Diabetes Detective 101: When High Blood Sugar is Caused by Fear of Low Blood Sugar

I would like to introduce a guest blogger this week and an expert in Diabetes education.  Enjoy this new material.

Eating for Target Blood Glucose levels
Eating for Target Blood Glucose levels

Image from University of Illinois Extension Your Guide to Diet and Diabetes

By Donna Ryan RN, RD, MPH, CDE, FAADE

As a diabetes educator, I am humbled sometimes (okay, often) by what I learn from people who live with diabetes every day. Simple assessment questions can open the flood gates of information, or elicit one word answers.  If I listen closely and ask probing questions, I occasionally get a glimpse into the fear, sadness and/or resignation of living with a disease that can cause incredibly high, and paradoxically low, blood sugar.   In many patients, these extremes in blood sugars are intertwined and a focused assessment is needed. And though it is counterintuitive, I have found many patients who present with hyperglycemia and high blood glucose values have a history of hypoglycemia events.

The body senses hypoglycemia, or low blood sugar, as a life threatening event and patients have told me ‘I felt like I was going to die’, ‘I was frozen in my body’ and ‘it’s the worst feeling I have ever had’. Avoiding hypoglycemia is a survival mechanism and can have a deleterious effect on diabetes self-care behaviors. For example, the fear of hypoglycemia drives some people to not take their insulin or pills as ordered and to overeat in an attempt to prevent going low.  This then can then lead to hyperglycemia, poor diabetes control, and likely, the label of ‘noncompliance’.

I ask patients to tell me their hypoglycemia stories: How does it feel, how do you know you are low? How low does your sugar have to go to feel low? How do you treat it? Who helps you?  And, ‘Do you sometimes not take your meds for fear of a low blood sugar or eat extra food to avoid a low’? Some amazing and humbling answers I have received include: ‘I don’t feel my lows until I’m in the 30s’ ‘My cat licks me in the middle of the night and wakes me up when I am low’. Or, ‘Jesus wakes me up in front of the refrigerator and sometimes He wakes me up when I’m on the floor and I crawl to the kitchen to get my juice’.  Family members have told me they have to ‘pull grandma out from under the bed’ when she has a low blood sugar, which is where she rolls when she has an attack.   I ask if they tell their doctor these stories, and many do not.  Why? They believe it’s a part of having diabetes that they must live with, they are waiting until the next appointment to tell them (in 3-6 months), or they ‘forget’ to tell them.  Some patients are surprised to learn that a severe, prolonged hypoglycemic event can be fatal.

How can we intervene and help minimize the toll of hypoglycemia? Ask, listen and educate.

  • Know who is high risk for hypoglycemia
  • Ask about signs, symptoms, frequency of hypoglycemia
  • Educate patients and families how to detect, prevent and treat hypoglycemia
  • Encourage patients to wear medical alert identification
  • Teach ALWAYS check blood sugars before taking your diabetes medicines. Why? If glucose is already low, it’s best to treat the low first.
  • And most importantly: Notify the doctor of low blood sugars, as a change may be needed to the medical plan.

Technology is now making it easier to detect low blood sugars. For patients with recurring and severe hypoglycemia, continuous glucose monitors (CGMs) are available to augment checking sugars with a meter. Some CGMs alert the patient when their glucose is going low. See the resources below to learn more about hypoglycemia and diabetes.

References:

http://www.niddk.nih.gov/health-information/health-topics/Diabetes/hypoglycemia/Pages/index.aspx  

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html   

http://dtc.ucsf.edu/living-with-diabetes/complications/hypoglycemia/  

http://www.niddk.nih.gov/health-information/health-topics/Diabetes/continuous-glucose-monitoring/Pages/index.aspx  

http://www.diabetesselfmanagement.com/ 

This post was written by Donna Ryan RN, RD, MPH, CDE, FAADE,  Diabetes Educator Sacred Heart Hospital, Pensacola, FL. and Director American Academy of Diabetes Educators (AADE) and posted by Robin Allen, a member of the Military Families Learning Network (MFLN) Nutrition and Wellness team which aims to support the development of professionals working with military families.  Find out more about the MFLN Nutrition and Wellness concentration on our website, on Facebook, on Twitter and on LinkedIn.

 

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