Care
TREATING HYPOS
THE LATEST LOW-DOWN Knowing how best to treat a hypo isn’t always easy – sometimes it feels hit and miss. However, New Zealand-based researchers have done groundbreaking work on hypo treatment methods.
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or people living with type 1 diabetes, keeping blood sugar under tight control with insulin is all important. But this inevitably brings a risk of hypos – hypoglycaemia – when blood sugar drops too low. Likewise, people living with type 2 diabetes may find themselves dealing with hypos if they’re on insulin therapy or sulphonylurea tablets. When you go low, you need a hit of glucose fast, to bring your blood sugar into target range again. But it’s easy to undertreat the low, which can mean your body keeps desperately craving food. You cram in snacks, and, before you know it, you’ve eaten enough to send your blood sugar high again – a “rebound high”. You need more insulin to bring it down, but it’s even harder to know how much you need this time. Next thing, you’re on a blood-sugar roller coaster until you finally find the right balance. For the past decade, a small team of New Zealand researchers have been investigating the optimum treatments for hypos. Diabetes Nurse Specialist Lindsay McTavish has spearheaded the research, working with endocrinologists Esko Wiltshire,
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DIABETES WELLNESS | Autumn 2021
Lindsay McTavish, Diabetes Nurse Specialist
Jeremy Krebs, and Brian Corley, and geriatrician Mark Weatherall. It’s research the whole diabetes community can benefit from. WHICH HYPO TREATMENT WORKS BEST?
Ideally, a hypo treatment works as quickly as possible – not just so you can function normally again fast, but to calm your body’s food cravings and make sure you don’t end up consuming more sugar than you need and going high. What works best for that? Lindsay McTavish realised that most hypo treatment guidelines were based on expert opinion rather than solid evidence. In 2008, with Esko Wiltshire, Lindsay conducted a trial at a national diabetes youth
camp. With the permission of children, parents, and camp leaders, they tested four commonly used treatments when children had hypos: glucose tablets, jellybeans, orange juice, and fruit Mentos. In the end, 52 hypos were treated with glucose tablets, 45 with jellybeans, 44 with juice, and 48 with fruit Mentos. Blood glucose was measured at 0, 2, 5, 10, and 15 minutes. The conclusion? Glucose tablets, juice and fruit Mentos all gave similar quick results. However, jellybeans produced a lower, slower response. HOW MANY CARBS DO YOU NEED TO TREAT A HYPO?
Until recently, most guidelines around the world, including in New Zealand, recommended giving a standard amount of carbohydrate (usually 15g for adults and less for children) to treat a hypo. (Although sometimes weight-based protocols were used for children.) Lindsay and his coresearchers had used a weightbased method in their study at the children’s camp – treating hypos in each participant with 0.3g carbohydrate per kg of body weight. This had been effective.
