Risk Factors for Hypoglycemia when you have Diabetes

Hypoglycemia, or low blood sugar, is an unpleasant condition that may cause dizziness, blurry vision, weakness, headache, shaking, and a fast heart rate. It may also make you experience confusion, and you have trouble concentrating. This is why it is essential that anyone with diabetes should assess their risk of experiencing hypoglycemia. Here are some of the major risk factors for hypoglycemia when you have diabetes.

Risk Factors for Hypoglycemia when you have Diabetes

1. Skipping Meals

If you have diabetes, then skipping meals should definitely not be something you practice on a regular basis.(1,2) Skipping a meal can easily make your blood sugar levels fluctuate, causing your blood glucose levels to fall too low.(3,4) Certain diabetes medications, if taken without good, can significantly increase your risk of experiencing a hypoglycemic episode. Skipping meals can also make you consume more foods that are high in refined carbohydrates, which are not good for people with diabetes. Being hungry can also make you binge eat, again causing a spike in your blood glucose levels.(5)

2. Elderly Age

The risk of developing severe hypoglycemia nearly doubles with every decade of life once after the age of 60 years.(6) This is believed to be so because older people are more sensitive to medications.(7)

3. Weight Loss

Being obese or overweight significantly increases the risk of having diabetes, and managing your weight is also a significant part of diabetes treatment.(8) However, if you lose weight too quickly, it carries several risks when you are on diabetes medications.

Losing weight rapidly makes you more sensitive to insulin, meaning you will need to decrease the amount of insulin to manage your diabetes.(9)

So if you are trying to lose weight, it is better to first consult your doctor as you will need to discuss how some of your medication dosages can be modified to prevent an episode of hypoglycemia.

4. Erratic Eating Times

People with diabetes need to manage their blood sugar levels with medication and proper meals. Eating erratically throughout the day can cause an imbalance between some of your diabetes medications and your blood glucose levels. Research has found that people who eat at regular intervals have a significantly lower risk of hypoglycemia than those who have an irregular eating habit.(7)

5. Taking Beta-Blockers

Beta-blockers are commonly prescribed medications that are used for treating high blood pressure and other conditions. Beta-blockers themselves don’t necessarily increase the risk of developing hypoglycemia, but they can make it more challenging to recognize the symptoms of hypoglycemia when you are experiencing an episode. For example, one of the common first symptoms of hypoglycemia is that you have a fast heart rate. However, beta-blockers slow down your heart rate, which is why you won’t be able to rely on this symptom.

If you are on a beta-blocker and you have diabetes, you will need to check your blood glucose levels more regularly, and you will need to eat regularly.(10)

6. Heavy Exercising

Regular exercise is necessary for everyone. When you exercise, the body uses up the excess glucose present in your bloodstream at a faster rate. An increase in physical activity also helps increase your insulin sensitivity. However, when you engage in heavy exercise without monitoring the levels of blood sugar, it can prove to be dangerous.

To avoid having an episode of hypoglycemia while you are exercising, it is essential to test your blood sugar levels once before, during, and then after you finish your workout. Many doctors also recommend that you eat a snack before you begin your exercise routine. Or, have a snack if you find your glucose levels to be too low after you finish your exercise. Many people keep glucose tablets handy with them during exercising for such situations.(11)

7. Taking Antidepressants

A 2017 study carried out on over 1200 people with diabetes found that the use of antidepressants was strongly linked with hypoglycemia.(6) Tricyclic antidepressants, in particular, were more strongly linked with a high risk of severe hypoglycemia as compared to selective serotonin reuptake inhibitors. 

The researchers noted that the symptoms of depression, such as loss of appetite, could also be a contributing factor to increasing the risk of hypoglycemia.

8. Repeated Use of the same Injection Site

Certain people with diabetes need to use insulin injections daily for managing their diabetes. If you repeatedly inject insulin into the same site, over time, it can lead to an accumulation of fat and scar tissue underneath the surface of your skin. This is known as lipohypertrophy.(12,13)

Lipohypertrophy has an impact on the manner in which the body absorbs insulin. Continuing to inject insulin at the same site puts you at a potentially higher risk of having an episode of hypoglycemia or even hyperglycemia. This is why it is crucial to keep rotating the injection site.

It is also essential to keep in mind that different parts of your body absorb insulin in different ways. For example, the absorption time is the fastest when you inject insulin in the abdomen, followed by the arm. It surprises many people to learn that the buttocks have the slowest rate of absorption.

9. Kidney Damage

Your kidneys are responsible for metabolizing the insulin you take, reabsorbing the excess glucose in the bloodstream, and removing the medication from your body. Due to this, people with diabetes are more prone to kidney disease, which in turn increases the risk of having hypoglycemia.(14)

10. High Intake of Alcohol

Drinking too much alcohol can cause your glucose levels to plummet overnight. Alcohol is responsible for blocking the production of glucose in the liver. When there is a combination of diabetes medications and alcohol present in your body, it can cause your blood sugar to fall rapidly. If you want to have a drink once in a while, it is recommended that you eat a snack or meal before going to bed. Also, you need to be extra careful when you monitor your blood sugar levels the next day.(15)

11. The Longer You Have Diabetes, The Higher The Risk Of Hypoglycemia

The risk of hypoglycemia is higher in people who have had diabetes for a long time. This is because they have been taking insulin for a long and sustained period of time.

Conclusion

If you have any of the above-mentioned risk factors, you should talk to your endocrinologist or doctor about developing a plan for how to prevent hypoglycemia. You may not be able to prevent ever having an episode of hypoglycemia, but you can follow these tips to lower the risk of a hypoglycemic episode:

  • If you drink alcohol, have a snack while drinking or after drinking.
  • Keep rotating your insulin injection site regularly.
  • Avoid skipping meals or having an erratic eating pattern.
  • Keep monitoring your blood sugar levels closely while exercising.
  • Ask your doctor if any of your medications, such as beta-blockers or antidepressants, may increase your risk of hypoglycemia.
  • When you are losing weight, make sure that your doctor adjusts the dosage of your diabetes medications.

If you do experience an episode of hypoglycemia, immediately eating a fast-acting carbohydrate like orange juice or hard candy can increase your blood sugar level. If you experience mild to moderate hypoglycemic episodes two to three times a week, it is necessary to talk to your doctor to determine the underlying reason behind these episodes.

References:

  1. Zhao, D., Cho, J., Kim, M.H., Friedman, D.S. and Guallar, E., 2015. Diabetes, fasting glucose, and the risk of glaucoma: a meta-analysis. Ophthalmology, 122(1), pp.72-78.
  2. Øverby, N.C., Margeirsdottir, H.D., Brunborg, C., Dahl‐Jørgensen, K., Andersen, L.F. and Norwegian Study Group for Childhood Diabetes, 2008. Sweets, snacking habits, and skipping meals in children and adolescents on intensive insulin treatment. Pediatric diabetes, 9(4pt2), pp.393-400.
  3. Uthoff, H., Lehmann, R., Sprenger, M. and Wiesli, P., 2010. Skipping meals or carbohydrate-free meals in order to determine Basal insulin requirements in subjects with type 1 diabetes mellitus?. Experimental and clinical endocrinology & diabetes, 118(05), pp.325-327.
  4. Reutrakul, S., Hood, M.M., Crowley, S.J., Morgan, M.K., Teodori, M. and Knutson, K.L., 2014. The relationship between breakfast skipping, chronotype, and glycemic control in type 2 diabetes. Chronobiology international, 31(1), pp.64-71.
  5. Torimoto, K., Okada, Y., Mori, H. and Tanaka, Y., 2013. Relationship between fluctuations in glucose levels measured by continuous glucose monitoring and vascular endothelial dysfunction in type 2 diabetes mellitus. Cardiovascular diabetology, 12(1), p.1.
  6. Lee, A.K., Lee, C.J., Huang, E.S., Sharrett, A.R., Coresh, J. and Selvin, E., 2017. Risk factors for severe hypoglycemia in black and white adults with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care, 40(12), pp.1661-1667.
  7. Ahrén, B., 2013. Avoiding hypoglycemia: a key to success for glucose-lowering therapy in type 2 diabetes. Vascular health and risk management, 9, p.155.
  8. Hossain, P., Kawar, B. and El Nahas, M., 2007. Obesity and diabetes in the developing world—a growing challenge. New England journal of medicine, 356(3), pp.213-215.
  9. Sjöström, C.D., Peltonen, M., Wedel, H. and Sjöström, L., 2000. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension, 36(1), pp.20-25.
  10. Kjekshus, J., Gilpin, E., Cali, G., Blackey, A.R., Henningj, H. and Ross Jr, J., 1990. Diabetic patients and beta-blockers after acute myocardial infarction. European heart journal, 11(1), pp.43-50.
  11. Riddell, M.C. and Perkins, B.A., 2006. Type 1 diabetes and vigorous exercise: applications of exercise physiology to patient management. Canadian Journal of Diabetes, 30(1), pp.63-71.
  12. Young, R.J., Hannan, W.J., Frier, B.M., Steel, J.M. and Duncan, L.J., 1984. Diabetic lipohypertrophy delays insulin absorption. Diabetes Care, 7(5), pp.479-480.
  13. Vardar, B. and Kızılcı, S., 2007. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes research and clinical practice, 77(2), pp.231-236.
  14. Alsahli, M. and Gerich, J.E., 2014, November. Hypoglycemia, chronic kidney disease, and diabetes mellitus. In Mayo Clinic Proceedings (Vol. 89, No. 11, pp. 1564-1571). Elsevier.
  15. Steiner, J.L., Crowell, K.T. and Lang, C.H., 2015. Impact of alcohol on glycemic control and insulin action. Biomolecules, 5(4), pp.2223-2246.

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