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Hypoglycaemia (Hypos)
	Hypoglycaemia is when blood sugar levels are too low (below 4 mmol/l). Hypos can happen when you are treated with insulin or with some diabetes tablets. Hypos can happen very quickly and may be caused by: More exercise than usual Too little food Missed or late meals Too much insulin/tablets Alcohol Hot weather No obvious reason
Symptoms
	Hypo warning symptoms will vary from person to person. You may feel: Shaky/dizzy Confused Anxious Hungry Tingling lips Tired Sweaty You may have: A headache Blurred vision Others may notice that you are: Pale with glazed eyes Unable to speak properly Unco-ordinated Showing mood changes Carry sugar with you at all times (Dextrosol/Lucozade tablets). At the first sign of a hypo take something sugary: Small glass of Lucozade 2 - 4 glucose tablets 2 teaspoons honey or jam If you feel no better after 2-3 minutes repeat the sugar. To prevent your blood sugar falling again follow the sugary food with a snack: Biscuit Sandwich Fruit Glass of milk Your next meal if it is due Mild hypos don't matter at all provided you recognise and treat them. Even severe hypos rarely cause any serious harm. Frequent hypos however usually mean that your insulin/tablet dose is too high. Hypo warnings can get weaker or even disappear. This usually happens when a person has been going hypo fairly frequently, perhaps because they are taking a bit too much insulin or when they are tightening control for pregnancy. Many people have hypos in the nights which may not wake them up but which damage their hypo warnings. It is worrying to lose hypo warnings because blood sugar can then drop dangerously low very quickly. If you think you are losing your hypo warnings, please discuss this with your diabetes doctor or specialist nurse.
Getting Hypo Warnings Back
	It is often possible to get hypo warnings back. The best way to do this is to completely avoid going hypo (including at night) for several weeks. This will almost certainly involve dropping your insulin dose and is best done after one-to-one advice from your diabetes doctor or specialist nurse.
Avoiding Hypos At Night
	Sometimes, a hypo may not wake you up. Clues that you may have had a hypo in the night include having an unexpectedly high blood sugar and/or a headache in the morning. You may have been sweaty or restless while asleep: if you have a partner who notices these things, it would be a good idea for them to wake you up and give you something sweet to eat. It is a good idea to have a snack before bed (a bowl of cereal or sandwich) whatever insulin you are on. It is also a good idea to avoid drinking too much alcohol as this can cause hypos and stops you realise that you are having a hypo. If you are going to go out for a couple of drinks, remember to have a meal before you go and a good snack when you get in. Exercise can lower your blood sugar for several hours, and many people find that they go hypo in the night if they have done exercise in the evening, even if they have had extra food. If this happens, it is a good idea to reduce the dose of insulin you take with the meal before you exercise. How much you reduce your dose depends on the dose you normally take and the exercise you do. If in doubt, please consult your diabetes doctor or specialist nurse. Changing your insulin type or the way you take it can also help to avoid hypos. If you would like to discuss changing your insulin, please make an appointment to discuss this on a one-to-one basis.
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