Everyone with diabetes is advised to try to keep their blood glucose levels steady and within the recommended range. For most people with diabetes this is below 48 mmol/mol (6.5 mmol/l*) (NICE guidelines for type 2 diabestes 2016). The 2016 NICE Type 2 diabetes guidelines do not contain recommendations for fasting and postprandial (before and after meals) blood glucose targets. However, Diabetes UK Council of Healthcare Professionals (CHP) has advised that the general targets recommended by NICE in the Type 2 diabetes 2008 guidelines be maintained as a guide.
The NICE – National Institute for Health Care Excellence guidelines for type 2 diabetes (2008) recommends that people with type 2 diabetes should aim for
• 4–7 mmol/l* before meals (20-53 mmol/mol)
• less than 8.5 mmol/l two hours after meals (69 mmol/mol):
It is important that individual blood glucose levels should be agreed between the person and their diabetes team. Normal blood glucose levels e.g. for someone without diabetes are 3.5 -5.5mmol/l before meals (15-37 mmol/mol) and under 8mmol/l (64 mmol/mol) 2 hours after meals.
*millimoles per litre: a measurement of the concentration of a substance in a given amount of liquid
Hypos are when the blood glucose levels drop too low (about 3 mmol/l or 9 mmol/mol). Treatment is usually very simple and requires taking some fast acting carbohydrate, such as a sugary drink or some glucose tablets, and following this up with some longer acting carbohydrate, such as a cereal bar, a sandwich, piece of fruit, biscuits and milk or the next meal. (For more detailed information about hypos see resources for links to further information).
Many people we talked to had experienced episodes when they had low blood glucose levels and had had a mild hypo. They described the sensation of a hypo as being lightheaded, 'shaky', 'trembly', having tingling lips and feeling confused. Most people said that once they had experienced low blood sugar, they learned how to recognise the early signs and knew how to deal with them. Mild hypos are more likely to happen if the person has not eaten enough food after they have taken their medication, or if someone has taken too much exercise without having built up enough energy. If someone on insulin takes too high a dose, s/he may also have a hypo.
- Age at interview:
- Age at diagnosis:
- Malcolm is a sales manager and is married with two adult children aged 26 and 19. Ethnic background/Nationality: White British.
I guess it would be useful to maybe talk about the highs and the lows, how you manage them?
Yes. Basically I have my breakfast about 7 o'clock, take my medication, go off to work. I tend to have my lunch, apples, fruit, might buy some sandwiches, by about half past 11. Because by that time the food I had for my breakfast is wearing off, and the tablets are still kicking in and they lower my blood sugars. The gliclazide and the metformin will lower the blood sugars. So that's when you need to eat to bring your blood sugars back up. Also about 4, 4.30 in the afternoon they tend to - if I've been, had a stressful day at work or exerted myself, lots of running about - they tend to drop a little bit then. So then I've got some glucose tablets in the car, which I take and that will bring the blood sugars back up again.
And it's all about balance. Keeping them between 4 and 7 is the ideal. If they drop down to about 3, that's what I call a bit low. And generally you don't get a problem so much when they're high until, unless they're up round the 20's, and then that's the equivalent of being down to 3 the other end of the scale. So you've just got to try and keep them balanced, which is not as easy. It's okay if everything's going alright, but if you're ill, stressed, you know, one reason or another, they can either drop or go up. That's when you do a blood test just to check. And sometimes you feel unwell and it's nothing to do with the diabetes. You just don't feel very well. Other times, yes, you've got a low blood sugar or a high blood sugar.
How do you know when you've, when you need to check?
Tingling lips, you know. And that, that's, I'm lucky. A lot of people don't get any symptoms at all, especially those that are injecting insulin, and they can just collapse on the floor. I'm lucky. One of my first signs is my lips tingle. Don't know why, but luckily they do, and then I think, 'Ah.' You know, I haven't eaten for a while, I've been rushing round at work or whatever. And I'll just take a couple of dextrose tablets or a glass of milk with some sugar in, and that brings them back up. But in about twenty minutes you feel perfectly okay.
- Age at interview:
- Age at diagnosis:
- Philip is a retired senior sales engineer and is married with two adult children. Ethnic background/Nationality: White English.
I get very good warnings. I know when I'm coming down round between the 4 and 3 mark, I know I'm coming down, and I've got extremely good warnings right from the word go. So I know that I've got to do something, and of course I always carry my glucose tablets with me, and a couple of Mars Bars in my pocket. So, I can always adjust.
How do you know then? How do you know when you're about to '?
I get a light feeling, a funny feeling. I can't really explain the feeling. It's you know when I say a distant feeling. You' 'Lightness'. I always think if you've had... a number of drinks and you are starting to go 'light' - you're not drunk, but you're starting to, things aren't quite as sharp as they should be - and it comes on quite... I know when I am coming into that point between 4 and 3, or 3 and 4 whichever way. I know then that I am going low. I have been low. I have been down to 2.8 but that has been for other reasons, you know when I have gone down, it' s a, not getting my meal on time and that type of thing but you can't always cater for. You try to sort of look at all emergencies that could possibly have and try to cater for them. But you can't always, there have got to be times when you can't. And in 10 years, 9 years, I think, I've done pretty well.
The remedy for a hypo is to raise blood glucose levels as quickly as possible either by drinking a sweet drink e.g. fruit juice or Lucozade, or some sweets. Some people say they carry fruit drinks, chocolate bars and biscuits around with them all the time; others keep emergency supplies of juice etc. at work and also in their cars. You should start to feel better after drinking/eating something sweet after about 15 minutes.
- Age at interview:
- Age at diagnosis:
- Balvinder is a retired electician and is married with three adult children aged 44, 42 and 36. Ethnic background/Nationality: Punjabi Sikh.
So have you ever had, what they call a hypo - hypoglycaemia - when your blood sugar drops a lot?
Only once has it gone down to 2. That's it. It became 2 just once.
So then what symptoms did you have, how did it feel?
Like shaking, and I got very sweaty, and I couldn't stand up. So then I knew that it's very low. So then, you know milk, I put 2 or 3 spoonfuls of sugar so then I, drank that. And after 5 minutes, I was okay. So, if that ever happens to me, I know that my sugar must be low. Sometimes I test it too, when it's low then I do test it, sometimes 3 or 4.
And like for a hypo, I mean when the sugar goes very low, do you do anything to avoid that?
Yes for that, I have that, what do you call it? Glucose sweet. I've got that and sometimes if it's low, I'll have that, or I'll have a banana. I'll take that. I'll definitely have that, a small banana I'll eat that. So with that it it'll become fine. Or sometimes it could just be some juice, only, sweetness. I keep that sometimes, like in the car, in traffic sometimes, so juice, apples, banana, I keep those. I've never had a problem, but if sometimes I do have it, then I'll have orange juice or you know the sweet tablets, special glucose ones, those.
If the hypo is more severe, and the person is unable to eat, it is probably better and safer to call a doctor or ambulance. Some carers of people with diabetes may feel they can put a glucose gel (e.g. Glucogel) inside the mouth, but usually better for this to be dealt with by a doctor (as the person may be unable to swallow). In some cases it will be necessary for a glucagon injection to be administered.
- Age at interview:
- Age at diagnosis:
- Gareth is a retired paramedic and is married with 2 grown up children.
But I mean as a paramedic had you ever attended to somebody else who might be having a hypo?
Yeah. I have been to people who have been hyper and hypo. So I knew the difference of them and yeah, the glucagon and things like this, the drugs that you use. And 50% dextrose which is ideal you know, because it's, that's a wake-me-up drug which is fantastic. So I know, how things react on, with certain things, how much sugar you can get in and the forms of what people do. Because a lot of people say that you should have ready like glucagon to inject, but the first thing is orally and so I knew everything that, the treatments that should go with the condition. Which I didn't know I had [laughs].
So you knew all that at that time as well?
Yeah. I did yes. So you know. You know, you pick up things, but there we are, because you always remember you go to casualty especially with somebody with diabetes who is in a hypo and one of the sisters here used to say, 'Go and get a Mars Bar for them.' And you know it is only simple things like that but you remember, or a sugary drink. You know, to try to get them to drink it, milk is another thing, which you try and do. Marie biscuits. So, you know you tend to prepare yourself. Afterwards I was prepared for it, you know, I always had something like that. And make sure that you, I make sure that I eat fairly regularly at times, you know within a certain times. Not exactly heavy meals. But may, I have a little something to eat before I got to bed in the night because when you are at rest sometimes you don't want to go want to go hypo in the middle of the night, and you have got to experience being hypo as well. Because it's really, ah it is something different. It is like walking on eggshells. Its you are sort of like getting a little bit risen, it is just surprising and'
There is no pain with it, it is just that you feel that you're in a different part, you are just rising, in my experience that is, you know, but the eggshells, and you know, you start to know how, what you're having and how it was coming about, so you know, even in the, you wake up in the night sometimes, you know, very rarely happens to me, but I have woke up in the night and I've had to get up. I know I am sweating, and so I come down and make myself a piece of toast or some bread or have a drink, biscuit etc. anything, just so that it is quite then. And you, but it's like walking as I say it is walking on eggshells, you know, you know your know your feet are going there, but you know you can't really feel it.
Watching someone having a hypo can be worrying and often people around will not understand what is happening. The symptoms, which include dizziness, mental confusion, sweating, going grey in the face, unsteady uncoordinated movements can lead them to think that the person is drunk or high on drugs.
If you have Type 2 diabetes and are not taking medication for your diabetes, you cannot have a hypo.
Diabetes UK has a Careline you can call to speak to an expert about managing hypos.
Last reviewed March 2016.
Last updated March 2016.