Queries of Lows and Sleep Woes

Theresa answers readers' questions.

Theresa Garnero By Theresa Garnero, APRN, BC-ADM, MSN, CDE

This month, several readers inquired about situations with low blood sugar (hypoglycemia, or a blood glucose less than 70) and sleep issues. Here is a sampling of these questions and my thoughts on the matter.

Q: My 82-year-old husband recently recovered from open heart surgery. He is taking insulin. If he does light exercise at the rehab center, his blood sugar goes way down 46 to 50. He has his glucose tablets with him but still sweats profusely. How quickly should the tablets take affect?

A. The tablets should start to take effect immediately and be fully into his system in 15 minutes. Have you heard of the rule of 15? If the glucose is less than 70, have 15 grams of simple sugar (examples: chew 3 glucose tablets, or have 4 ounces of juice, or 8 ounces of milk), then wait 15 minutes and retest glucose. If it is still less than 70, have 15 more grams of simple sugar. Once the glucose is above 70, a person needs to eat something like a half of a sandwich.

Your husband may be experiencing exercise-induced hypoglycemia triggered or worsened by the insulin profile (the typical time it takes for insulin to reach full effect in the body). What time does he exercise? Is it at the same time his insulin is working at its strongest (which would plummet his sugar even further)? Did you know that hypoglycemia can occur 4 hours after exercise? Does his doctor know he is running that low? It may mean a simple insulin adjustment on the days he exercises or making sure he had enough to eat before going to the rehab center. All signs point to talking with the doctor and also a diabetes educator can help uncover why he is going low to prevent it from happening in the first place. Treating hypoglycemia is one thing; preventing it is key.

Q: My hematologist called to report my last two blood sugar levels showed 58 and 56. These were taken 6 months apart and I felt fine on both occasions. I had gestational diabetes twice and needed insulin both times. I had a full physical with my primary doctor who did my A1C, but never said anything about my sugar levels to me. While I know that hypoglycemia means low sugar, what, on a practical level, are these readings indicating to me? What should I do?

A. Ask your doctor for more information about these low values, about being screened for diabetes, and for copies of lab tests which will show your A1C value (3-month glucose average) and hopefully other glucose levels. Asymptomatic hypoglycemia (no symptoms of blood sugars less than 70), occurs in a small percentage of the population. Typically, most people will feel symptoms of being low (shakiness, dizziness, shaking, sweating, irritability) when sugars drop below 50.

Your history paints an interesting picture. Women who have had gestational diabetes have a high risk for developing type 2 diabetes later in life. Hypoglycemia can be an early sign of type 2 diabetes. In an attempt to deal with the body's growing resistance to insulin, the pancreas releases extra insulin in response to food, thereby causing low sugars after a meal. Eventually, the pancreas makes less insulin and/or the insulin isn't effective, so we see glucose values rising into the diabetes range (above 126 fasting or above 200 anytime of the day).

You mentioned seeing a hematologist (blood specialist). Blood abnormalities can interfere with A1C value validity, one of the main ones being anemia. Since the A1C measures how much glucose is attached to the red blood cell, if a person is anemic and doesn't have many red blood cells, the A1C can be falsely low. The A1C is not a standard for diagnosing diabetes for this reason. The oral glucose tolerance test (OGTT) is the best bet. For those of you who have never had the pleasure of an OGTT experience, it involves fasting for 8 hours overnight, having your glucose level drawn, then drinking 100 grams of really sweet, orange-flavored liquid. Blood is taken by vein hourly for 3 hours to measure the body's response to the glucose load. Consider asking your doctor about an OGTT and/or if you need to see an endocrinologist.

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Last Modified Date: February 16, 2013

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by Nicole Purcell
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