People with well-controlled diabetes are at greater risk for car crashes and other driving mishaps, according to two recent studies.
Diabetes patients strive for tight control of blood sugar, aspiring for glycosylated hemoglobin (hbA1c) levels of 6.5-7. However, the methods used to stay at these levels, including regular blood tests and treatment with insulin and drugs can cause episodes of hypoglycemia, leading patients to lose concentration or even consciousness.
One 2-year study in the Public Library of Science compared the Hba1c levels of 795 drivers with diabetes who had or hadn’t been in an accident. The researchers found that lower HbA1c levels were tied to a higher risk of a motor vehicle crash. Those in previous accidents had an average HbA1c level of 7.4, compared with 7.9 among those who had not. The authors claim that the increase risk of lower HbA1c might account for about one-third of the 57 accidents in the study.
A 1-year study in Diabetes Care screened 452 drivers with type 1 diabetes for mishaps such as collisions, citations, and losing control, as ell as self-reported hypoglycemic episodes. More than half the drivers (52%) reported at least one hypoglycemia-related driving mishap, 32% reported two or more, and 5% reported six or more. Additionally, almost (41%) said they had experienced disruptive moderate hypoglycemia that impaired driving. Participants using pump therapy to manage their glucose were 35% more likely to record a hypoglycemia-related fender bender than those using insulin injections.
Both results suggest the need for laws that restrict driving in patients with diabetes. Countries that permit people with diabetes to drive (which is most) require that the drivers have no eyesight problems and can document their glycaemic control.
A new way to treat diabetes may be just around the corner. Several biotechnology companies are in hot pursuit of an oral form of insulin. So far, two options exits for patients with diabetes who require insulin – pumps or syringes, with other needle-free options remaining elusive. In 2007, Pfizer, Inc., withdrew Exubera, an inhaled insulin, saying it failed to find favor with doctors and patients.
The main hurdle with taking insulin by mouth is the challenge of avoiding digestive action that breaks it down.
Last month, Novo Nordisk started a phase 1 clinical trail in Germany with an oral insulin analog (NN1952). Novo is using Merrion Pharmaceuticals PIc’s GIPET technology to shield insulin from the digestive tract. The trial will investigate the safety and efficacy of NN1952 in healthy volunteers and people with type 1 or type 2 diabetes. The enrollment target is about 80, and results are anticipated in the first half of 2011.
Other biotechnology companies like Biocon Ltd as well are in the race to be the first out with an insulin pill. Oramed Pharmaceuticals is currently conducting phase 2B trials of its oral insulin capsule, ORMD-0801.
Oral Medicine in non-pill form are also in the works. Biodel is developing a sublingual oral insulin formulation called VIA tabTM that dissolves in minutes when placed under the tongue. Generex Biotechnology Corp. is forging ahead with an oral insulin spray, Oral-lynTM.
IF you have Diabetes,
Don’t worry and freeze,
Careful about your diet Please,
Best are grams vegetables & green leaves,
Must exercise everyday with ease,
Make sure your doctor sees,
Your Eyes, Heart, Kidneys and below knees:
If you have a problem to cease,
Go to Specialist in Diabetes,
Your problem just flees,
So why worry about Diabetes.
Dr Enoch Sundaram
DIABETES – You have heard about it often, now know about it, but when you have to face it yourselves, it is difficult. You ask why me, what I have done wrong? Important is to remember that it is no fault of yours that you have Diabetes. It is the single most important metabolic disease that can affect nearly every organ system in the body. There are 190 million diabetics in the world now. Indians are genetically more susceptible (India has been labeled as Diabetes capital of the world) and the World Health Organization predicts the number of diabetics in India would go up to 40 million by 2010 and 74 million by 2025. See – you are not alone! Now, let us face the truth together.
There was a school of thought that “ignorance is bliss”, knowledge of illness causes distress and prevents or reduces hope. Days have gone, now the challenge is to move away from this and to be a mature person who is capable of accepting the responsibility of treating his own illness. The whole idea is to understand that treatment will be beneficial and delaying treatment will lead to undesirable consequences.
Different types of patient responses that have been seen with Diabetes as an illness
-
Knowledgeable – Whoever knows the impact of his illness is willing to continue with right treatment and has his full family support. He is calm and composed about his illness
-
Scared – Whoever fears his illness, resents the rigid lifestyle, with low family support and is dependent on others
-
Casual – Whoever is nonchalant about his illness and does not want to take action till complications set in)
-
Myopic – Whoever wants maximum results with minimum input and has minimum awareness of the illness.
-
Know it all – Whoever fakes he has all the knowledge about the disease, but seldom has. A little knowledge is a dangerous thing!
We want to give you all information in a clear language so that you can understand the problem and take an active part in solving it. At the same time you need to be aware the new things are happening in this field.
Not uncommonly, the first response in knowing a chronic illness is Denial and Diabetes is o exception. Reactions to news about chronic illness vary from person to person. They include disbelief, revolt (accusation), depression (sadness for health lost), confronting reality and consenting (coping) with serenity. These are integrating processes. The process of integration is also dependent on how the patient views his or her disease. Hence patient education plays a very important role.
A young lady had a blood sugar test which revealed that she was suffering from Diabetes Mellitus. She just could not come to terms with this and went through a myriad of emotions, finally leading to denial. She refused treatment, saying that she just did not have Diabetes. A suitable approach would be to acknowledge the denial and to seek reasons for it. She could be asked the reasons for her denial which would evoke a response, which could be addressed suitably. Should the denial continue with the patient saying that she just does not believe it, one could proceed by gently placing before her the consequences of her denial. On gently persisting, issues that can be handled will come out and the denial broken successfully.
Look at another extreme example. A young man, a juvenile diabetic, decides to tie the knot, but fearing that his young bride would reject him if she knew his medical condition, keeps her in the dark. The marriage is over and off they go for their honeymoon. No insulin is possible and the young man lands into complications of high sugar Diabetic coma on return after three days. He promptly gets himself into the nursing home of the doctor who has been treating him, pleading that the doctor announces that diabetes was just detected! What does the doctor do?
Art of communication as an important part of therapy; occasionally it is the only constituent. It usually requires greater thought and planning than a drug prescription, and unfortunately it is commonly administered in sub therapeutic doses! Nothing can be farther than the truth and acceptance of reality lies in the manner in which it is disclosed. This responsibility lies with the health care provider. Various steps in helping patients cope with Diabetes would help them accept the diagnosis, give information that is required, scope for ventilation of feelings, formulate an action plan and be available for the patient.
Researchers are intensively studying the genetic and environmental factors that underlie the susceptibility to obesity, pre-diabetes and diabetes. As they learn more about the molecular events that lead to diabetes, they will develop ways to prevent and cure the different stages of this disease. Until then, we can hope to prevent further progression of this pandemic by eating healthy and having an exercise filled healthier lifestyle. Yes, you may be at risk. But you can surely postpone it. The doctor is a friend, not a dictator in sharing the treatment responsibility and should make the patient “knowledgeable”. Let’s tackle Diabetes hand in hand!
Childhood Diabetes Mellitus is traditionally called Type1 Diabetes or Juvenile Diabetes where pancreas fails to produce the key enzyme Insulin, as a result the child becomes dependent on Insulin for whole of his/her life. We all know the incidence of Diabetes is increasing very rapidly all over the world but fortunately we do not have much cases of type 1 Diabetes in our country as opposed to the west.
The problem in our country is the adult type of Diabetes, so called type 2 Diabetes where body does produce Insulin but the insulin is either less in amount or lacks quality or both. We use diet and tablets to make the Insulin work better, at least in the initial stage. This is the type of Diabetes which is increasing in India in epidemic proportion, so much so that India has been labelled as the diabetic capital of the world. Far worse news is that we are getting Diabetes at least 10 years earlier as our counterparts in the west.
Modernisation, lack of exercise, easy availability and palatability (!) of fast food all are to share the responsibility along with the change of the environmental pollution etc. In India, 15-20 % of people living in cities aged 20 years+ have Diabetes as opposed to 4-5 % in the villages. This so called “TV and Couch syndrome” is catching our children and that is the worst we can think of. Older children and adolescents are fond of fast food, watching TV and physical inactivity. Typically the child is obese and has family history of type 2 Diabetes (they are born with the gene). They may have peripheral marker of Insulin resistance called Acanthosis Nigricans (a blackish appearance in the skin fold areas). We do not know exactly what is the percentage of type 2 Diabetes in childhood and adolescence as there is no population based study yet available in our country but we are seeing this more and more in our day-to-day clinical practice.
We need to do a lot better to prevent this and at the same time to treat the affected. Not only concentrating on the patient, we need to educate families as almost all have positive family history of type 2 Diabetes. We need to create awareness of this type of Diabetes in young among health care providers (be it general Practitioner, Physician, Paediatrician, nurse), governmental and non-governmental agencies involved in health care, pharmaceutical companies and charitable foundations.
Till today our knowledge is limited, we do not know what is the best way to treat this group, but as we see Insulin may not be required from the day 1 of the diagnosis unlike juvenile or type 1 Diabetes where Insulin is a must. We need good quality research to explore the problem, its’ pathogenesis, prevention and treatment. As Bangalorean, we are proud to be a part of multinational multicentric research study to find out the best treatment option of type 2 Diabetes in childhood and adolescence.
What are the types of Diabetes in childhood?
Childhood Diabetes is of 2 types. Type 1 is insulin dependent and type 2 is due to defective insulin action.
Why my child?
It is unfortunate it is your child. The cause of diabetes is not fully understood. Diabetes is most often associated with a genetically determined predisposition, the presence of autoimmunity and environmental influence.
Is Insulin a must?
Yes. Insulin is a must for Type 1 diabetes as their body is deficient of insulin. If insulin is not given the child can progress to diabetic coma.
When my child should start injecting?
Insulin treatment should be started as soon as the diagnosis is done to prevent the metabolic disturbances and diabetic coma. From around the age of 8 years your child is expected to inject him- or her-self.
What special monitoring is required?
Self -monitoring of blood glucose (SMBG) with a glucometer is an essential tool in the management of childhood diabetes. This will help in good monitoring of blood sugar, detects hypoglycaemia (low sugar), and helps in safe management of hyperglycaemia.
What to do in the school?
School is not at all a problem. They should be treated as a normal child but care to be taken about meal and snack timings and education about recognition and treatment of hypoglycaemia to the teachers and caretakers should be given.
What about parties?
Children should not be restricted from parties, but too much is too bad. Occasional parties are allowed but take care to inform the host about diabetic child and make arrangements for diabetic sweets.
What about marriage?
Diabetic patients can get married as any other individual.
Will it be all right for her to become pregnant?
Pregnancy is not contraindicated to diabetic patients. Care should be taken regarding good glucose control of the mother and close monitoring of baby’s growth through out pregnancy
Will she pass on diabetes to the baby?
When a member of the family has diabetes there is a risk to relatives of developing the disease. And it is as follows
-risk to child of a father with type 1 diabetes –7%
-risk to child of a mother with type 1 diabetes- 2%
-risk to identical twin of a child with type 1 diabetes- 35%
-risk to sibling of a child with type 1 diabetes- 3-6%
Treatment Options for people with Diabetes
While Insulin is a must for type 1 Diabetes, type 2 Diabetes is THE problem us (more than 98% of all people with Diabetes), a standard treatment plan for which includes diet & exercise, tablets and Insulin. Despite progress in understanding of the underlying disease mechanisms for diabetes, there is still a paucity of effective therapies. Unfortunately till today we do not have a perfect Diabetes tablet or another way to take Insulin other than the injection.
RAYS OF HOPE !!!
Researchers have stumbled upon various new modalities of treatment for Diabetes. They include
Inhaled Insulin
Here is Insulin is delivered directly to the lungs by an inhaler akin to those used by people with Asthma. This only can work for 3-4 hours, so the long acting insulin has to be still taken as an injection. Te absorption depends on various factors like presence of flu, nasal allergy, asthma, chronic bronchitis, etc.
DPP IV Inhibitors
This group of medication works increasing the blood Insulin, because it inhibits the enzyme called Dipeptidyl peptidase (DPP)-IV which normally degrades Insulin. inhibitors are a promising new approach to Type 2 diabetes that function as indirect stimulators of insulin secretion. They may be available as tablet or injection, one tablet has been launched in US, going to be available in our country soon. One form of injection is available with us here recently.
The beauty of this group of medicine is that they are less likely to cause low sugar because they inhibit the enzyme when sugar is high but not when normal.
Sodium glucose transport inhibitors
This unique group of medicine is different from all others as they spill extra sugar from the blood to urine when blood sugar goes above a certain level. Researches are ongoing with this molecule.
Pancreatic transplant
This is a treatment option mainly for people going for Kidney transplant when a portion of the Pancreas of the donor is taken and implanted, in that way same medicine to prevent rejection can be used to protect the transplanted pancreas. If only the part of the pancreases is transplanted the side effects of the chemotherapy are much more detrimental than Diabetes and this does not offer any guarantee.
Stem cell therapy for Diabetes
Human beings are made from one cell in the beginning of the development; the cell multiplies and they take individual responsibilities. So initial rows of ells are unspecialized cells, later when they take up individual responsibilities they are called specialized cells. Unspecialized cells are called Stem cells. The two broad categories of human stem cells are (a) Embryonic stem cells, derived from aborted fetal tissue and (b) Adult stem cells that are found in adult tissues. There is a lot of Ethical, Moral, Legal and scientific issues are there in embryonic stem cell therapy knowing the fact very well that this type is better suited for the job.
To treat diabetes, stem cells need to be cultivated into insulin-producing cells. Once that has been accomplished, researchers plan to transplant stem cells that have been cultivated into insulin-producing cells into diabetic patients. Currently, those who receive transplants must take drugs that suppress the body’s immune system. If a person’s own stem cells could be cultivated and used for transplant, such drugs would not be needed.
Before any cell-based therapy to treat diabetes makes it to the clinic, many safety issues must be addressed. A major consideration is whether transplanted stem cells can grow uncontrolled and induce the formation of tumors.
What are the types of Diabetes in Pregnancy?
Pregnancy Diabetes is a very important area, which needs special attention and very close supervision both by Obstetrician and Diabetes physician. Diabetic pregnancies are mainly of two types. First one is women with known diabetes either type 1 or 2 becoming pregnant called pre-gestational Diabetes. The other is diabetes for the first time detected in the current pregnancy what is called Gestational Diabetes. Your Obstetrician will check this as part of routine antenatal check up. Most of the cases you do not require insulin after delivery. Your blood sugar should be checked 6 weeks after delivery (GTT) to make sure that Diabetes has disappeared.
Who are at risk of developing Diabetes in Pregnancy?
Any of the following conditions can be a risk for developing diabetes in pregnancy: obesity, family history of diabetes, high blood pressure, birth of big baby in the last pregnancy, pregnancy after 35 years of age, history of unexplained loss of baby in uterus before. This high risk women should be carefully looked for diabetes by frequent monitoring rather than waiting for symptoms of diabetes to appear.
Why is it important to treat Diabetes in Pregnancy?
It is important to treat Diabetes in pregnancy for a safe confinement. Some potential risks to the foetus if sugars are uncontrolled include:
-
The baby’s body is larger than normal—called macrosomia. A large baby may need to be delivered by cesarean section, instead of naturally through the vagina.
-
The baby’s blood sugar is too low—called hypoglycemia. Starting to breastfeed right away can help get more glucose to the baby. The baby may also need to get glucose through a tube into his or her blood.
-
The baby’s skin turns yellowish and the whites of the eyes may change color—called jaundice. This condition is easily treated and is not serious if treated.
-
The baby may have trouble breathing and need oxygen or other help—called Respiratory Distress Syndrome.
-
The baby may have low mineral levels in the blood. This problem can causes muscle twitching or cramping, but can be treated by giving the baby extra minerals
Why pregnancy Diabetes is different from Diabetes in other time?
This is one situation where we strongly recommend controlling diabetes very strictly with particular emphasis on postprandial sugar checking (two hours after food). Also it is very important to remember that dose requirement of Insulin in pregnancy always increase as the baby grows bigger. This is because placenta increases in size through out the pregnancy to keep the baby well. Placenta secretes some hormones which works against Insulin. If the dose of Insulin does not increase we feel worried with the function of the placenta.
Is the diet different in Pregnancy?
As the demand is more the calorie intake should be more in pregnancy. In average an increase of 500 calorie is advised. If you are overweight then there is no need to increase this, also you should not try to diet strictly or loose weight. It is better to see a professional dietitian at the time of diagnosis. Three meal and three snack regimen is very much indicated in pregnancy.
Why can not I use tablet for Diabetes in pregnancy?
Tablets available for treatment of Diabetes cross the placenta. We do not give tablet in pregnancy with the fear that baby’s blood sugar may drop. Also tablets take long time to work and we need to change the treatment in pregnancy very frequently, so tablets are not good.
What is the best way of monitoring Diabetes in Pregnancy?
In pregnancy we strongly recommend using glucometer, so that control will be there in your hand. It is important to remember that we check all postprandial sugar, rather than checking only after breakfast, as is the common practice. HbA1C checking can be of some value to keep an eye on average control.
How often to monitor sugar in pregnancy?
It is important that we keep a close eye on the sugar in pregnancy. Normally in pregnancy we prefer monitoring fasting and 2-hr after meal sugars i.e., fasting, 2 hrs after breakfast, 2 hrs after lunch and 2 hrs after dinner. This set; we would prefer should be done twice a week 2-3 days apart.
|
Fasting
|
2-hr after breakfast
|
2-hr after lunch
|
2-hr after dinner
|
What is the sugar control to be achieved in pregnancy?
In pregnancy the targets are much stricter. We want fasting sugar <90mg/dl, but surely <100mg/dl and 2 hr value <125mg/dl, but surely <140mg/dl.
Why my Insulin dose is changing every time?
This is very important to understand. As pregnancy advances, particularly from after 28 weeks, placental activity increases to keep the baby in good health. To do this placenta produces some hormones which act against Insulin and your dose of Insulin goes up and up, sometimes on daily basis we need to increase Insulin dose.
So, increment of Insulin dose in pregnancy is normal, if the dose does not go up, we get worried whether the placenta is working normally or not.
What exercise is good in Pregnancy?
Standard antenatal exercise should be fine from sugar point as well. Walking would be the best and weight lifting or strainous exercise should be avoided. Swimming is also a very good exercise.
What extra care needed during delivery?
At the time of delivery, a normal or near normal sugar is very important. Most of the time during delivery you will not be eating, particularly if the delivery is by section. So we commonly connect you to a glucose drip (to give you nutrition) with Insulin. At this time for a strict control we check blood sugar by pricking finger frequently, sometimes once in every hour. In case of gestational diabetes we disconnect Insulin soon after delivery of the placenta. If you had diabetes from before your dose of Insulin reduced to that before pregnancy. If you were on tablet before, you should continue Insulin till the time you are breast feeding.
What happens to the sugar of my baby?
The baby’s sugar is usually normal. If at the time of delivery, the mothers sugars are not under control, then there is a chance that the baby’s sugar can be on the lower side. Early initiation of breast feeding after delivery is advised.
What follow up is required?
People with gestational diabetes should get glucose tolerance test 6 weeks after delivery to make sure that diabetes is disappeared. You must remember that you will have a high risk of diabetes in future, so take precaution. Eat healthy food, take some form of regular exercise and do not become fat.
Follow up for people with type 1 or 2 diabetes would be the same as in non-pregnant time. If you are planning to conceive again, make sure your control at the time of conception is very good and you take Folic acid vitamin 5 gm every day.
What are the organs that can be damaged by Diabetes?
High blood sugar for a few days may not create lots of problem but if high sugar remains for some time chronic complications set in. We are concerned about the eyes, kidneys and the nerves. Circulation can be a problem with diabetes and that’s why the problem with the heart (angina, heart attack), Brain (stroke) and leg (diabetic foot) are common in Diabetes.
How do I know whether I have Diabetic eye disease?
At the beginning you may not have symptoms, so the only way is to check the eye (specially the back of eye called retina). If you have Diabetes and are seeing an eye specialist you must tell him or her that you have Diabetes. The specialist will do the required check. If you have already Diabetic eye disease, the specialist will also tell the solution. Remember Diabetes is the commonest cause of blindness all over the world and early detection and treatment can prevent that.
Why people with Diabetes develop foot problem?
Foot problem can be there for three reasons in people with Diabetes. The first and the most common is Diabetes affecting the nerves so that you don’t feel the pain when you get hurt or pricked. The unnoticed and uncared wound gets deeper and bigger. The next is Diabetes affecting the circulation so that blood supply becomes less and the wound does not heal. Lack of circulation can also cause gangrene. The other one, as you will know, Diabetes reduces the resistance to infection, so the wound gets infected and does not heal. Amputation of toes/limb is 25 times commoner in people with Diabetes in comparison to general population.
What are the warning signs of Diabetic foot?
There are certain features when patient with Diabetes should consult doctor without wasting time. They are redness, unusual pain, ulcer or cut, swelling and change of colour. Delay in getting treatment may lead to septic or gangrene.
How to check for Diabetic Kidney?
At the beginning you may not have symptoms, so the only way is to check for it. The simple things are to check urine for protein and blood for creatinine. Protein starts leaking in urine when the kidneys are affected with Diabetes and we have treatment available now for this. Ultrasound scan of the kidney is not helpful for diagnosis of Diabetic kidney disease.
What is the relation between Diabetes and BP or Cholesterol?
Adult (or type 2) Diabetes is very often associated with high blood pressure, blood cholesterol and obesity. This is called Metabolic Syndrome. For complete management we should look from all these angles.
What is the target BP in Diabetes?
Target BP is less than 130/80 mm, we should be taking good effort to keep BP normal as it is clear from the current medical research that BP control in people with Diabetes is equally if not more important than controlling Diabetes.
Is heart attack or stroke common in Diabetes?
Heart attack is at least five times more common in people with Diabetes than without and stroke four times. This is because circulation is affected in Diabetes and unfortunately this happens all over the body. We are concerned for three organs mainly; the compromise of circulation in the heart gives rise to angina or heart attack. Similar problem in brain would give rise to stroke and in the feet would result into gangrene.
What are the minimum tests to be done given the fact that there is no end of tests these days?
Routine test of urine to check for infection and protein is very important. Blood should be checked for kidney function (creatinine and cholesterol). A detailed eye check up should be done by an eye specialist. An electrocardiogram on top of detailed clinical examination is all that is usually necessary for assessment of circulation in routine clinical practice.
How frequently tests should be done?
If the reports are normal, we recommend them doing once in a year. If they are not normal, your doctor will decide you what to do and whom to see.
Teamwork is the key for success
There have to be a teamwork for success. The team includes family physician, diabetes physician, diabetes nurses, dieticians, foot care specialists, medical specialists like eye specialists, surgeons, cardiologists, etc. Obviously the cornerstone is the patient and family. We need help from government and non-governmental agencies interested in healthcare, pharmaceutical companies and importantly media who have a tremendous role in taking the message to the mass.
“Hypo” in people with Diabetes
What is Hypo?
“Hypo” is the short form of “Hypoglycaemia” meaning low sugar in the blood. This can be potentially dangerous and you need to understand very clearly how to recognise hypo, what to do in case you have hypo and how can you avoid that happening again.
How would I feel in Hypo?
The symptoms of hypo usually appear when your blood sugar is around 50 mg or less, obviously this varies from person to person. Initially you will feel sweaty, shaky, hungry and heart thumping. Everybody may not get all the symptoms. If not corrected in time you may feel confused and drunk. With further lowering of blood sugar you may go into coma.
How my friends will know I have Hypo?
Your friends or family members may notice a few things when your sugar becomes low. Initially they may notice your change in behaviour, change in mood, pale face, slurring of speech, unstable gait. Situation may particularly be difficult sometime to differentiate from drunk. This is often a problem with traffic police; a sugar checking is the only way that time to make sure that you are suffering from a hypo.
What my friends and family do then?
They can give you a drink, may be fruit juice or biscuits and see you for some time till they find you normal and you feel ok. You should take sugar only if you are desperate.
What should I do if I have Hypo?
If you have glucometer with you better check your sugar. This will confirm the diagnosis because there are so many reasons in day to day life when we do not feel well. If you do not have a glucometer it will be better to eat something so that you can indirectly diagnose whether symptoms get corrected with eating or not.
What to take for hypo?
You can take different things for treating hypo. Some fruit, biscuits, bread, sandwich, milk anything will do. If you are not too much symptomatic or sugar is not very low, it is better to avoid taking sugar simply because if you take too much sugar it will not only correct your hypo but also blood sugar will go very high.
How can I prevent Hypo?
Once you have corrected hypo the most important thing to do is to find out why your sugar dropped. Then only you can take action to prevent another hypo. The commonest cause of hypo is mismatch of food and treatment. If you have taken Insulin and delayed your meal or missed a snack, your sugar may drop. Remember if your Diabetes is very well controlled you are likely to get hypo if you miss snack, meal or delay meal. If you have taken less food for some reason or other, you have done unusual exercise and taken the same treatment your sugar may drop.
Hypo also can happen when kidney is affected by Diabetes or thyroid is underactive, your doctor is the best person to help you out on this. Hypo with tablet and Insulin is different because tablets may remain active in the body for longer time, may be even for 48 hours. So you need observation in hospital.
|
|
