Shaina Aggarwal will never forget this year’s Diwali. “As the festivities neared, there was naturally a lot of giving and taking of various sweets and fried stuff. I was worried about my diabetic father-in-law. Like most diabetics, he loves his laddoos and barfis,” she rolls her eyes. This Diwali, she had her extended family visit them from Mumbai. Amid all the chaos, she managed to keep an eye on her father-in-law’s diet, made sure he took his insulin on time and stayed away from sweets. But she had not bargained for what happened next. The night after Diwali, around 2 am, her father-in-law started shivering and sweating uncontrollably. Before the family could realise what was happening, his talk became incoherent, and he was in and out of consciousness. Aggarwal measured her father-in-law’s sugar levels with the family physician on call to find that they had dropped below 60 mg/dL. “Hypoglycemia,” ruled the physician, and the septuagenarian was immediately rushed to hospital.
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Dr Dheeraj Kapoor, Chief – Endocrinology, Artemis Hospital, Gurgaon, says, “Low sugar levels may affect your sensorium. It can cause traumas, palpitations, anxiety, headache, perspiration and hunger, and of course, high blood pressure. Among the neurological symptoms, it can cause seizures, drowsiness, unconsciousness, and can also be fatal if not treated in time.”Unfortunately, while the Aggarwals focused on high sugar levels, they completely ignored the dropping levels. High sugar levels are easy to keep a check on with insulin treatment and lifestyle changes; however, low sugar levels can be equally deadly.
The risks involved with hypoglycemia are manifold. In many countries, patients prone to developing hypoglycemia are not given a license for driving heavy vehicles. In the elderly, it can cause falls from dizzy spells. Besides, there are long-term effects. Some studies have shown that if you had repeated instances of hypoglycemia, it could severely impact brain function well over time. Additionally, hypoglycemia can have a psychological effect. Dr Harish Kumar, Professor and Head, Centre for Endocrinology and Diabetes, Amrita Hospital, Kochi, says, “Once the blood sugar level goes below 70 mg/dL, it is considered hypoglycemia. If it goes below 50 mg/dL, it is considered severe hypoglycemia. There are various stages as it varies from patient to patient.”
Monitoring blood sugar levels is essential. This is particularly important when you have just started using insulin or other drugs to manage your blood sugar. Aggarwal’s father-in-law was put on insulin six months ago. One of the leading causes of low sugar levels is the consumption of large quantities of alcohol. It is then essential to supplement it with a diet rich in carbohydrates as it helps raise blood sugar levels. Since glucose is absorbed faster in the body when consumed in liquid form, Aggarwal has been advised by the physician to administer a sweet beverage to her father-in-law should he feel that his blood sugar levels are below normal. Mild hypoglycemia can be easily treated with a sweet drink or carbohydrate-rich food. This usually works within about 15 to 20 minutes, and then the patient feels better. If the hypoglycemia is moderate, one may need to take glucose.
At the same time, the trick is to do this in a calibrated manner, so that blood sugar levels are not elevated abnormally. But home treatment may not be enough at all times. Dr Kushal Banerjee, Senior Homeopath at Dr Kalyan Banerjee’s Clinic, Delhi, says, “Severely low blood sugar levels should be treated at a hospital or a healthcare centre since this may require medication and close monitoring. Such patients may also need to be examined for other complications.” When the circulating level of blood glucose falls, the brain senses the drop. The brain then sends messages that trigger a series of events, including changes in hormone and nervous system responses to the blood glucose levels. Insulin secretion decreases, and hormones promoting higher blood glucose levels, such as glucagon, cortisol, growth hormone, and epinephrine, increase. In addition to the biochemical processes that occur, the body starts to consciously alert the affected person that it needs food by causing the signs and symptoms of hypoglycemia.
Dr CR Magesh Babu, Sr Consultant – Diabetology, Meenakshi Mission Hospital & Research Centre, Madurai, says, “Low blood sugar levels can increase a person’s vulnerability to other conditions, such as heart disease. Hypoglycemia can also increase the risk of other conditions, including eye disease, kidney disease and nerve damage.” Having gone through such a health scare recently, Aggarwal feels that it is important that caregivers and family members of patients with diabetes know how to manage moderate hypoglycemia. “I feel thankful that we could address it on time. Now I’m doubly careful. Even though sweets are banned for diabetics, our family physician has advised that we check the sugar levels every night at bedtime. If it is even slightly below normal, we should immediately give my father-in-law some glucose,” says a visibly shaken Aggarwal, stressing, “I think every caregiver should know how to spot and tackle hypoglycemia."