Hypoglycemia without diabetes medication?
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Friday, March 31, 2006 |
Q: "Your answers have been a great help, and now my question is about low blood glucose with non-medicated diabetic patients as myself. Is there ever too low of a blood glucose reading?"
"I have lost 40lbs and have about 70lbs more to go. I have gradually increased my daily exercise from a 20-minute walk averaging about 4000 total steps a day to two, 60-minute daily walks averaging 12,000-16,000 steps a day and have brought my 2-week average glucose down to 88 from an average of 150. I have also had to make sure I eat about 20 grams of carbs (daily intake 180g) before I walk. I also brought my blood pressure down to 115/70 from 120/88. Usually I have a BG between 80-90 before and 70-80 after, without any adverse effects. Is there such a thing as being too low if you’re not on any diabetes medications?"
A: First, let me congratulate you on your tremendous success with increasing exercise, losing weight, lowering blood pressure, and lowering your blood glucose!
To answer your question, no, if you are not on any diabetes medication, then technically you cannot get “too low” requiring treatment for hypoglycemia. In the non-diabetic, as well as the person with diabetes who is not taking diabetes medication, the liver will release stored glucose to provide energy. In fact, during exercise or fasting, your pancreas knows not to release any unnecessary insulin, thereby protecting you from hypoglycemia—providing you aren’t taking a sulfonylurea or insulin. The exception would be for the person who has an extremely rare unrelated disorder, such as a disease that affects their ability to store glucose, or a tumor of the pancreas.
Snack before exercise: You stated that you require a snack before exercise. If you are restricting your calories to achieve weight loss, then yes, you may need the snack before exercise, not to prevent hypoglycemia, but simply to prevent hunger/fatigue. However, I’d recommend you check with your diabetes team, as perhaps you don’t need the snack before exercise.
Normal values for a non-diabetic: <100 mg/dl before meals, and <140 mg/dl, two-hours after meals, with no lower limit. A caution here would be if you had alcohol on an empty stomach: in this situation, the liver is busy metabolizing the alcohol, so it cannot also release its usual store of glucose. That’s why it is always wise to have food with alcohol. That’s not to say that you could become officially “hypoglycemic” from the alcohol (nor would you need to take sugar to treat this), but simply that you would not be getting your usual supply of glucose from the liver.
In contrast—for the person with diabetes who is taking insulin or a sulfonylurea: In these situations, you “can’t take your shot/pill back” so if the medication dose were too high, or if the person delayed or skipped a meal or ate inadequately, or did excessive/unexpected exercise (as well as if the person had alcohol without food as noted above), the result could be hypoglycemia.
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Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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