Understanding Hypoglycaemia: The Hidden Risks for People with Diabetes

Hypoglycaemia, commonly known as low blood sugar, is a condition that many people with diabetes may not fully recognize. Surprisingly, many individuals experience episodes of hypoglycaemia without awareness, sometimes even suffering from amnesia regarding severe episodes. For some patients, the only "real" hypoglycaemia is the type that brings on noticeable symptoms, leading to a misunderstanding of the condition's broader implications.

Symptoms of hypoglycaemia can be subjective and vary widely between individuals and even across different episodes. Common symptoms include sweating, weakness, trembling, hunger, inability to concentrate, and blurred vision. These symptoms can manifest differently, and relying solely on them to identify hypoglycaemia is not reliable. As a general rule, any person with diabetes who exhibits abnormal behavior should be considered hypoglycaemic until proven otherwise, particularly if they are on glucose-lowering medication.

The body's response to falling blood sugar levels is complex and involves the release of counter-regulatory hormones such as adrenaline and glucagon. These hormones trigger the body's emergency response to combat hypoglycaemia. However, in many people with diabetes, this response may be blunted or absent, making it critical to recognize that hypoglycaemia can occur even at blood glucose levels that are typically considered safe for others. For instance, individuals with persistent high blood sugar may feel hypoglycaemic at levels that are above the standard threshold of 4 mmol/l.

Current guidelines suggest that blood glucose levels below 4 mmol/l are a cause for concern, prompting individuals to stop their activities and consume a source of glucose. In urgent situations, treating hypoglycaemia quickly is essential, as symptoms can escalate rapidly. Patients are advised to eat glucose immediately followed by a snack or meal to stabilize their blood sugar, and to check their levels soon after.

Changes in cognitive function often precede a person's awareness of hypoglycaemia, leading to alterations in perception, concentration, and decision-making abilities. A person experiencing low blood sugar may find themselves confused, distracted, or unable to articulate their thoughts clearly. This can lead to dangerous situations, especially in tasks that require focus, such as driving. Unfortunately, as cognitive functions decline, individuals may not recognize their impaired state, making it even more challenging to seek help or take necessary precautions.

Recognizing and understanding hypoglycaemia is essential for anyone living with diabetes. By being aware of the symptoms and implementing appropriate responses, individuals can better manage their condition and mitigate the risks associated with low blood sugar episodes.