What do I need to tell my patients about hypoglycemia?

Key messages for patients about hypoglycemia include the following recommendations:

• Review the symptoms of hypoglycemia. Point out that they will not experience all of these symptoms but that they will generally have the same symptoms whenever they are hypoglycemic.
• Teach the “rule of 15s”: Treat with 15 g of carbohydrates, wait 15 minutes and treat with another 15 g of carbohydrates if the blood glucose level is still too low.
• Caution patients not to overtreat a hypoglycemic episode.
• Remind patients to always wear identification for diabetes and to test their blood glucose before driving a car or engaging in exercise. The general recommendation is that the blood glucose level should be >100 mg/dL prior to exercise or driving.
• If patients take medications prone to causing hypoglycemia (insulin or insulin secretagogues), a small carbohydrate snack before engaging in vigorous exercise is reasonable. Remind your patient to recheck blood glucose after exercise to help plan for future exercise sessions.
• Teach patients to keep glucose tablets or another form of treatment with them at all times (particularly when exercising) and to be sure to keep a form of glucose in the car, purse, briefcase, pocket, gym bag, desk drawer, and nightstand.
• Make sure that patients at risk for hypoglycemia have a current prescription for glucagon and that someone around them knows how to administer it.
• Provide information about when to contact clinicians about hypoglycemia (e.g., number of episodes per week, number of severe episodes).
• Teach patients with hypoglycemia unawareness to recognize neuroglycopenic symptoms early. These patients should have higher targets to avoid hypoglycemia until adrenergic symptoms return.