t notice them. Healthcare providers call that situation hypoglycemia unawareness. People with such a challenge aren’t aware when they need to do something about their blood sugar. They’re then more likely to have severe episodes and need medical help. People with hypoglycemia unawareness should check their blood sugar more often.

Diagnosis and Tests

How is hypoglycemia diagnosed?

The only way to know if you have hypoglycemia is to check your blood sugar with a blood glucose meter. It’s a small machine that measures blood sugar. Most of these devices use a tiny prick of the finger to take a small amount of blood.

People with hypoglycemia unawareness may need a continuous glucose monitor. These wearable devices measure glucose every few minutes, day and night. An alarm sounds if blood sugar drops too low.

Management and Treatment

How do I treat an episode of hypoglycemia?

The American Diabetes Association recommends the “15-15 rule” for an episode of hypoglycemia:

• Eat or drink 15 grams of carbs to raise your blood sugar.
• After 15 minutes, check your blood sugar.
• If it’s still below 70 mg/dL, have another 15 grams of carbs.
• Repeat until your blood sugar is at least 70 mg/dL.

If you have symptoms of hypoglycemia but can’t test your blood sugar, use the 15-15 rule until you feel better.

Note: Children need fewer grams of carbs. Check with your healthcare provider.

How do I measure carbs?

To know how many carbs you’re having, read food labels. Some examples of about 15 grams:

• 1 small piece of fruit.
• 1 tablespoon of sugar, honey or corn syrup.
• 1 tube instant glucose gel (check the instructions).
• 3 peppermint candies (not sugar-free).
• 3-4 glucose tablets (check the instructions).
• 4 ounces (half-cup) of juice or regular soda (not diet).
• 5 Life Savers® candies (not sugar-free).

What if the 15-15 rule doesn’t work?

If you don’t feel better after three tries, or if your symptoms get worse, call your healthcare provider or 911. Healthcare providers can use a medication called glucagon. They inject it with a needle or squirt it up your nose. Glucagon is also available for home use. Your healthcare provider can prescribe it and teach a family member or friend how to use it in the event of severe hypoglycemia.

Prevention

How can I prevent hypoglycemic episodes?

The key to preventing hypoglycemic events is managing diabetes:

• Follow your healthcare provider’s instructions about food and exercise.
• Track your blood sugar regularly, including before and after meals, before and after exercise and before bed.
• Take all your medications exactly as prescribed.
• When you do have a hypoglycemic event, write it down. Include details such as the time, what you ate recently, whether you exercised, the symptoms and your glucose level.

Outlook / Prognosis

What is the outlook for people with hypoglycemia?

Hypoglycemia can be managed when you and your healthcare provider understand what causes your blood sugar to go down. Give your healthcare provider as much information as possible about any hypoglycemic episodes. Fixing the problem may be as simple as changing the times you take medication, eat and exercise. Minor changes to the types of food you eat may also help.

Living With

How can I be better prepared for hypoglycemia?

You can take some steps to be ready for hypoglycemia:

• Be aware of the symptoms and treat them early.
• Carry some fast-acting carbs with you all the time.
• Check your glucose levels frequently, especially around meals and exercise.
• Inform family, friends and co-workers so they know what do if you need help.
• Talk to your healthcare provider regularly to make and update your plan.
• Wear a medical bracelet that lets people know you have diabetes. Carry a card in your purse or wallet with instructions for hypoglycemia.

A note from Cleveland Clinic

Hypoglycemia is quite common in people with diabetes. If not treated, it can cause troubling symptoms, and even serious health problems. Fortunately, you can avoid hypoglycemic episodes by monitoring your blood sugar. You can also make small adjustments to eating and exercising routines.

Symptoms, Causes, Treatment & Safety Tips

Overview

What is hypoglycemia?

Hypoglycemia is when the level of sugar in the blood drops below a healthy range. It’s also called low blood sugar or low blood glucose.

Everyone has different levels of blood sugar at different times. But for most people, low blood sugar is defined as below 70 mg/dL (milligrams per deciliter). Severe hypoglycemia usually happens at lower levels and is generally defined as a low blood sugar event that requires the assistance of someone else in order to correct the low blood sugar. Severe hypoglycemia is dangerous and needs treatment right away.

Symptoms and Causes

What causes hypoglycemia?

Hypoglycemia comes from too much insulin in the body. Insulin is a hormone that controls certain functions in your body. It helps your body use glucose for energy.

What’s the link between diabetes and hypoglycemia?

Hypoglycemia is most common, by far, in people with diabetes. Treatment for the disease often involves taking medication to increase insulin. Hypoglycemia can develop if things like food, exercise and diabetes medications are out of balance.

Common pitfalls for people with diabetes include:

• Being more active than usual.
• Drinking alcohol without eating.
• Eating late or skipping meals.
• Not balancing meals by including fat, protein and fiber.
• Not eating enough carbohydrates.
• Not timing insulin and carb intake correctly (for example, waiting too long to eat a meal after taking insulin for the meal).

Also, if someone with diabetes uses the wrong insulin, takes too much or injects it incorrectly, that can cause hypoglycemia.

Can someone have hypoglycemia without diabetes?

Very rarely, someone has hypoglycemia without diabetes. Scientists are still trying to understand the cause.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia can start quickly, with people experiencing them in different ways. The signs of hypoglycemia are unpleasant. But they provide good warnings that you should take action before blood sugar drops more. The signs include:

• Shaking or trembling.
• Sweating and chills.
• Dizziness or lightheadedness.
• Faster heart rate.
• Headaches.
• Hunger.
• Nausea.
• Nervousness or irritability.
• Pale skin.
• Restless sleep.
• Weakness.

You may also experience symptoms while sleeping:

• Crying out loud.
• Feeling tired or confused after waking up.
• Having nightmares.
• Sweating through pajamas or sheets.

When a hypoglycemic episode gets worse, the brain doesn’t get enough sugar, so you may experience:

• Blurry vision.
• Confusion or trouble concentrating.
• Sleepiness.
• Slurred speech.
• Tingling or numbness in the face or mouth.

During a severe hypoglycemic event, a person may:

• Be unable to eat or drink.
• Have a seizure or convulsions (out-of-control body jerks).
• Lose consciousness.
• Slip into a coma or die (very rarely).

Does everyone have symptoms from hypoglycemia?

Some people don’t have symptoms or don’t notice them. Healthcare providers call that situation hypoglycemia unawareness. People with such a challenge aren’t aware when they need to do something about their blood sugar. They’re then more likely to have severe episodes and need medical help. People with hypoglycemia unawareness should check their blood sugar more often.

Diagnosis and Tests

How is hypoglycemia diagnosed?

The only way to know if you have hypoglycemia is to check your blood sugar with a blood glucose meter. It’s a small machine that measures blood sugar. Most of these devices use a tiny prick of the finger to take a small amount of blood.

People with hypoglycemia unawareness may need a continuous glucose monitor. These wearable devices measure glucose every few minutes, day and night. An alarm sounds if blood sugar drops too low.

Management and Treatment

How do I treat an episode of hypoglycemia?

The American Diabetes Association recommends the “15-15 rule” for an episode of hypoglycemia:

• Eat or drink 15 grams of carbs to raise your blood sugar.
• After 15 minutes, check your blood sugar.
• If it’s still below 70 mg/dL, have another 15 grams of carbs.
• Repeat until your blood sugar is at least 70 mg/dL.

If you have symptoms of hypoglycemia but can’t test your blood sugar, use the 15-15 rule until you feel better.

Note: Children need fewer grams of carbs. Check with your healthcare provider.

How do I measure carbs?

To know how many carbs you’re having, read food labels. Some examples of about 15 grams:

• 1 small piece of fruit.
• 1 tablespoon of sugar, honey or corn syrup.
• 1 tube instant glucose gel (check the instructions).
• 3 peppermint candies (not sugar-free).
• 3-4 glucose tablets (check the instructions).
• 4 ounces (half-cup) of juice or regular soda (not diet).
• 5 Life Savers® candies (not sugar-free).

What if the 15-15 rule doesn’t work?

If you don’t feel better after three tries, or if your symptoms get worse, call your healthcare provider or 911. Healthcare providers can use a medication called glucagon. They inject it with a needle or squirt it up your nose. Glucagon is also available for home use. Your healthcare provider can prescribe it and teach a family member or friend how to use it in the event of severe hypoglycemia.

Prevention

How can I prevent hypoglycemic episodes?

The key to preventing hypoglycemic events is managing diabetes:

• Follow your healthcare provider’s instructions about food and exercise.
• Track your blood sugar regularly, including before and after meals, before and after exercise and before bed.
• Take all your medications exactly as prescribed.
• When you do have a hypoglycemic event, write it down. Include details such as the time, what you ate recently, whether you exercised, the symptoms and your glucose level.

Outlook / Prognosis

What is the outlook for people with hypoglycemia?

Hypoglycemia can be managed when you and your healthcare provider understand what causes your blood sugar to go down. Give your healthcare provider as much information as possible about any hypoglycemic episodes. Fixing the problem may be as simple as changing the times you take medication, eat and exercise. Minor changes to the types of food you eat may also help.

Living With

How can I be better prepared for hypoglycemia?

You can take some steps to be ready for hypoglycemia:

• Be aware of the symptoms and treat them early.
• Carry some fast-acting carbs with you all the time.
• Check your glucose levels frequently, especially around meals and exercise.
• Inform family, friends and co-workers so they know what do if you need help.
• Talk to your healthcare provider regularly to make and update your plan.
• Wear a medical bracelet that lets people know you have diabetes. Carry a card in your purse or wallet with instructions for hypoglycemia.

A note from Cleveland Clinic

Hypoglycemia is quite common in people with diabetes. If not treated, it can cause troubling symptoms, and even serious health problems. Fortunately, you can avoid hypoglycemic episodes by monitoring your blood sugar. You can also make small adjustments to eating and exercising routines.

Symptoms, Causes, Treatment & Safety Tips

Overview

What is hypoglycemia?

Hypoglycemia is when the level of sugar in the blood drops below a healthy range. It’s also called low blood sugar or low blood glucose.

Everyone has different levels of blood sugar at different times. But for most people, low blood sugar is defined as below 70 mg/dL (milligrams per deciliter). Severe hypoglycemia usually happens at lower levels and is generally defined as a low blood sugar event that requires the assistance of someone else in order to correct the low blood sugar. Severe hypoglycemia is dangerous and needs treatment right away.

Symptoms and Causes

What causes hypoglycemia?

Hypoglycemia comes from too much insulin in the body. Insulin is a hormone that controls certain functions in your body. It helps your body use glucose for energy.

What’s the link between diabetes and hypoglycemia?

Hypoglycemia is most common, by far, in people with diabetes. Treatment for the disease often involves taking medication to increase insulin. Hypoglycemia can develop if things like food, exercise and diabetes medications are out of balance.

Common pitfalls for people with diabetes include:

• Being more active than usual.
• Drinking alcohol without eating.
• Eating late or skipping meals.
• Not balancing meals by including fat, protein and fiber.
• Not eating enough carbohydrates.
• Not timing insulin and carb intake correctly (for example, waiting too long to eat a meal after taking insulin for the meal).

Also, if someone with diabetes uses the wrong insulin, takes too much or injects it incorrectly, that can cause hypoglycemia.

Can someone have hypoglycemia without diabetes?

Very rarely, someone has hypoglycemia without diabetes. Scientists are still trying to understand the cause.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia can start quickly, with people experiencing them in different ways. The signs of hypoglycemia are unpleasant. But they provide good warnings that you should take action before blood sugar drops more. The signs include:

• Shaking or trembling.
• Sweating and chills.
• Dizziness or lightheadedness.
• Faster heart rate.
• Headaches.
• Hunger.
• Nausea.
• Nervousness or irritability.
• Pale skin.
• Restless sleep.
• Weakness.

You may also experience symptoms while sleeping:

• Crying out loud.
• Feeling tired or confused after waking up.
• Having nightmares.
• Sweating through pajamas or sheets.

When a hypoglycemic episode gets worse, the brain doesn’t get enough sugar, so you may experience:

• Blurry vision.
• Confusion or trouble concentrating.
• Sleepiness.
• Slurred speech.
• Tingling or numbness in the face or mouth.

During a severe hypoglycemic event, a person may:

• Be unable to eat or drink.
• Have a seizure or convulsions (out-of-control body jerks).
• Lose consciousness.
• Slip into a coma or die (very rarely).

Does everyone have symptoms from hypoglycemia?

Some people don’t have symptoms or don’t notice them. Healthcare providers call that situation hypoglycemia unawareness. People with such a challenge aren’t aware when they need to do something about their blood sugar. They’re then more likely to have severe episodes and need medical help. People with hypoglycemia unawareness should check their blood sugar more often.

Diagnosis and Tests

How is hypoglycemia diagnosed?

The only way to know if you have hypoglycemia is to check your blood sugar with a blood glucose meter. It’s a small machine that measures blood sugar. Most of these devices use a tiny prick of the finger to take a small amount of blood.

People with hypoglycemia unawareness may need a continuous glucose monitor. These wearable devices measure glucose every few minutes, day and night. An alarm sounds if blood sugar drops too low.

Management and Treatment

How do I treat an episode of hypoglycemia?

The American Diabetes Association recommends the “15-15 rule” for an episode of hypoglycemia:

• Eat or drink 15 grams of carbs to raise your blood sugar.
• After 15 minutes, check your blood sugar.
• If it’s still below 70 mg/dL, have another 15 grams of carbs.
• Repeat until your blood sugar is at least 70 mg/dL.

If you have symptoms of hypoglycemia but can’t test your blood sugar, use the 15-15 rule until you feel better.

Note: Children need fewer grams of carbs. Check with your healthcare provider.

How do I measure carbs?

To know how many carbs you’re having, read food labels. Some examples of about 15 grams:

• 1 small piece of fruit.
• 1 tablespoon of sugar, honey or corn syrup.
• 1 tube instant glucose gel (check the instructions).
• 3 peppermint candies (not sugar-free).
• 3-4 glucose tablets (check the instructions).
• 4 ounces (half-cup) of juice or regular soda (not diet).
• 5 Life Savers® candies (not sugar-free).

What if the 15-15 rule doesn’t work?

If you don’t feel better after three tries, or if your symptoms get worse, call your healthcare provider or 911. Healthcare providers can use a medication called glucagon. They inject it with a needle or squirt it up your nose. Glucagon is also available for home use. Your healthcare provider can prescribe it and teach a family member or friend how to use it in the event of severe hypoglycemia.

Prevention

How can I prevent hypoglycemic episodes?

The key to preventing hypoglycemic events is managing diabetes:

• Follow your healthcare provider’s instructions about food and exercise.
• Track your blood sugar regularly, including before and after meals, before and after exercise and before bed.
• Take all your medications exactly as prescribed.
• When you do have a hypoglycemic event, write it down. Include details such as the time, what you ate recently, whether you exercised, the symptoms and your glucose level.

Outlook / Prognosis

What is the outlook for people with hypoglycemia?

Hypoglycemia can be managed when you and your healthcare provider understand what causes your blood sugar to go down. Give your healthcare provider as much information as possible about any hypoglycemic episodes. Fixing the problem may be as simple as changing the times you take medication, eat and exercise. Minor changes to the types of food you eat may also help.

Living With

How can I be better prepared for hypoglycemia?

You can take some steps to be ready for hypoglycemia:

• Be aware of the symptoms and treat them early.
• Carry some fast-acting carbs with you all the time.
• Check your glucose levels frequently, especially around meals and exercise.
• Inform family, friends and co-workers so they know what do if you need help.
• Talk to your healthcare provider regularly to make and update your plan.
• Wear a medical bracelet that lets people know you have diabetes. Carry a card in your purse or wallet with instructions for hypoglycemia.

A note from Cleveland Clinic

Hypoglycemia is quite common in people with diabetes. If not treated, it can cause troubling symptoms, and even serious health problems. Fortunately, you can avoid hypoglycemic episodes by monitoring your blood sugar. You can also make small adjustments to eating and exercising routines.

Night Sweats And Diabetes: What Is Nocturnal Hypoglycemia?

Do you find yourself waking at night drenched in sweat and feeling hot and clammy – even when the room is cold? You’re not alone. Night sweats are a common symptom of nocturnal hypoglycemia – the night-time low blood sugar episodes experienced by some diabetics.
 

What is nocturnal hypoglycaemia?

Not heard diabetic night sweats referred to as nocturnal hypoglycaemia before? Nocturnal hypoglycaemia is when a hypoglycemic episode happens as you sleep. It is more common in people who control their diabetes with insulin and often you will only realise you’ve experienced a night time hypo on waking up. You may only discover night time hypos when you wake with some or all of the following nocturnal hypoglycemia symptoms:

• Headache
• Clammy neck
• Damp from excessive sweating
• Feeling fatigued

What causes night sweats in diabetics?

The main cause of night sweats in diabetics is low blood sugar at night (hypogylcemia).

When blood sugar levels drop, this can cause a number of sleep-disturbing symptoms, including headaches and excessive sweating. While night sweats can occur across the whole body, in people experiencing nocturnal hypoglycemia, the neck often becomes noticeably sweaty, making this a key sign to look out for.

So what causes diabetes and night sweats? Essentially, this is anything that could cause glucose levels to drop overnight. Some of the most common causes of nocturnal diabetes include:

• Insulin use: Hypoglycemia is more common in diabetics who use insulin to manage their condition.
• Exercise: Being more active means you’ll have used more glucose during the day. In particular, exercising in the hours before bed increases the chances of low blood sugar at night.
• Alcohol: Drinking alcohol in the hours before bed can decrease your liver’s ability to produce glucose overnight.

Dealing with low blood sugar and night sweats

For the most part, dealing with diabetic night sweats and nocturnal hypoglycaemia means making sure that you manage your condition to reduce the risk of experiencing low blood sugar levels at night.

The following tips can help:

• Test your glucose levels before bed: If levels are already on the low side, you can take preventative action before going to sleep.
• Watch what you eat in the evening:
  • Avoid wine, beer or other alcoholic drinks in the hours before bed
  • Increase snacking if you’ve been more physically active during the day
  • Avoid hot and spicy foods as these can cause night sweats even in those who don’t have diabetes

• Reschedule your exercise routine: If you usually workout in the evening, try moving this to earlier in the day.
• Speak with your GP: They may be able to advise on changes to your medication to help ease nocturnal hypoglycaemia symptoms. It’s also important to remember that while night sweats are quite common for diabetics, they can also be a sign of other underlying conditions. Discuss your night sweats with your GP to eliminate any other possible causes.

How to get relief from diabetic night sweats

Taking steps to prevent the nocturnal hypoglycemia that can cause diabetic night sweats is the first and most important thing. But there are also a number of steps you can take to alleviate the symptoms of diabetic night sweats and get a better night’s sleep.

• Keep your bedroom cool: Turn heating off or down to an absolute minimum in the hours before bed. You can also try leaving a window open or keeping a fan running to improve ventilation.
• Choose natural nightwear: Sleep in natural fibers such as cotton, wool or silk. These materials are more breathable and more effective at absorbing moisture than synthetic alternatives such as polyester. So, you can stay cool and avoid that clammy feeling.
• Sleep in natural bedding: As with nightwear, bedding made from natural fibers is more effective at regulating temperature and absorbing moisture. For maximum benefit try wool bedding as this natural fiber is more absorbent than feather/down alternatives. Partner a wool duvet, pillows and protector with cotton sheets and covers for best performance.

Want to know more about your health and sleep? Learn about the other reasons for night sweats, from hot flushes to medication and more. Visit our Sleep Health & Advice Hub today.

11 Warning Signs Of Hypoglycemia, Explained By Doctors

If you get the tremors and feel decidedly tired and grumpy when you haven’t eaten for a while, you may just be getting hangry — or you could have hypoglycemia, the technical term for very low blood sugar. Although it’s most common in people with diabetes, it can occur for other reasons as well, and there are distinct warning signs of hypoglycemia that you can look out for. Low blood sugar can cause both short-term and longer-term complications, making it important you know what bodily changes could signify the condition.

Blood sugar is the amount of glucose in your blood at any given time, and it’s pretty crucial to your health. Glucose fuels your body, including your muscles and brain, and is a major source of energy. When it dips to low levels, you’ll definitely start feeling it.

“Hypoglycemia typically relates to a blood sugar less than 60 for most people,” says Dr. Heather Bartlett M.D.. “However, some people that are unknown diabetics or are pre-diabetic may be living at a higher blood sugar all the time, above normal, so even a drop to what is considered normal for most people could provoke a symptom of hypoglycemia.”

Dr. Katherine Araque, M.D., an endocrinologist at Providence Saint John’s Health Center, tells Bustle that there are two types of hypoglycemia symptoms: neuroglycopenic ones, which are caused by the brain being deprived of glucose, and neurogenic ones, which are caused by adrenaline rushes. When you’re hypoglycemic, your brain produces adrenaline to tell your liver to make more sugar, and that can make you jittery as hell. Think of it a bit like a panic attack, accidentally kicked off by your liver.

In addition to diabetes, hypoglycemia can be caused by diet, certain medications, hormone or enzyme deficiencies, and more, according to Harvard Health. Discovering signs of hypoglycemia can help you get treated for any underlying medical issues and prevent possible damage.

If you’re feeling off and think your blood sugar might be to blame, watch out for these 11 warning signs that could mean you’re hypoglycemic.

1

Fatigue

“Each person’s individual reaction to low blood sugar may vary,” Dr. Neal Shipley M.D., medical director at Northwell Health GoHealth Urgent Care, tells Bustle, but tiredness is pretty common. Glucose is a big source of energy for your brain; without a lot of sugar in your blood, it’ll lack get-up-and-go, according to the U.S. National Library of Medicine. When you’re hypoglycemic, your brain doesn’t have enough blood sugar to fuel its activities, so you’ll likely start feeling like you need some ZZZs immediately.

2

Irritability & Anxiety

“Some people may experience feeling anxiety [during hypoglycemia],” Dr. Becky Koickel, M.D., associate medical director at Northwell Health GoHealth Urgent Care, tells Bustle. This, Dr. Araque says, is a neurogenic symptom, where adrenaline rushes through your brain. It can cause severe mood swings or anxiety, or it could even be something as mild as general irritability or feeling easily annoyed. Suddenly your housemate’s breathing might sound really aggravating.

3

Headaches

Headaches from hypoglycemia are usually described as a dull, throbbing feeling in the temples, and Dr. Koickel says that’s pretty common. Low blood sugar can also trigger migraines (yeesh), but they’re not usually accompanied by the usual nausea, vomiting, and sensitivity to light and sound. Instead, this variety of migraine comes with other symptoms of hypoglycemia, like blurry vision, fatigue, irritability, and confusion.

4

Constant Hunger

Hypoglycemia can make you feel like you need to devour everything in your fridge. Dr. Araque says that when you have low glucose levels, your body starts releasing glucose from your liver and craving food to replace it. Eating can usually help raise blood sugar (though maybe don’t go for the old pickles that expired in 2017).

5

Heart Palpitations

“One of the most common symptoms of hypoglycemia is feeling like your heart is pounding,” Dr. Shipley says. Blame this one on adrenaline, too; as it courses through your system, it can cause a rapid heartbeat and heart palpitations. If you find that your heart is racing more than normal, your blood sugar might be bottoming out.

7

Brain Fog

Yep, hypoglycemia can also cause a brain fog. Your brain needs glucose for fuel, Dr. Araque says, so it can’t perform properly, leaving you feeling dazed and confused. Dr. Koickel says you may also experience blurry vision alongside your confusion. Math problems no; naps, yes.

8

Dizziness

“Dizziness and lightheadedness,” Dr. Shipley says, can occur as a result of low blood sugar. This is on the extreme end of symptoms, and it’s often accompanied by confusion and fatigue. You could even start acting oddly drunk, despite not going near alcohol.

9

Tingling Sensation Around The Mouth

10

Sweating

Feeling anxious and sweaty is a common symptom of low blood sugar, Dr. Shipley says. If you start feeling unusual sweating that may be later accompanied by chills, it may feel like you’re having a sweaty panic attack, but it’s a common reaction to adrenaline. It can occur all over the body, not just on the armpits, and it can progress from mild to drenching. Deodorant to the rescue.

11

Shaking

Shakiness, Dr. Koickel says, is one of the classic early signs of hypoglycemia. When your blood sugar drops, you may get some shakiness along with your anxiety and fast heart rate. It’s all part and parcel of your body’s adrenaline response. This can be really scary, but it’s likely to fade as soon as you get your blood sugar up again with some food.

“Always consult with your endocrinologist and primary provider if you suspect you’re suffering of symptoms suggestive of hypoglycemia,” Dr. Araque says. They’ll help you sort it out post-haste.

Experts:

Dr. Katherine Araque M.D.

Dr. Heather Bartlett M.D.

Dr. Betsy Koickel M.D

Dr. Neal Shipley M.D.

9.3 Hypoglycemia and Hyperglycemia – Clinical Procedures for Safer Patient Care

The overlapping symptoms of hypo- and hyperglycemia (e.g., hunger, sweating, trembling, confusion, irritability, dizziness, blurred vision) make the two conditions difficult to distinguish from one another (Paradalis, 2005). Since the treatment is different for each condition, it is critical to test the patient’s blood glucose when symptoms occur. The risk factors that may have led to the condition, and the recent medical history of the patient also help to determine the cause of symptoms.

Hypoglycemia

Hypoglycemia is a condition occurring in diabetic patients with a blood glucose of less than 4 mmol/L. If glucose continues to remain low and is not rectified through treatment, a change in the patient’s mental status will result. Patients with hypoglycemia become confused and experience headache. Left untreated, they will progress into semi-consciousness and unconsciousness, leading rapidly to brain damage. Seizures may also occur.

Common initial symptoms of hypoglycemia include:

• Cold, clammy skin
• Weakness, faintness, tremors
• Headache, irritability, dullness
• Hunger, nausea
• Tachycardia, palpitations

These symptoms will progress to mood or behaviour changes, vision changes, slurred speech, and unsteady gait if the hypoglycemia is not properly managed.

The hospitalized patient with type 1 or type 2 diabetes is at an increased risk for developing hypoglycemia. Potential causes of hypoglycemia in a hospitalized diabetic patient include:

• Receiving insulin and some oral antidiabetic medications (e.g., glyburide)
• Fasting for tests and surgery
• Not following prescribed diabetic diet
• New medications or dose adjustments
• Missed snacks

Hypoglycemia is a medical emergency that must be treated immediately. An initial blood glucose reading may confirm suspicion of hypoglycemia. If you suspect that your patient is hypoglycemic, obtain a blood glucose level through skin puncture. A 15 g oral dose of glucose should be given to produce an increase in blood glucose of approximately 2.1 mmol/L in 20 minutes (Canadian Diabetes Association, 2013). Table 9.2 outlines an example of a protocol that may be used in the treatment of hypoglycemia.

Hyperglycemia

Hyperglycemia occurs when blood glucose values are greater than 7 mmol/L in a fasting state or greater than 10 mmol/L two hours after eating a meal (Pardalis, 2005). Hyperglycemia is a serious complication of diabetes that can result from eating too much food or simple sugar; insufficient insulin dosages; infection, illness, or surgery; and emotional stress. Surgical patients are particularly at risk for developing hyperglycemia due to the surgical stress response (Dagogo-Jack & Alberti, 2002; Mertin, Sawatzky, Diehl-Jones, & Lee, 2007). Classic symptoms of hyperglycemia include the three Ps: polydipsia, polyuria, and polyphagia.

The common symptoms of hyperglycemia are:

• Increased urination/output (polyuria)
• Excessive thirst (polydipsia)
• Increased appetite (polyphagia), followed by lack of appetite
• Weakness, fatigue
• Headache

Other symptoms include glycosuria, nausea and vomiting, abdominal cramps, and progression to diabetic ketoacidosis (DKA).

Potential causes of hyperglycemia in a hospitalized patient include:

• Infection
• Stress
• Increased intake of calories (IV or diet)
• Decreased exercise
• New medications or dose adjustments

Note that testing blood glucose levels too soon after eating will result in higher blood glucose readings. Blood glucose levels should be taken one to two hours after eating.

If hyperglycemia is not treated, the patient is at risk for developing DKA. This is a life-threatening condition in which the body produces acids, called ketones, as a result of breaking down fat for energy. DKA occurs when insulin is extremely low and blood sugar is extremely high.

DKA presents clinically with symptoms of hyperglycemia as above, Kussmaul respiration (deep, rapid, and laboured breathing that is the result of the body attempting to blow off excess carbon dioxide to compensate for the metabolic acidosis), acetone-odoured breath, nausea, vomiting, and abdominal pain (Canadian Diabetes Association, 2013). Patients in DKA also undergo osmotic diuresis. They pass large amounts of urine because of the high solute concentration of the blood and the body’s attempts to get rid of excess sugar.

DKA is treated with the administration of fluids and electrolytes such as sodium, potassium, and chloride, as well as insulin. Be alert for vomiting and monitor cardiac rhythm. Untreated DKA can be fatal.

Patients with hyperglycemia may also exhibit a non-ketotic hyperosmolar state, also known as hyperglycemic hyperosmolar syndrome (HHS). This is a serious diabetic emergency that carries a mortality rate of 10% to 50%. Hyperosmolarity is a condition in which the blood has a high sodium and glucose concentration, causing water to move out of the cells into the bloodstream.

Further information on the treatment of DKA and HHS can be found on the Canadian Diabetes Association clinical guidelines website.

1. At 0930 hours, your diabetic patient complains of feeling faint. You check his blood sugar and get a reading of 2.8 mmol/L. What actions will you take?
2. What blood glucose level range do you expect immediately post-operatively from your patient who has type 2 diabetes? Why?

90,000 Six dangerous consequences of diabetes that few people know about – Rossiyskaya Gazeta

422 million people worldwide, according to WHO statistics, suffer from diabetes today, most of them from preventable type 2 diabetes. In our country, due to the ongoing obesity epidemic, the number of patients with diabetes is also growing and, according to experts, may reach eight million.

Serious complications of diabetes associated with vascular lesions are well known – these are cardiovascular diseases, kidney damage, rhinopathy (up to blindness).In an interview with AiF, endocrinologist Elena Syurakshina spoke about the less well-known, but no less formidable, consequences of this disease.

“All problems arise from unstable blood plasma sugar levels,” explains the doctor. “Increased glucose levels change the properties of the blood, disrupt the functions of the brain, cardiovascular system, and damage the kidneys and nerve cells. The catalyst for complications is most often stress. , as well as infections, viruses that can suppress the immune system.Against their background, one or several complications may appear at once. “

What pathologies threaten patients with uncompensated diabetes?

Ketoacidosis

Decompensation of diabetes mellitus often leads to ketoacidosis. glucose and ketone bodies Symptoms: thirst, increased urination, dry skin, odor of acetone from the mouth, abdominal pain, headaches, lethargy, irritability, drowsiness, lethargy.”The mainstay of treatment is insulin therapy, rehydration measures and correction of pathological changes in electrolyte metabolism. In this state, you should definitely consult a doctor as soon as possible, since without proper treatment, ketoacidosis can be fatal,” the doctor warns.

Hypoglycemia

This condition is caused by very low blood sugar levels and is often associated with diabetes treatment itself. The main symptoms are: malaise, fatigue, pale skin, excessive sweating.Treatment should be as prompt as possible to return blood sugar levels to the normal range, and include the use of foods and drinks that are high in sugar. And here it is important not to allow the development of such a state. Therefore, it is imperative to consult a doctor to correct the situation and select prevention. After all, a sharp drop in sugar can lead to hypoglycemic coma and even death.

Coma

With diabetes in humans, several variants of coma can occur against the background of surges in blood glucose levels.

Hyperosmolar non-ketone coma is an acute complication of diabetes mellitus, characterized by impaired glucose metabolism and an increase in its level in the blood, a sharp increase in plasma osmolarity (negative changes in blood composition), including dehydration within cells, absence of ketoacidosis. The main symptoms are increased urination, dehydration, muscle hypertonia, convulsions, increasing drowsiness, incoherent speech. Treatment includes rehydration, restoration of normal insulin levels, and elimination and prevention of complications.There should be no self-medication in such a situation.

Lactacidemic coma – characterized by an insignificant level of glycemia, a decrease in the alkaline reserve of the blood, pH and an increase in the level of lactic acid. The cause of development may be chronic hypoxia, severe dehydration of the body with hyperosmolar coma. Symptoms: increasing weakness, pain in muscles and heart. If such signs appear, you should immediately seek specialized help. In such a situation, hospitalization is laid, since paralysis of the respiratory center with a threat of death is possible.

Vision problems

High blood sugar levels increase the likelihood of eye diseases. This is due to damage to small vessels and is called microangiopathy. Diabetic retinopathy refers to complications of a vascular nature in diabetes mellitus. This pathology leads to irreversible blindness. It is clear that in such a situation it is better to prevent than to try to stop the disease. Therefore, for the purpose of prevention, one should constantly and responsibly control the level of sugar in the blood, also monitor the level of cholesterol so that the vessels do not break down even more, and it is worth maintaining normal blood pressure.

Diabetic foot

Diabetic foot syndrome – damage to the skin, large and small vessels, nerves, bones and muscles of the foot. The cause is the toxic effect of high blood sugar levels on large and small vessels, nervous, musculoskeletal tissue. First of all, it manifests itself as pain in the lower extremities, numbness, burning sensation, cooling of the feet, parasthesias (goose bumps, tingling sensations). At an advanced stage, poorly healing ulcers, infectious lesions, gangrene appear.Patients with diabetes need to be especially careful if they have problems such as an ingrown toenail, darkening of the nail, fungal lesions of the nail plates, calluses and corns, cuts, burrs, and cracked heels. For treatment, you should contact specialists, for example, podiatrists, who will carry out the necessary manipulations taking into account the main diagnosis. The prevention of diabetic foot is based on the treatment of diabetes mellitus as an underlying disease.

Skin diseases

People with diabetes mellitus most often face numerous and varied skin lesions, most of which are bacterial and fungal infections.Infection occurs with uncompensated diabetes mellitus. As a result, wounds, cracks, and non-healing ulcers begin to appear more often on the skin. Those who are diagnosed with diabetes require special adherence to personal hygiene: regular shower, use of skin protection products.

Diabetic Athlete’s Handbook (Part 2)

Managing Glycemia During Exercise

All diabetics know that keeping sugars within normal limits is like solving equations.Exercise adds to the challenges of diabetes management. Sometimes it’s hard to even imagine how to incorporate exercise — another variable — into this complex set of equations. The better you understand what leads to lower (and higher!) Blood glucose levels with exercise, the easier it will be for you to control glycemia and the more confident you will be in sports.

Exercise as another unknown in equation

Any muscle activity in the blood that can lead to the development of hypo during or after exercise.The amount of insulin in the blood and how well this insulin works is important to change the level of glycemia. If insulin levels are high during exercise, your muscles will take more glucose from the bloodstream and you may end up hypo. Tardive hypoglycemia may also develop, 48 hours after exercise (more on this topic later in this chapter).

On the other hand, exercising when your blood sugar is too high — especially when you have ketone bodies, a byproduct of using fat as an alternative fuel, when you don’t have enough insulin — you can increase your sugar even more.Exercising in this situation can lead to diabetic ketoacidosis (DKA), a condition resulting from high glycemic levels and a lack of insulin. DKA is a life-threatening condition and requires hospitalization. Certain types of strength training can also increase blood glucose levels (as discussed below), regardless of diabetes.

There are so many factors that affect glycemia while exercising, especially if you are on insulin or antidiabetic pills, that sometimes you feel like quitting! Don’t do this – despite the despair that comes to you from time to time: the benefits of exercising are far greater than the side effects.

The best way to combat the many variables that affect your fitness during exercise is to measure your glycemic levels before, during (occasionally), and after exercise, and thus find out how your body responds to exercise.

Table 2.1 provides a list of typical “variables”. Once you learn how to control some of them and anticipate their effects, you will be able to predict your glucose responses to similar exercises.

Hormonal response to exercise

Studies of people with type 1 and type 2 diabetes have shown that high-intensity exercise, such as lifting weights, or anaerobic training close to the maximum level of stress, can cause a rise in glycemic levels due to the body’s hormonal response to exercise.Intense exercise leads to the secretion of hormones that promote the production of glucose by the liver and a delay in the uptake of glucose by the muscles. These hormones include epinephrine (better known as adrenaline) and norepinephrine, which are secreted by the sympathetic nervous system (this system allows, for example, the body to respond with increased heart rate to physical or mental stress), as well as glucagon, growth hormone, and cortisol.

Table 2.2 Hormones that increase glycemic levels during exercise Hormone

Even in a person without diabetes, the body increases insulin production after such intense exercise.After these hormonal effects are depleted, your sugar levels can easily drop as your body replenishes glycogen stores used up during exercise.

Energy Systems and ATP Use

The speed at which you move, the strength of your muscles, and the amount of time you can continue exercising – that is, everything that then affects your glycemic level – depends on how your muscles produce and use energy. your body has three separate energy systems that supply the muscles with ATP (adenosine triphosphate) molecules.ATP is a high-energy structure, fuel for muscles, found in all cells of the body. Three systems go into action one after the other and produce ATP during your workout. If the exercise is long enough (even for one minute), you use all three.

All three systems increase the production of ATP. ATP is the only fuel that directly causes muscle contraction as it breaks down. When a nerve impulse starts muscle contraction, calcium is released in muscle cells, ATP gives strength to fibrin fibers and they start moving.Without ATP, your muscles would not contract and training would be impossible.

Muscle cells contain trace amounts of ATP molecules. They are, at best, enough for one second of work. If you want to keep working, your muscles need to find another source of ATP immediately. Although all systems can deliver ATP, the speed of these channels is different. Different systems have different raw materials for the production of ATP and different speed of operation. Keep in mind that due to different systems, the type of exercise can change glycemic levels in different ways.

ATP-KF system: short and intense

For short and intensive work, the ATP-CP system, also known as phosphagenic, provides energy mainly. It consists of ATP molecules stored in the muscle and creatine phosphate (CP), which quickly replenishes the ATP supply. This system is anaerobic, in other words, it does not require oxygen to function. CP is not a direct source of fuel, but the energy generated during its rapid breakdown is used to synthesize ATP within the next 5-9 seconds after depletion of the primary supply of ATP in the muscles in one second.

In general, all the reserves of ATP and CP of the body can be enough for only 6-10 seconds of hard work. Thus, all work that takes less than 10 seconds, including lifting the barbell, 40-meter sprint, pole vault, long jump, baseball serve, or basket ball throwing on basketball, is primarily powered by phosphagens. Generally speaking, these activities do not lower blood glucose levels because the system does not use glucose to generate energy.In fact, they can raise glucose levels because they increase the secretion of hormones that increase glycemia.

Lactic acid system: Using only muscle glycogen and glucose

The second energy system, the lactic acid system, delivers energy for work lasting from 10 seconds to approximately 2 minutes. The lactic acid system also acts anaerobically (does not use oxygen) to break down muscle glycogen. Glycogen is a form of glucose storage, and the process of breaking down glycogen is called glycogenolysis.Once released from storage, glycogen produces energy through glycolysis, and lactic acid is produced as a by-product. When you rest, glycolysis occurs in your muscles, but since the body does not use ATP, carbohydrates are involved in aerobic conversion and lactic acid is not produced in large quantities.

If your workout lasts more than 10 seconds, then the muscles require energy and glycolysis continues to rapidly provide ATP. The accumulation of lactic and other acids quickly slows down the operation of this system.When stored in large amounts in muscle, lactic acid lowers the pH in muscle cells and blood, resulting in muscle burning and fatigue. This system is capable of synthesizing only 3 ATP molecules from each glucose molecule released from muscle glycogen. This is a very small amount compared to the 37-39 ATP molecules that can be produced in the aerobic system. Consequently, this system cannot provide enough energy for prolonged exercise. Sports activities that are conducted using this system include running 800 meters, swimming 200 meters, and sports that include interval loads (“stop and start”): basketball, field hockey, ice hockey.

Aerobic system:

Use of carbohydrates, fats and proteins in the presence of oxygen

The other part of the spectrum is the aerobic energy system, which is used for prolonged exercise requiring high or very high endurance. Due to their increased duration, these types of work depend mainly on aerobic energy production by the oxygen system. Your muscles need a constant supply of ATP during walking, running, swimming, cycling, rowing, skiing, which is what you usually do for more than two minutes.Running a marathon or ultramarathon distance, completing a triathlon, or participating in a multi-day bike race or hike are extreme options for prolonged aerobic activity.

The fuel for these sports activities is mainly a mixture of carbohydrates and fats, with an increase in the proportion of fats in this process during rest and carbohydrates during work. Protein can participate in this process, but, as a rule, it provides less than 5 percent of all energy. Your body can use slightly more protein (up to 15 percent) during extreme long-term activities, such as a marathon.

Your diet and the time of your last workout will affect the fuel your body uses, but most people get 60 percent of their energy from fat and 40 percent from carbohydrates.

Your body will quickly start using carbohydrates as soon as you start exercising, and the proportion of carbohydrates will increase with increasing exercise intensity. Exercising at high and close to maximum intensity consumes 100 percent of the carbohydrates.Muscle glycogen provides more energy — usually about 80 percent — than blood glucose, unless muscle glycogen stores have been depleted by this time after prolonged exercise, or if you are not following a low-carb diet. The body’s choice of fuel for the aerobic system depends on your level of fitness, nutrition (diet) before and after exercise, intensity and duration of exercise, and the amount of insulin in circulation.

Circulating hormones such as adrenaline mobilize fat from fat cells (adipocytes), and active muscle fibers can use these fats, circulating in the blood as active fatty acids, under less intense exercise.Your body can use fat at low to moderate intensity, along with some carbohydrates. Fats stored in the muscles themselves (muscle triglycerides) are especially important as fuel during recovery from exercise or during prolonged exercise (longer than 2-3 hours).

Remember that the activation of the third (aerobic) system occurs only after the first two systems have been connected in series. Both anaerobic systems (phosphagenic and lactic acid systems) are important at the beginning of a long workout, before your metabolism “warms up” to start synthesizing enough ATP.These two systems are also important whenever you pick up your pace or take on heavier work, such as running uphill or finishing a 10km sprint.

Why does your body use carbohydrates during exercise

During rest, your body takes up 40 percent of its energy from carbohydrates — to maintain the functioning of all systems under normal environmental conditions.

Once you start exercising, the proportion of carbohydrates in energy production increases.This proportion directly depends on the intensity of work, so hard workouts require more glucose from the bloodstream and from glycogen than the light ones, but even the lightest ones use some amount. Muscle contractions stimulate the breakdown of glycogen in the muscles, along with the removal of glucose from the bloodstream. Carbohydrates are more efficient fuel, which means that the body receives more ATP from them, based on the oxygen consumed. Therefore, and for some other reason, carbohydrates are the body’s number one fuel.

Fatigue (inability to continue working at the same intensity) is often associated with the depletion of muscle glycogen stores. This phenomenon is known to long-distance runners as the “wall.” It takes more than 90 minutes to reach this point with moderate exertion, but it takes less time for intense and close to maximum loads. Your muscles use blood glucose and glucose from the breakdown of glycogen, sometimes more depending on the dose of insulin injected (more on this in the next chapter), but you will start using glucose more.when glycogen stores are diminishing – this is when you especially need to be on the lookout for low glycemic levels! you can deplete muscle and liver glycogen, especially if you haven’t eaten for a while, and then you can get into trouble.

Taking carbohydrates (for example, in the form of an orange) during exercise increases and maintains blood glucose levels, which helps prevent fatigue

If you engage in long enough physical activity, then you need to take care of an adequate supply of muscle glycogen to prevent early fatigue and hypoglycemia.

Taking carbohydrates during exercise increases and maintains blood glucose levels, which helps prevent fatigue. They are digested and absorbed faster than fats and proteins; carbohydrates usually begin to enter the bloodstream after 5 minutes. The amount of carbohydrates depends on the time and severity of the workout, the time of day and the dose of insulin administered. you should track your glycemic level to find out how much carbs you need (if needed) for a particular activity.Some general guidelines for increasing your carbohydrate intake with aerobic exercise can be found in Table 2.3.

Table 2.3 General guidelines for carbohydrate intake for endurance sports. Please note the notes to table

Notes to table 2.3:

The recommended amount is indicated in grams of digestible carbohydrates. One fruit or piece of bread equals 15g of carbohydrates.

1 Work with low intensity is carried out at less than 50%, moderate – from 50 to 70%, high 70-85% of the heart rate reserve (see chapter 1)

2 With glycemic levels above 11.1 mmol / L or in the presence of ketones, an additional dose of fast-acting insulin may be required to reduce this glycemic level during physical activity; the recommended amount of carbohydrates may be higher than what is actually required.

3 Intense (close to maximum), short-term physical activity can cause an increase in glucose levels.

How the amount of injected insulin affects

In people without diabetes and most people with type 2 diabetes, blood insulin levels drop during exercise, and an increase in glucagon forces the liver to produce more glucose. If you have to inject yourself with insulin, your body cannot lower its levels when you start exercising. Large amounts of insulin play an unpleasant role under these conditions, as insulin forces the muscles to absorb glucose from the blood.Muscle contractions have the same effect. The effect is mutually reinforcing, which means that high insulin levels can lead to a rapid decrease in glucose levels, that is, a hypoglycemic state.

The level of insulin in your bloodstream affects your well-being during exercise and the likelihood of early fatigue due to hypoglycemia.

However, you need a certain amount of insulin in your body. If there is too little of it, the body will have nothing to oppose to the action of those hormones that increase glycemia, and for you it may end in hyperglycemia.An accurate balance is required, otherwise high insulin levels will inhibit the secretion of these hormones and hypo will ensue. You need some of these hormones because adrenaline releases fat from the depot and triggers the breakdown of glycogen, and glucagon increases your liver’s glucose production. Without it, your muscles can take up more glucose than your liver produces. In one study, intense cycling with very low insulin levels resulted in hyperglycemia and increased lipolysis (fat mobilization), while the same exercise with too much insulin resulted in hypoglycemia and decreased fat release.To create the optimal workout environment, you need enough insulin to balance with the hormones that increase your glucose levels, but not too much insulin to avoid a sharp drop in blood sugar.

Planning Exercise During the Day and Insulin Levels

Exercise time can also play a large role, and the body’s response will vary. For example, it is unlikely that your blood sugar will drop dramatically if you exercise before breakfast, especially before your insulin injection.At this time of day, only the basal amount of insulin is in your body (i.e. the amount of insulin your body needs between meals), so the level of insulin in your circulation is low at this time. Cortisol levels are usually high, which increases insulin resistance and compensates for the condition.

If you often experience hypoglycemia during exercise, you can try exercising in the morning, before your insulin injection before breakfast (rather than after breakfast or at other times of the day….

People with type 2 diabetes who still make their own insulin are more likely to drop glycemic levels when exercising after breakfast or other meals (but not before meals) due to insulin secreted in the body in response to food. However, keep in mind — are you diabetic or not — that long runs can cause hypoglycemia due to depletion of fuel and liver glycogen after an overnight fast, so running a marathon on an empty stomach is a bad idea.

Lowest risk of developing glycemia – with moderate activity in the early morning before breakfast, or at any other time of the day when insulin levels are low

Adjusting insulin levels during exercise

Physical activity is one of the main causes of hypoglycemia in people with tightly controlled diabetes. More physiologically, exercise with low insulin levels. By reducing the dose, it is necessary, firstly (if possible), to reduce the insulin for food.In table 2.4 you will find recommendations for adjusting the insulin dose, but these refer primarily to fast or short acting insulins, not basal.

Basal insulin can also be lowered, see sports-specific recommendations in Part II. The amount of insulin in your body between workouts also affects your health and well-being at the next workout. If you don’t have enough insulin or your insulin action is reduced, this can lead to incomplete restoration of muscle glycogen stores after exercise (or at other times).Although your muscles can store glycogen with little to no insulin input for about an hour after you end an intense or prolonged workout, you need insulin to continue to capture glucose from the bloodstream and store it as glycogen. If glycogen is not accumulated in sufficient quantities, then the next workout, the body will use more fats, which will reduce your resistance to stress – especially if low glycogen levels lead to a rapid uptake of glucose from the blood.Maintaining normal post-workout glucose levels helps replenish glycogen stores better than high sugar at this time. Thus, you will most likely need insulin after exercise, albeit at a reduced dose.

Table 2.4 General guidelines for lowering insulin during endurance sports

Notes to Table 2.4: These insulin dose adjustments are based on the assumption that the athlete does not eat anything extra either before or during exercise to compensate for glycemic levels. For those using an insulin pump, the decrease in basal rate may be greater or less than indicated, and these changes can be made together or separately from the bolus changes.

1 When exercising at near-maximum intensity, it may be necessary to increase (rather than decrease) the dose of short-acting insulin to reverse the effects of hormones that increase glucose during exercise.

2 These dose reduction recommendations apply to insulins that peak during exercise (short-acting insulins). A smaller dose reduction is required if the last injection of short-acting insulin was made more than three hours before the start of the exercise. You may also need to lower your insulin dose after exercise.

How exercise affects the body’s choice of fuel

Exercise enhances your body’s ability to metabolize fat, which usually results in more fat utilization, slower muscle glycogen loss, and less glucose dependence during physical activity after your muscles have adapted.The impact of exercise on fuel choice becomes apparent if you have diabetes, because after a few weeks of exercise, your carbohydrate requirements will decrease or you will need to reduce your insulin dose to compensate.

This adaptation to the training load occurs for various reasons. For example, when you exercise at low to moderate intensity, fewer glycemic-raising hormones are released. People without diabetes experience the same training effect, but it is more difficult for them to feel it because their glucose levels are not very mobile.Insulin secretion during exercise usually decreases (if it is synthesized in your body, in a small or sufficient amount), but regular training leads to an even greater decrease. As a result, after exercise, your body uses less glucose and muscle glycogen and slightly more fat when you exercise at the same intensity – all of which lead to normal glycemic levels and reduce the risk of getting hypo.

This change in fuel usage explains why you may need more carbohydrates in the beginning to maintain normal glycemic levels, and then decrease your carbohydrates after a few weeks of exercising.But if your workouts get harder to reach the same relative intensity (for example, over time you have to expend more energy to reach 80% of the maximum load than was originally required), then the amount of carbohydrates needed will probably remain as high. , like before.

In addition, the training effect depends on the sport, so if you were involved in jogging and then decided to start, for example, swimming, then your sugar will initially decrease more against the background of swimming – until you reach a certain level of training and in this kind of sport.

It may happen that after a few weeks of training, your glycemic level stops dropping as much as it did in the beginning.

How exercise affects insulin action

If you are physically trained, you probably have high insulin sensitivity, allowing your muscles to take in glucose more easily despite lower insulin levels (for a relatively lower insulin level). This effect is particularly evident in type 2 diabetics.

Regular exercise normalizes glycemia by enhancing the effect of insulin, both immediately after exercise and one to two days after.

Immediately after your workout, the effects of insulin are enhanced because you capture glucose to replenish your wasted glycogen. You may need to lower your basal insulin and insulin per meal (bolus) in order to mitigate this effect and reduce the risk of hypo after exercise.By measuring your glycemic level, you have a better idea of ​​how it changes — better than anyone without diabetes. You need less insulin not only during, but also after exercise, especially during the “window” – which lasts from half an hour to two hours after exercise. At this time, the maximum renewal of glycogen stores occurs.

After a while (long enough, however), training helps to gain muscle mass. This is another aspect of the positive effect of training on insulin action: it increases the “reservoir” for excess glucose formed after eating.

Circulating insulin levels in trained athletes are usually low, while insulin sensitivity is very high. Insulin action, however, begins to decline if you stop exercising for one to two days, even if you maintain your normal activity level. Many athletes indicate that their total insulin dose increases 2-3 days after stopping normal exercise (if, for example, they are too busy to exercise, sick or injured).For example, Peter Nerotin of San Diego, California, noticed that if he did not exercise for several days, then his post-meal glycemia was drastically different from what it was. To adapt to this level of glycemia, he has to take a large dose of insulin before meals in order to absorb carbohydrates. In addition, he injects a few extra units with an insulin pump, double wave, to cover 3-4 hours after a meal and then take a break before eating to reduce the post-meal spike in blood glucose.

A study of runners with type 1 diabetes found no change in insulin sensitivity after a marathon. Despite a 50% decrease in glycogen stores in these athletes, their insulin sensitivity on the day after the marathon was the same as on the day of rest before the marathon. Their use of fat was increased. These rates are similar to those of people without diabetes after a marathon. Perhaps the cause is muscle damage during a long run, which interferes with the ability to replenish glycogen stores until the muscles regain their structure.

As you can see, there are many factors that affect glycemic levels during and after exercise. Keep in mind that blood sugar is more likely to decrease if you participate in new or unusual sports, but the intensity and duration of exercise also plays a role in glucose absorption. Intense exercise can temporarily raise your glycemic levels and then cause your blood sugar to drop as muscle glycogen begins to synthesize, so be on the lookout to prevent hypo after exercise.Thus, the daily insulin dose is reduced with regular training of any type.

Effect of exercise and hypoglycemia on hormonal response

What are the physiological mechanisms behind low blood sugar in different situations? In many cases, this is due to exercise, which is not surprising for most athletes. Unfortunately, if diabetes lasts 10 years or more, your body’s response to hypoglycemia, in the form of secretion of glucose-increasing hormones (such as adrenaline and glucagon), is dulled.This means that the body releases less of these hormones than before, and the glycemia remains low or continues to decline.

Hypoglycemic state before exercise may recur during exercise

An episode of hypoglycemia can dull the body’s hormonal response later, during exercise, during the day or more. For example, in one study, volunteers with type 1 diabetes were asked to endure 2 two-hour periods of hypoglycemia (specially induced during the experiment) with a glucose level of 2.8 mmol / L.The next day, they rode a bicycle for 90 minutes, and they showed an extremely weak response from hormones that increase glycemia. Conclusion: a hypoglycemic state the day before makes it difficult to maintain a normal glycemic level the next day. In women, these hormones are secreted more adequately to physical exercise, in comparison with men, despite the hypoglycemic state suffered the day before.

Finally, your ability to respond the next time depends on how much your glucose drops during hypo.In another recent study, the following levels of hypoglycemia were induced: 3.9, 3.3 and 2.8 mmol / L. Initially, the volunteers experienced 2 two-hour periods at one of these levels, with a break at normal glycemic levels. The next day, they did moderate exercise (90 minutes, cycling). If the day before they had normal glycemic levels, then the hormonal response was excellent, and if the day before there was hypoglycemia — any of the given levels, even 3.9 mmol / l — the hormonal response was erased.

In fact, the lower the hypoglycemia was the day before, the worse their hormonal response in training was. These studies are just another reminder that you should try to prevent hypo, especially severe hypo, if you want to keep yourself from low sugars later on in your workouts.

In a similar study, two 90-minute low-to-moderate-intensity cycling sessions inhibited the secretion of key glucose-increasing hormones in response to hypolycemia. This means you can get hypo the day after your workout.This effect develops rapidly — within a few hours — and increases the risk of hypo for the remainder of the day after training and the next day.

What to do with exercise-induced hypoglycemia?

Hypogycemic conditions are one of the main factors that reduce the quality of life in patients with diabetes mellitus. Even remembering this condition can increase feelings of anxiety. However, you can reduce their risk. First, you need to know the signs of hypoglycemia.

Signs of hypoglycemia

You need to be aware of all the possible signs of hypo, at rest and during exercise, in order to identify and treat them early.

As you know, the normal fasting blood glucose level is between 3.9 and 5.5. Although hypoglycemia. strictly speaking, this is any glucose level below 3.9 mmol / L, the glucose levels at which symptoms appear differ in different situations. For example, in the absence of glycemic control for a long time, symptoms of hypoglycemia may appear at normal glucose levels if glucose drops rapidly before reaching 3.9 mmol / L.If you have tight control, then signs of hypoglycemia may appear only at a level of 3.1 mmol / L or lower. Some people have, so to speak, “glycemic blindness”: they do not feel or cannot recognize its usual symptoms. This condition is more common in people with tight control or frequent hypo (we will return to this question later).

The hormones your body secretes during exercise sometimes cause the same symptoms as hypoglycemia.It is difficult to distinguish between the onset of hypoglycemia and normal sports-related sensations such as fatigue – especially when exercising in cold weather. Typical signs of hypoglycemia: tremors (of the whole body or only hands), tingling sensations in the hands and on the tongue, sweating, confusion, irritability, poor coordination of movements and changes in vision;

For more information on the symptoms of hypoglycemia, see table 2.5.

Table 2.5 Symptoms of hypoglycemia

Symptoms may vary from person to person and from activity
different kinds of sports.For example, one athlete reports that he has
the point seen by one eye when he runs, and the other when the hypo starts during
running begins to touch the toe of one foot on the heel of the other. Your symptoms
hypoglycemia may change depending on whether your
physical fitness, so you must learn to recognize the response of your body.
To this it must be added that symptoms can vary from training to training.
depending on the exercise performed, the rate of sugar reduction and the conditions in
which you are.

You must always have something with you for the treatment of hypo:
for example, glucose tablets or sweets. you can get heavy
hypoglycemic state simply because they left the house and did not take with them
nothing to stop hypo. Even a triathlete who always carries with her
means for stopping possible hypo during hard long workouts,
can get hypo if she goes for a walk with the dog. Maybe it seems to her that
Walking the dog is not enough to induce hypo, but it is not.Motto
for the attitude to hypoglycemia is the same as that of the Boy Scouts: “Always
ready! “

Checks for detecting hypo

Usually, it is not easy to tell right away, high level
sugar or low if you suddenly feel unwell, especially at
training. When sugars are changing rapidly — rising or falling — you often don’t
you can tell in which direction the process is going until the symptoms intensify. If
you run at a high pace for a while or do another heavy
workout when your blood sugar drops quickly, you may feel
hypoglycemia even if the glucose level is still slightly elevated, or does not feel
at all.

Regardless of the type of diabetes, the determination of the sugar level in
blood more often than before meals and before bedtime, will help identify trends that
otherwise they would have remained invisible. An increase in blood glucose after a meal leads to
complications of diabetes and controlling these outbreaks can be the key to preventing
microvascular complications such as diabetic retinopathy. Thus,
determining glycemia one and two hours after a meal will show you how different
types of food affect your blood glucose levels and how many
changes occurs in the body.

Although it is customary to measure blood glucose levels two hours after
the first spoonful of food, the peak of glycemia can be 72 minutes after eating, give or take
23 minutes — these are the results of monitoring the level of glycemia. Best of all, especially
if you have incorporated exercise into your lifestyle, diversify the verification scheme
blood glucose levels, rather than being limited to pre-meal and bedtime tests. The more often you do
analysis, the better you understand what is happening in the body and when
more likely to develop hypo: during or after training.other methods
prevention of hypo is given in table 2.6

Table 2.6 Methods for preventing hypoglycemia

“Know thyself” – find out your reaction to various
food, exercise and stress – frequent blood glucose measurements will help you better know your
unique features of glucose metabolism.

Do your blood glucose test more often when you start
a new kind of physical education, travel, generally go beyond the daily
routine.

If you calculate the dose of fast-acting insulin per
food, find out how many units you need for a certain amount of carbohydrates to
do not overdose insulin.

Keep in mind the rules for calculating the time of action of insulin,
to represent the situation at any moment. Fast-acting insulin
stays in the bloodstream for at least 2 hours; if you have injected,
and the sugar is still high, wait a while for the effect of insulin
manifested itself before giving an additional injection.

Never skip a meal for which you have already made
insulin injection or have taken PSS.

If you are not sure when to start eating (for example, in
restaurant), do not do the entire dose before the food is brought; better wait
so that food stands in front of you and.

Monitor your blood glucose levels for a few hours after exercise
sports, so as not to miss and prevent possible delayed
hypoglycemia.

Eat small amounts of carbohydrates (at least 15g)
within an hour after a long or strenuous workout to get faster
restore your muscle glycogen. In addition to carbohydrates, eat a small
the amount of protein and fat that will last longer.

Prevention
hypoglycemia during and after exercise

You can prevent, heal, and stop barely
hypoglycemia that began during training in various new ways.Remember,
how did we recently discuss the hormonal effects of intense exercise? Some
the researchers decided to study the effect of a short, maximum sprint on
drop in blood glucose levels. Several men ate breakfast after injecting their
the usual dose of insulin, waiting for the glucose level to fall below 11.1 mmol / L and
then they easily pedaled on the bicycle ergometer for 20 minutes, after which they did 10
second sprint. Curiously, the sprint prevented further decline
glycemia for at least 2 hours (in comparison with the study, in
which they didn’t sprint).This method works at any time during training.
Although sprint will have limited effect if you have very high
insulin level or blurry hormonal response, but still for a short time
it has a beneficial effect on increasing glucose levels.

When you feel hypoglycemia approaching, sprint in
full force, within 10-30 seconds, increases the secretion of hormones that increase
glucose level.

Similarly, in another experiment by the same researchers
it was shown that a 10 second sprint, this time after 20 minutes of moderate
cycling, prevent a drop in blood glucose levels during subsequent
45 minutes.Glucose levels decrease during 20 minutes of exercise, but large
the amount of hormones triggered by sprinting can keep glycemia from dropping.

You can increase your glucose level during exercise by
including a 4 second sprint in light work. When a diabetic patient does
4-second sprint every 2 minutes for 30-minute moderate-intensity
cycling, their hormone levels rise and glycemia decreases in a different way
quickly. This is a result of both the greater release of glucose by the liver in the process.
exercise as well as more glucose uptake during exercise and
recovery.Be prepared for the fact that when the hormonal action ends,
you may go into hypo due to depletion of muscle glycogen stores.

After exercise, your primary concern will be to prevent
delayed hypoglycemia, which can occur due to the fact that the level
Your glycogen is low and has been renewed (during this time the action of your
insulin higher) and from the fact that the hormonal response decreases after the end
exercise. Keep in mind that there are two ways to prevent this.If you
you can start replenishing your carbohydrate supply as soon as you finish exercising,
as quickly as possible and in sufficient quantity, then the onset of delayed hypo
unlikely. The first 30-60 minutes after the end of the exercise is critical
the time when muscles can take glucose from the blood without insulin.
Secondly, after a workout, it may seem to you more than once that glucose stores in
the blood was depleted. Recent studies have shown that the need for carbohydrates
is biphasic – one phase immediately after training and the second after 7-11
hours.Stay alert: don’t miss the second wave of hypo after exercise and
carry out adequate prophylaxis by changing the amount of food and the dose of drugs.

Another study found that not all drinks are created equal
prevent the onset of hypo during and after exercise. Volunteers from
number of patients with type 1 diabetes mellitus used water, whole milk and
low fat, sports drinks A (carbohydrate and electrolytes) or sports
B drinks (carbohydrate, fat and protein) before, during and after the evening
Cycling at moderate intensity.The number of calories in drinks was in
an average of about 450 and no pre-injections of insulin were given.
Interestingly, all drinks, with the exception of water and whole milk, caused
a rise in glycemia above 11.1 mmol / l from the end of the workout to lunch.
Sports drink B (with added protein and fat) caused a steady rise
glycemic level. The drop in blood glucose after lunch was lowest in those who drank
whole milk. Therefore, despite the fact that carbohydrates are very important, for
preventing hypo for an extended period of time can be helpful
extra protein and fat.

Increased sensitivity to hypoglycemia

Mild hypoglycemic reactions are unpleasant, but at least
at least pass after taking glucose; if your sugar drops without symptoms, or
so quickly that you do not have time to react in time, hypoglycemia can
lead to impairment or loss of consciousness. If you ever had
severe hypoglycemic conditions, the onset of which you did not feel,
it is possible that you have a glucose lowering insensitivity that is affected
about 20 percent of patients using insulin.Although with type 2 sugar
diabetes is less common, if you do develop the condition, you
even more at risk of severe hypoglycemia.

If you are insensitive to hypoglycemia, you have erased
or no symptoms due to poor hormone secretion. Due to the low level
sugars impair the cognitive ability of the brain, so you can
measuring glycemia with hypo and not even understanding what you need to eat,
reject help with treatment or fight and flee from nursing staff who
trying to help you.Insensitivity to hypoglycemia occurs at night.
time (people wake up during about half of all cases of hypo) and during the day.
Unless someone from outside notices that you have hypo and does not come to
help, you may have a seizure resembling an epileptic,
or you may pass out.

Fortunately, the body can get out of this state. Though
often in people with diabetes mellitus experience from 2 to 10 years, secretion decreases
glucagon in response to hypoglycemia, the most common cause of insensitivity to
hypoglycemia — frequent hypo.One study has shown that patients who
transferred the hypo at night without noticing it (and which, as a result, passed without
treatment), hypo is noticed worse during the next day. Symptoms may
recover if you haven’t had hypo for 3 weeks. If hypo is still
happened, try to avoid the next one for at least 2 days,
to restore the ability to feel them. you can pass the corresponding
training (offered by some diabetologists) to learn better
feel changes in blood glucose levels.

How to be an athlete: Exclusively female concerns

Before the advent of blood glucose meters, it was impossible to trace
the influence of female hormones on the action of insulin. If you are a woman in
postpubertal but young enough to follow menstrual
loop, you should read this chapter to learn how to reconcile assignments
insulin with a cycle period. If you are pregnant, physically active, and ill
diabetes, you will also face some special circumstances.

How monthly cycles affect insulin action

The normal menstrual cycle has two phases: (1)
follicular, which lasts from the beginning of the cycle until ovulation, and (2) luteal, from
ovulation before the start of the next period. It has long been known that women are more
insulin resistant during the luteal phase, due to the greater secretion of female
hormones (estrogen and progesterone) during this time. Such changes
may affect the athlete who should include this factor in the ”
the equation “to achieve the balance of sugars in sports.

For example, Betty Ferreira, a regular athlete
from Toronto, Ontario, found that her blood sugar gradually increased in
within 7-10 days before your period and then instantly decreases the day before
menstruation. To compensate, she must increase her basal insulin dose.
(Levemir) by 1 unit per day, starting at least 5 days in advance, that is, its total
the basal rate increases from 16 to 23 units during this time, including
an increase in the night dose by 1-2 units.Cynthia Fritshi Chicago, Illinois,
found out that she needed to increase the total dose of insulin by one and a half times
3 days before her period (and still she has difficulty keeping control of her
glycemia at this time). In addition, she has to change doses from one
training to another.

Not all women react in the same way, although a difference is likely
associated with a rise in estrogen levels: the higher they are, the greater the effect they
have on glycemia.

Oral contraceptive use may also affect
the level of glycemia in women.Most birth control pills contain
low doses of estrogen and progestin. Since these remedies prevent
ovulation, the effect of insulin may decrease, but at least remains
even during the monthly cycle, which leads to predictability of glycemic levels.
For most women who use birth control pills, this is
facilitates glycemic control.

Physical activity in pregnant women with diabetes: Hardest
task for women

Even if you exercise regularly, the secretion of the same
hormones during pregnancy, as in the luteal phase of the menstrual cycle,
indicates the need to increase the dose of insulin.Under the influence of hormonal
storms in the third trimester of pregnancy, the mother’s body becomes insulin resistant
and some of the glucose is sent to the fetus. If you continue to play sports, you
do not have to increase the insulin dose too much during this period, even during
the last months of pregnancy. Exercise will also prevent excess intake
weight and physical loss. Stopping physical exercise, for any
reason, will require a significant increase in the dose of insulin due to secretion
hormones and decreased insulin sensitivity.

During pregnancy, energy consumption increases when
any kind of physical activity, in particular, with strength training. Your
activity during training will decrease, especially in the latter stages
pregnancy because Mother Nature cares about the health of your baby and you
it is difficult to work out with the same intensity (even if you try).
should exclude certain types of physical activity – contact sports, and
also requiring a sharp change in direction of movement (such as sports with
racket), water skiing, and cycling (when it is necessary to maintain balance),
but you can continue with many other sports.In the last
three months, replace running and large volumes of walking with such physical education that does not
includes work with heavy weight: classes in the pool and an exercise bike. After
the second trimester, exclude exercises lying on your back, as they can
disrupt the blood flow to the fetus. Despite all these changes, you will see that
Glycemic control during pregnancy is the very last of your
difficulties, especially if you have the opportunity to exercise.

Athlete portrait

Name: Scott Danton

Hometown: Honoka,
Hawaii, USA 36

Medical history: Type 1 diabetes mellitus, diagnosed
in 2002 (aged 16)

Athletic achievements: The first diabetic patient who
went on a world tour as a professional surfer.

Sport: Surfing

Preparations and method of administration of insulin: Insulin pump
Medtronic

Training specifics I really don’t know what else to me
I like it as much as training. I practice almost every day
surfing whenever there are waves. I live in the most beautiful place
I saw — and this is where the best waves in the world come. I roll into the sand
by car, with my girlfriend and two dogs, put chairs and a barbecue grill
and go surfing.I come back when my hands start to fall off
tiredness or if I get hungry. I know that training is necessary because
that if I do not practice all the time, I will not be able to keep at this level.
Surfing is the best thing I have; at this time I forget about all worries.
Surfing has always meant a lot to me, although things have changed a bit
when I was diagnosed.

Diabetes followed me everywhere. All the time I needed
worry about blood sugar and whether I need to eat something.So,
at first, all this put a lot of pressure on me. But now that new ones have appeared
technologies, such as devices for continuous monitoring of glycemia, I have achieved
such control over diabetes that I feel the slightest decrease or increase
Sahara. I can surf and not worry about diabetes because I know
that I will feel fluctuations in the level of glycemia. Now that I’m surfing
I am not too worried about my diabetes and when I do something on land: I go to
hiking, fishing, hunting, I put on a system for long-term tracking
glycemia.This device made my life easier, as I now know the level
glycemia every five minutes and I don’t have to do tests all the time. My life and
water activities have become much smoother.

Typical daily and weekly training plan and introduction
insulin: I usually take the same dose of insulin on days when
I train when I don’t. I keep my blood glucose levels between 120 and 150
before surfing, just for your own peace of mind. I would say that in
99 percent of my sugars are when I finish my workout.Even in the days
when I surf for 3-4 hours, I’m fine on the water. Right now
I have been doing the first few weeks since my knee surgery this winter (2007)

Monday I woke up and went surfing for about
for three hours. With a suitable excitement, the waves rolled over the sandy
a sandbank that I call the Face of the Ghost. I studied until 11.00 and went home
lunch. I dined, worked a little in the garden, and then rested. Then I came back
to surf for another couple of hours, but if the waves were not very good, I got out of
water and just played with the dogs on the shore.

Tuesday The wind picked up early and broke the wave. At me immediately
laziness attacks, because as soon as I find out that the wave is not the same, I disappear
desire to study. Finally, at about 4.30, the wind died down and I went out for a short
evening session. The waves were surprisingly good and I practiced until it got dark
so much so that the shore became invisible.

Wednesday The waves were intractable and I decided to go fishing. to me
I always like to fish close to home, because there are so many fish here that
you have to wait a long time until you catch something.

Thursday My neighbor woke me up at half past three in the morning, on
hunting, so the day began early. I love to walk the mountains and watch the sun
rises above the ocean and everything awakens to life. When we returned there was
it’s been a long time since morning, I wanted to go into the water, although the waves were small. I AM
having fun trying to learn different new tricks – days when the waves are small
very suitable for this: it’s like skateboarding on the curb of a sidewalk. I AM
rode the waves for a little over an hour and went home to rest: of course, that’s all
only the middle of the day, but I already had enough physical education!

Friday I went to Hilo to take pictures, together with one
a photographer from the city.I don’t really like surfing in the city
because I am from the village and do not like the crowd. I rode along with friends who
have not seen for a long time.

Saturday Today I decided to go ride one of my
favorite waves on the West Side. This beach has a 200-yard wave (183
meter), with an excellent takeoff and ridge, on which you can try all the feints,
what are there. I rode for three hours, which is quite a lot, because the paddle
long. I finished, and my friend Steve just came and talked me into a ride
another half hour and then I could barely stay on my feet, so the muscles were tired.I hunted
until it got dark and returned home to dine.

Sunday Today I didn’t go out and did my business
around the house.

Other interests and
hobby

I also like hiking, fishing and hunting. Not
every day there are good waves to ride!

Diabetes and Exercise Story My Physician, Kevin Kaiserman,
had the biggest impact on me. Without him, I would never have achieved anything from
what I can do now in surfing and diabetes control.He convinced me that
we must fight for the result and not let diabetes take over. When the diagnosis is only
set, I was told that being a professional surfer is unrealistic
a goal for a diabetic patient and that it is dangerous to be alone in the ocean for hours. I AM
I heard this, and the day I was diagnosed with diabetes was not just the most
on a bad day in my life — I didn’t really care about this life at all. I’ve always wanted
just being a surfer — since I was five when my uncle taught me to ride.AND
behold, they tell me that I cannot surf anymore, because I have
diabetes! Dr. Kaiserman convinced me not to listen to these conversations and not to leave my
dream. A few years later, I became the first surfer diabetic to
made a world tour. It was the happiest day of my life because
I knew I had done it despite all the difficulties. I have shown an example to many
guys who are also probably advised by someone to give up their dream because of diabetes.It’s good that I didn’t obey.

Named a product with which it is dangerous to combine coffee

https://rsport.ria.ru/20210620/kofe-1737737138.html

Named a product with which it is dangerous to combine coffee

Named a product with which it is dangerous to combine coffee – RIA Novosti Sport, 20.06.2021

A product with which it is dangerous to combine coffee has been named

Pavel Isanbaev, a weight loss specialist at the Bormental clinic in Chelyabinsk, told RIA Novosti why it is very harmful to combine coffee with sweets.RIA Novosti Sport, 20.06.2021

2021-06-20T02: 35

2021-06-20T02: 35

2021-06-20T02: 35

healthy

health – society

sweets

/ html / head / meta [@ name = ‘og: title’] / @ content

/ html / head / meta [@ name = ‘og: description’] / @ content

https://cdnn21.img.ria.ru /images/07e5/02/11/1597

1_0:388:2750:1935_1920x0_80_0_0_ed4667ae1a57d61731e42eaa3ed4f7d4.jpg

MOSCOW, June 20 – RIA Novosti. Pavel Isanbaev, a weight loss specialist at the Bormental clinic in Chelyabinsk, told RIA Novosti why it is very harmful to combine coffee with sweets.He noted that coffee is often drunk with sweet: with sugar, dessert. But sweet and coffee don’t go together. The drink temporarily increases blood glucose levels. Normally, this leads to the fact that the body must spend glucose, and the person feels a surge of strength and vivacity. The caffeine then ends and the “normal” state returns. “When it comes to coffee with sweetness, the glucose level rises excessively and then drops sharply. Hypoglycemia may occur; it manifests itself with symptoms such as weakness, dizziness, cold clammy sweat, drowsiness.For some, this state is weakly expressed, for others it is stronger – it all depends on the specific organism. Metabolism after coffee is different, so your observation of your well-being should be of decisive importance, “says Pavel Isanbaev.

https://rsport.ria.ru/20210613/vino-1736813965.html

RIA Novosti Sport

internet- [email protected]

7 495 645-6601

FSUE MIA “Russia Today”

https: //xn--c1acbl2abdlkab1og.xn--p1ai/awards/

2021

RIA Novosti Sport

internet- group @ rian.ru

7 495 645-6601

FSUE MIA “Russia Today”

https: //xn--c1acbl2abdlkab1og.xn--p1ai/awards/

News

ru-RU

https: // rsport. ria.ru/docs/about/copyright.html

https: //xn--c1acbl2abdlkab1og.xn--p1ai/

RIA Novosti Sport

[email protected]

7 495 645-6601

FSUE MIA “Russia Today”

https: //xn--c1acbl2abdlkab1og.xn--p1ai/awards/

https: // cdnn21.img.ria.ru/images/07e5/02/11/1597

1_0x1080: 2732:2048_1920x0_80_0_0_1d1ec4f8b7eee60c5a6ee1c593097ffd.jpg

RIA Novosti Sport

[email protected]

[email protected]

MIA

»

https: //xn--c1acbl2abdlkab1og.xn--p1ai/awards/

RIA Novosti Sport

[email protected]

7 495 645-6601

FSUE MIA“ Russia Today ”

https: //xn--c1acbl2abdlkab1og.xn--p1ai/awards/

health – society, sweets

Named a product with which it is dangerous to combine coffee

MOSCOW, June 20 – RIA Novosti. Pavel Isanbaev, a weight loss specialist at the Bormental clinic in Chelyabinsk, told RIA Novosti why it is very harmful to combine coffee with sweets.

“Coffee contains antinutrients – substances that interfere with the assimilation of world elements, vitamins from food. Thus, it is better to use a tonic drink between meals,” says Pavel Isanbayev.

He noted that coffee is often drunk with sweet: with sugar, dessert. But sweet and coffee don’t go together. The drink temporarily increases blood glucose levels.Normally, this leads to the fact that the body must spend glucose, and the person feels a surge of strength and vivacity. The caffeine then ends and the “normal” state returns.

“When it comes to coffee with sweets, the glucose level rises excessively and then drops sharply. Hypoglycemia may occur; it manifests itself with symptoms such as weakness, dizziness, cold clammy sweat, drowsiness. Someone has this condition is mild, someone is stronger – it all depends on the specific organism.Metabolism after coffee is different, so your observation of your well-being should be of decisive importance, “says Pavel Isanbayev. hypoglycemic state /

Currently, the health authorities of the leading countries of the world consider type 2 diabetes mellitus as the most important problem, approaching in scale to an epidemic.Thus, in Novosibirsk, there has been an increase in the incidence of diabetes mellitus over the past 2 years from 16.2 to 19.1 per 1000 population. And this is only the official statistics of registered patients. The number of people who are not even aware of their illness is several times greater, since their sugar level is slightly increased and they attribute the symptoms of diabetes to old age, fatigue, bad weather, stress, etc.

One of the complications of diabetes mellitus is a hypoglycemic state (a decrease in blood plasma glucose levels below the conventional norm).The causes may be:
1. overdose of antihyperglycemic drugs;
2. fasting;
3. with intense physical activity;
4. when taking sulfonamides, salicylates;
5. when taking alcohol.

In the event of complications such as hypoglycemia, the main symptoms are:
1. feeling of hunger;
2. severe weakness;
3. cold clammy sweat;
4. pallor of the skin;
5.first, there is excitement, turning into a state of stunning, loss of consciousness is possible.

Help with symptoms of hypoglycemia should be provided immediately, because development of an irreversible state is possible, when any help will be ineffective.

When providing first aid, it is necessary: ​​
1. To lay the patient with a raised head end, it is possible to half-side;
2. Unbutton all squeezing parts of clothing, provide fresh air;
3.Put cold on the head and large vessels;
4. Give an abundant sweet drink;
5. It is necessary to feed the patient, or give any sweetness (candy).

Medical Prevention Center

90,000 Cold sweat – causes, diagnosis and treatment

Cold sweat – this is increased sweating, which is accompanied by cold skin, chills. The symptom occurs against the background of weakness, dizziness. There are various reasons for the development of cold sweat: disorders of the autonomic nervous system, blood loss and other emergency conditions, endocrine and cardiac diseases.To identify the cause of the disorder, ECG, echocardiography, ultrasound, X-ray imaging, laboratory tests are used. To eliminate cold sweat, therapy of the underlying disease is carried out.

Causes of cold sweat

Severe stress

The body’s defense reaction to any stressful situation is the release of hormones from the adrenal medulla (mainly adrenaline). This substance constricts the blood vessels in the skin and activates the sweat glands.A person feels profuse cold sweat, which appears in the form of drops, more often in the head area, and sometimes it can drain in trickles. Such a manifestation is characteristic of the strongest emotional upheavals. Short-term sweating during stress is a variant of the norm, but when it is combined with dizziness, lightheadedness, medical attention is needed.

Migraine

A person is thrown into a cold sweat at the height of a painful attack. In addition to sharp headaches, the patient feels lightheaded, weak, and general sweating is observed.Hands and feet are cold, damp, and sweat may run down the face and neck. This condition persists during the entire migraine attack and disappears on its own after the pain stops. Severe pain sensations provoke excess production of adrenaline, which causes sweating. Unpleasant symptoms are aggravated by exposure to light and sound stimuli.

Vegetovascular dystonia (VVD)

This is a common cause of cold sweats, especially in young, emotionally labile patients.A person with VSD reports that bouts of increased sweating have a different frequency – from several times a month to several times a day. Sweating is triggered by being in a stuffy room, excitement. Patients note that the symptom is combined with severe weakness, dizziness, it seems to some people that they will now faint. Cold sweat is secreted all over the body, sweating of the palms, head, armpits is most pronounced.

Diabetes mellitus

In patients with diabetes mellitus, cold sweating most often develops against the background of a decrease in blood glucose levels.Often, the symptom is observed with long breaks between meals, erroneous administration of more insulin. First, there is a strong feeling of hunger, then sweat appears profusely on the face, trunk, while the limbs are very pale and cold. Increased sweating is sometimes accompanied by motor excitement, a feeling of fear. The condition requires urgent care, as hypoglycemia can go into a coma.

Cardiac pathology

Cold clammy sweat, which is caused by the ingress of large amounts of stress hormones into the bloodstream, appears on the skin during myocardial infarction.The symptom appears against the background of sharp chest pains radiating to the shoulder blade or left arm. In addition to pain, severe weakness, cold extremities are felt, cold sweat appears on the face and body. The patient is very pale, verbal reactions may be inhibited. Sometimes the cause of cold sweats is the development of acute heart failure with a sharp drop in pressure and activation of the sympathetic nervous system.

Bleeding

The loss of a large amount of blood (more than 10% of the BCC) is always accompanied by a violation of the general condition.With external bleeding from large vessels, cold sweat occurs immediately after injury, its appearance is due to both neurohumoral disorders and a strong emotional shock from the type of blood. With massive internal bleeding, hemorrhages in the abdominal or pleural cavity, there is sticky sweat, a sharp cold snap of the skin, diffuse cyanosis. Profuse blood loss can lead to loss of consciousness.

Infectious diseases

Cold sweats usually occur before bedtime, or else the patient wakes up at night with severe chills and notices excessive sweating.The development of a symptom is associated with intoxication of the body with particles of bacterial or viral agents, an increase in body temperature. With some infections, complaints of prolonged perspiration (more than 1 month), cold extremities are typical. Profuse sweat can be combined with muscle tremors, weakness. Cold sweating is common in diseases such as:

Withdrawal symptoms

Profuse cold sweats, which are mainly observed at night, occur in people with dependence on alcohol and drugs.Perspiration appears 2-3 days after stopping the use of these psychoactive substances. Sometimes the sweating is so intense that the sheets and pillowcases get soaked through and the person with withdrawal symptoms has to change the bedding in the middle of the night. Increased sweating is accompanied by aches and burning throughout the body, weakness, and severe headaches. Irritability and emotional instability are characteristic.

Emergencies

There are many acute conditions in which cold sweats can occur.Perspiration always appears in case of severe damage to internal organs, in which nervous regulation changes, a sharp release of biologically active compounds into the blood occurs. At the same time, the skin turns pale, the nasolabial triangle, nails, fingertips acquire a bluish tint. Sticky sweat appears on the entire surface of the body. The accompanying symptoms depend on the cause of the cold sweat. With profuse sweating and coldness of the extremities, flow:

Rare causes

• Oncological diseases : lymphogranulomatosis, non-Hodgkin’s lymphomas, acute and chronic leukemias.
• Idiopathic hyperhidrosis .
• Endocrine pathology : hypothyroidism, chronic adrenal cortex insufficiency.
• Cardiac arrhythmias : Morgagni-Adams-Stokes syndrome, paroxysmal tachycardia, QT prolongation syndrome.

Diagnostics

The general practitioner or therapist is responsible for determining the factors behind the increased sweating.The main task of the examination is to find the main cause – pathology, one of the symptoms of which is cold sweat. Diagnostic search involves laboratory and instrumental methods for assessing the general state of the body and the functioning of individual organs. The following studies are considered the most valuable:

• Cardiology . To exclude cardiac causes of the origin of cold sweat, an electrocardiogram is recorded in standard leads.The recording evaluates the voltage of the teeth, the size of the intervals between them. If pathological signs are detected, echocardiography is performed to clarify the diagnosis.
• Neurological examination . The standard examination includes checking deep and superficial reflexes, cutaneous dermographism. To exclude vegetative-vascular disorders, the Danini-Aschner phenomenon and orthostatic test are used. In some situations, it is recommended to record an electroencephalogram.
• Functional tests .The methods are used when idiopathic hyperhidrosis is supposedly considered as the main cause of cold sweat. The amount of sweating is assessed using evapometry and gravometry. To measure the area and intensity of hyperhidrosis, the Minor test (iodine-starch test) is performed.
• Imaging Techniques . During the initial examination of patients with complaints of cold sweat, ultrasound of the abdominal cavity and pelvic organs is informative.In the presence of concomitant symptoms, an x-ray of the chest and abdomen is indicated. Sometimes computed tomography or MRI is prescribed.
• Analyzes . A clinical blood test can detect signs of infectious diseases, which are often manifested by cold sweating. A coagulogram is performed in the presence of bleeding. In all cases of the disorder, a biochemical blood test with a proteinogram, measurement of fasting glucose is recommended.

The presence of a general infectious syndrome serves as an indication for bacteriological examination and performing serological tests to identify the type of pathogen (RIF, ELISA, PCR). With prolonged increased sweating, it is necessary to determine the concentration of insulin, thyroid hormones and adrenal cortex. For the examination of patients with cold sweat, other specialists (endocrinologist, phthisiatrician, oncologist) may be involved.

Treatment

Help before diagnosis

Cold sweats can be a symptom of various diseases, so only a doctor can determine the exact causes of unpleasant symptoms.Before establishing the cause of sweating, it is recommended to regularly take a hygienic shower and change bed linen more often. With heavy sweating, sedatives are used to normalize the functioning of the nervous system. If cold sweat has arisen against the background of severe weakness or dizziness, the patient must be seated, provided with air access, and in case of fainting, let the ammonia sniff.

First aid for critical conditions

Conservative therapy

Medical treatment depends on the underlying cause of the increased sweating.In critical conditions, resuscitation, oxygen support and the introduction of infusion glucose-saline solutions are required. In case of a satisfactory condition, drug therapy is carried out. Cold sweats due to autonomic dysfunction are treated with physiotherapy and psychotherapy. The treatment regimen may include the following groups of drugs:

• Sedatives . The remedies are effective when cold sweat is associated with disturbances in the functioning of the nervous system.Both herbal and synthetic medicines are used. In difficult situations, resort to “daytime” tranquilizers.
• Analgesics . Cold, clammy sweat associated with pain requires non-narcotic pain relievers. For severe pain, traumatic shock, opioid analgesics are used.
• Antibacterials . Medicines help eliminate sweating associated with infectious diseases.For tuberculosis, specific long-term treatment regimens are used with combinations of several anti-tuberculosis drugs.
• Thrombolytics . The drugs are prescribed to patients with myocardial infarction, against the background of which cold sweat occurs. They allow to restore the blood supply to the heart muscle and significantly shorten the recovery period.

Surgical treatment

In case of cold sweat caused by severe organic lesions of internal organs, surgery is indicated.Diseases accompanied by “acute abdomen” require laparotomy, revision and sanitation of the abdominal cavity. With the pathology of the organs of the reproductive system in women, resection of the altered tissue is carried out with preservation of fertility; with extensive lesions, oophorectomy, adnexectomy are necessary. For leukemia and lymphomas, bone marrow transplantation is possible.

Page not found |

Page not found |

404.Page not found

Monthly archive

MonTueWedThuFtSaSun

12

12

1

3031

12

15161718192021

25262728293031

123

45678910

12

17181920212223

31

2728293031

1

1234

5678

12

8

121314

11121314151617

28293031

1234

12

12345

678

12

5678

12131415161718

19202122232425

3456789

17181920212223

24252627282930

12345

13141516171819

20212223242526

2728293031

15161718192021

22232425262728

2930

Archives

Tags

Settings
for visually impaired

90,000 Hypoglycemia is a rather narrow topic related to diabetes mellitus.

Hypoglycemia is a rather narrow topic related to diabetes mellitus. However, it is still unrealistic to fully cover diabetes mellitus in one article. Therefore, today we will talk about one of its serious consequences, arising from a lack of glucose in the body. The hypoglycemic state develops with lightning speed, leads to severe disturbances in the brain and is potentially fatal. Physiology of the Phenomenon Boring and dry definition at first. Hypoglycemia is an metabolic endocrine syndrome that occurs when the plasma glucose level drops by at least 0.5 mmol / L from the lower limit of the norm and is accompanied by symptoms of disruption of the central nervous system.Let’s remind – the norm is 3.5–5.5 mmol / l. The fact is that the brain is a highly energy-consuming organ (especially its gray matter), one might say – a spender. Yes, yes, in comparison with other organs, he consumes an unmeasured amount of energy and at the same time lives in isolation (cranium). This means that any starvation, be it oxygen or glucose, within a few minutes can lead to the death of an organ. And the fact that the brain resides in the cranium, unable to grow even with swelling of the cells, further exacerbates the problem.Here we must clarify that any tissue damage leads to edema: bite yourself on the finger and it will swell, but after a couple of days (or even hours) the swelling will disappear and the finger will regain its previous appearance and functionality, but swollen brains, having increased in size, will rest against the walls of the dungeon (skull) and begin to flow away to where there is free space. The vessels will shrink, nutrition will stop, damage to nerve cells will increase, the brains will swell even more and proceed to the foramen magnum. The neurons of the medulla oblongata, in which the most ancient centers of respiration and control of the cardiovascular system are located, will be the first to suffer, and this will finish off the body completely.And I ask you not to think that the brain swells only from hitting a wall – they swell from any damaging factor, including a lack of oxygen, glucose and other substrates that lead to cell damage. Causes of hypoglycemia Undoubtedly, patients suffering from diabetes mellitus are most susceptible to this condition, for example, due to an overdose of insulin, errors in the method of its administration (administration of insulin without prior shaking in a vial, administration of the drug to places where rapid absorption of the drug can occur).After all, some manage (apparently, thinking that for some reason they did not insert it), together with the subcutaneous injection, they also make an injection of insulin into a vein. By the way, the development of a hypoglycemic state after the very first injection of insulin is quite possible. After all, it is not always possible to predict the body’s response to the usual dose of the drug. The causes of hypoglycemia that are not associated with diabetes mellitus are also distinguished: tumors that produce insulin, adrenal insufficiency, renal and hepatic insufficiency. Alcohol, β-blockers, sulfonamides are also capable of lowering glucose levels … We will not list all the reasons, enough frequent ones.But we think you realized that this condition is not so rare. Even completely healthy people can experience it for themselves. Sometimes patients are brought to the hospital in an alcoholic coma with low sugar, especially often during the cold period, when the muscles in the last attempt to save the body begin to contract, warming the body, but intensively consuming glucose. Someone may ask: what about the liver and glycogen stores in it? Good question. Let’s say more – not only the liver is able to maintain the vital activity of the nerve cell for some time, there are other systems and biochemical reactions (glycogenolysis, gluconeogenesis, proteolysis, lipolysis).However, these reserves are not endless and, moreover, are quite costly for the body, and the brain wants to eat here and now. And he, as an organ of higher origin, does not want to wait a couple of hours until “the chicken is caught, plucked and boiled.” The brain, like a hysterical woman, immediately loses consciousness and gives out convulsions, and not theatrical, but real. He feels bad, and he dies quickly … We want you to know what a person with hypoglycemia looks like outwardly, especially since sometimes such people themselves do not notice their condition, pushing themselves to the limit.So, in a state of hypoglycemia, a person becomes indifferent to the environment, lethargic, drowsy. He has a feeling of hunger, headache, dizziness, fog in his eyes, “flies are floating”, images are “double”. If you do not help in time, the patient loses consciousness, while the jaws are compressed and cramps begin throughout the body. Muscle contractions also require energy, which further exacerbates the situation. The heart beats faster, blood pressure rises. Those who experience hypoglycemia in their sleep have nightmares.In a patient with diabetes mellitus, the above symptoms should unconditionally suggest hypoglycemia. How can this condition be prevented? The overwhelming majority of patients with diabetes mellitus do not need our advice, but still we will set out general recommendations. So: Patients prone to the development of a hypoglycemic state should eat 6 times a day. It is recommended to have a snack before bed to prevent hypoglycemia at night. When the first signs of hypoglycemia appear, it is enough to drink a glass of milk and determine the level of glycemia using a glucometer (fortunately, there are no problems with this now).If your blood sugar is less than 3.3 mmol / L, consume 10 g of glucose, for example in the form of 100 ml of orange juice and several crackers. In general, each patient should have a piece of sugar or candy hidden in his bosom and a document certifying that the owner has diabetes. In case of severe hypoglycemia, patients should have glucagon, a physiological insulin antagonist, with them, and their relatives should be able to inject it in a dose of 1 mg subcutaneously (I just don’t know if anyone has seen this drug with their own eyes).It is clear that if the patient is in a coma, then it is not worth pushing sweets into his mouth, it is still not enough to arrange aspiration with a foreign body.