Hypoglycemia and other musings
It has been some time since I have written something. Now that we have a new year and some new technologies as well as some other interesting developments in Diabetes, I would like to make sure that I share some of them.. The actual article that caught my eye recently was in Empower Magazine with the title, Trained Alert Dogs, Sniffing out Hypoglycemia. There is a great Youtube video about this and one of our recent Diabetes Educator meetings was devoted to the subject Hypoglycemia. Hypoglycemia, that is, concern about it is perhaps the subject that we most address in education. It stands in the way of tight control in many cases and has certainly been responsible for a great number of Emergency Room visits by persons with Diabetes on medication. This applies to persons who takes pills as well as insulin. Some of the new medications such as Symlin can increase insulin sensitivity so much that a person’s dose of medication needs to be severly reduced. We ask persons to diet and lose weight but need to be aware that medications can interfere with weight loss and predispose to hypoglycemia if not adjusted. Persons on Insulin need education from experienced educators to avoid severe reactions. These can come from increased exercise on a particular day or starting a low carbohydrate diet. Many times the time of highest risk is at night and I certainly have experienced that myself. The effects of one of my bike rides can last more that the day and night and into the next day. We talk about adjusting bolus injections and basal rates on insulin pumps but even so hypoglycemia may be difficult to avoid. Now at last we have ways of detecting low blood sugar available to us. I am currently using the Dexcom G4 continuous glucose sensor. I found the previous version, the Dexcom 7 useful but frustrating due to short range and accuracy problems. Glucose sensors all are most accurate when blood sugars and are stable and not fluctuating greatly. They are particularly useful to avoid severe night time hypoglycemia. Early when I started with Diabetes I, I was using NPH insulin which caused sever unexpected hypoglycemia when I would try for tight control. Consequent to some pretty severe lows, for 20 years I got up every night at 0200 to test for safety. I encouraged other persons at risk to do the same, but many times that was too difficult . These sensors have definitely improved the safety margin for persons with Diabetes. Particularly, this G4 is an advance. Its range is much greater, at least 20 feet if not more. Its accuracy is much better. There does not seem to be any reaction after two weeks to this very fine platinum electrode. It has definitely reduced the number of fingersticks and has warned me many times when my blood sugar went below the 80 mg% that I have it set for. Persons interested in tight control, especially on Insulin should have this tool. Unfortunately it is quite expensive. But so are ER visits or poor control. The Dexcom 4 came out December 1 and has already reduced my A1C.
Trained alert dogs are remarkable and I have never met one myself. However the Youtube video is fascinating and these dogs can detect severe Hypoglycemia These dogs are trained to sense low blood sugar and even rapidly dropping blood sugar levels and alert the owner. D4D which is Dogs for Diabetics is a nonprofit that places these dogs with owners. The dogs are carefully selected and both the dog and the owners are trained. This is usually for persons with Type 1 Diabetes and especially those with Hypoglycemia Unawareness. In the magazine article and the video the owners attested to being alerted by their dog once a week or more. These are low blood sugar episodes that the dog detect through its extremely sensitive sense of smell and well before hypoglycemia emergencies occur. Another place to look for these dogs is Assistance Dogs International.
As we start another year trying for the best health and happiness possible it is nice to know that new tools keep coming available to advance the cause of self care for ourselves and our families. Happy New year to all of my patients and to sweet persons everywhere.