A Spectrum Health diabetes educator shows two glucose monitoring devices that are available for patients.
A Spectrum Health diabetes educator shows two glucose monitoring devices that are available for patients. (Chris Clark | Spectrum Health Beat)

Diabetes is the body’s inability to properly process sugar, causing blood sugar to rise to unhealthy, sometimes dangerous, levels.

But the opposite problem–low blood sugar–can be a concern for people with diabetes, too.

About 60 percent of people with diabetes have had episodes of low blood sugar, known as hypoglycemia, according to a national survey by the American Association of Diabetes Educators. Of those people, 19 percent went to an emergency room.

“The prevalence is huge, and patients are concerned about it,” said Evan Sisson, PharmD, MHA, and a certified diabetes educator and former American Association of Diabetes Educators board member.

But the survey also showed that many patients “don’t know how to recognize hypoglycemia, and what to do if they do have it,” Dr. Sisson added.

A surprisingly high percentage of the survey’s respondents—nearly one-fifth—didn’t know how to define low blood sugar.

The number of patients who are unaware of low blood sugar treatment, or not properly treating low blood sugar, is worrisome to medical professionals because they demonstrate high patient concern but low knowledge.

When addressed properly at the first sign of symptoms, hypoglycemia can be little more than a minor annoyance. But if ignored, the symptoms become significantly worse—sluggishness, mental confusion, loss of consciousness.

Low blood sugar symptoms—the alarm signals include feeling shaky or sweaty, hungry or nauseated, or having a pounding heart—can begin when glucose levels drop to 70 milligrams per deciliter, or lower.

“Several factors put patients at increased risk of hypoglycemia,” said Annie House, a certified diabetes educator and diabetes education program coordinator at Spectrum Health Medical Group.

These factors include: too much diabetes medicine, too little food, or unplanned activity such as extra exercise in the summer or snow shoveling during the winter—any of which can use up much of the body’s glucose supply.

Diabetes educators know to screen patients for these things and discuss the symptoms, treatment and methods of preventing low blood sugar,” House explained.

She added that modern technology is helping with such increasingly popular devices as continuous glucose monitors, which can warn patients electronically if their blood sugar is getting too low.

Dr. Sisson emphasized the importance of people with diabetes staying alert to their body’s changes.

“We’d like people to stay tuned to what their bodies are telling them,” he said. “Being able to anticipate changes in our body’s blood sugar from various activities, or from a missed meal or snack, is an important skill that comes from discipline and vigilance. And it’s important to include a patient’s medical professional in this effort.”

House said the diabetes professionals at Spectrum Health often bring up the subject of hypoglycemia during patient assessments. People with diabetes should ask their medical team about the impact of glucose medication or activities on blood sugar levels, just as a primary care provider may want to remind patients to check blood glucose before or after any physical activity, and to have appropriate snacks readily available if glucose levels fall.

Don’t be shy about this.

“When I talk with patients, one of the things I try to highlight is that hypoglycemia is a common issue,” Dr. Sisson said. “For that matter, diabetes itself is common. They’re not the odd person out. They’re not alone.”

Including a patient’s entire medical team to help develop a disciplined approach to monitoring symptoms is strongly recommended.

“We believe the patient is part of their own team,” Dr. Sisson said. “The take-home message for us in this survey is that more education is needed all the way around.”

House noted that the subject of hypoglycemia is covered, in depth, in Spectrum Health diabetes group classes, which are covered by most insurance plans.

“Hearing other people’s experiences resonates well,” she said. “Someone else’s story can have a big impact on another patient’s personal behaviors.”

By consistently monitoring their blood sugar and working with a diabetes educator, people can manage their diabetes and minimize the incidence of low blood sugar.