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For Friends, Relatives and Co-workers ....
Examples:
Let's say it's 12:45 p.m., and you and your friend usually go to lunch at 12:00. You are are at a busy restaurant, waiting for service. Your friend, let's call her Camilla, has now started the same topic three times without getting to the point. You might say, "You know, you're getting a little off-track in talking, and that's not like you. Do you think you might be low?"
It's 9 p.m., and you just came back from dinner at Bob and Sue's. They served dinner early - at 5:00 p.m. Bob and Sue are also serve very small portions, and never offer "seconds." Your husband Nate looks a little pale and "funny." You say, "Honey, you know that Bob and Sue never serve very much dinner, and we ate kind of early. Any chance you could be low? You look kind of pale and a little sweaty."
If your friend may have hypoglycemia, he needs to test his blood sugar. if his blood sugar is low, he needs to eat something (SEE BELOW FOR JOSLIN'S ADVICE ON WHAT TO EAT).
Why test? Why not just eat something?
It's important not to eat every time a person thinks they might be "low." Symptoms of hypoglycemia can be similar to other things, such as stress, illness, anxiety or even high blood sugar - Talulah gets a headache whenever she has a test in school, or when there is a lot of smog. Jack experiences a lot of anxiety in life in general, so he may feel lightheaded in response to his fears. Also, it is better for Camilla to know if she is really really low - she will need to be extra careful.
WHAT SHOULD THEY DO? When they test their blood sugar, if they find out that they are low, they should eat what their doctor/diabetes educator has told to eat in these situations. If you are with this person on a regular basis, you should know what they prefer to eat to raise their blood sugar. If that is not available, use something listed below. If their blood sugar is low, don't let them delay eating - their blood sugar could drop farther.
WHAT TO EAT OR DRINK? They generally need simple sugar, with no fat in it to slow down absorption, followed by some carb or protein (depending on their doctor's advice). Examples given on the Joslin web site include 3 glucose tablets or 4 ounces of fruit juice, 5 or 6 ounces (about 1/2 can) of regular soda such as Coke or Pepsi , 7-8 gummy or regular Life Savers, or 1 Tablespoon of sugar or jelly (see (www.joslin.org/Beginners_guide_655.asp) You can also store glucose gel that can be squirted into the side of the mouth, and absorbed through the cheek. (There is also something called Glucagon, which is injected into the body. Consult a physician about it.)
THEN WHAT? It takes about 15 minutes for most peoples' blood sugar to come up. It may take more or less time. The Joslin site recommends repeating this if the blood sugar is still below 70. "If your next meal is more than an hour away, you will need to eat one more carbohydrate choice as a snack to keep your blood glucose from going low again." There are also glucose tablets that you can buy, ahead of time, at any drugstore. They are less attractive to family or office snackers, and are unlikely to be "disappear."
WHY NOT SOMETHING RICH AND CHOCOLATEY? If you give a person a piece of a chocolate nutty candy bar, the fat in the candy bar will slow down the rate at which their blood sugar will come up. It is not fun for a person who is hypoglycemic to wait for their blood sugar to come up -- they may be really anxious, they may be really hungry, or they may just want to get on with their day. Hypoglycemia is not a pleasant state. They may also be tempted to empty out the entire refrigerator! It takes about 15 minutes for most peoples' blood sugar to come up. It may take more or less time.
How can I be helpful?
Get the person what they ask for, as quickly as possible. Hopefully, they carry something with them just for this purpose. If you sense that their blood sugar is getting quite low, you can offer to open a package of food or a juice container or a soda pop can for them, because they may have trouble doing it themselves. Make it as easy as possible for them to eat. Be polite and respectful. This is not a good time for teasing or joking around.
If they don't have anything,, get them something listed above. (This is not the time to arrive with a diet soda - they need sugar!). Stay calm. Don't talk too much. Be positive but not overly cheerful – "This will help." Hand the person what you want them to eat or drink. (It is harder to reject something if it is in your hand.)
One thing you can do as the onlooker is to notice what time it is when your friend eats – then when you are waiting with them, you can coach them "It's been 10 minutes – pretty soon your blood sugar will come up." If their blood sugar does not go up in 15-20 minutes, they may need to eat more simple sugar.
Severe hypoglycemia can be dangerous. A person whose blood sugar goes too low can have a seizure, or can die. If you spend a lot of time with a person with Type I diabetes, you need to know what to do in case the person has passed out, is asleep and you cannot wake them. Their doctor may want you to administer a special medication called Glucagon. If the person is unconscious and/or and you do not know what to do, call 911.
Insulin Reactions – Hypoglycemia – and the Personality
When people with diabetes get low blood sugar, there is an adrenaline surge, which prompts a "fight or flight" reaction. Their personalities can change quite rapidly.
My blood sugar is NOT low!
People with low blood sugar may deny that it's happening:
It's part of the physiological effect of the low blood sugar - their thinking gets narrower and they can often get "fixated" on one thing or one idea.
No one wants to stop in the middle of what they are doing and treat low blood sugar.
It can be frustrating to have someone else notice something about you that you don't notice about yourself, so some people will deny that it is happening..
Your friend may or may not be in agreement that she may have low blood sugar. This denial is part of the physiological problem of low blood sugar. It can also be a psychological thing - would you like it if you had to stop whatever you were doing in order to eat something, and then hope your blood sugar came up?
Your friend may also know her blood sugar is low, and may become argumentative about what she needs in order to treat it. For example, she may insist that she can only eat one thing (e.g., orange juice and not cola, or a glucose tablet and not sugary candy. This stubborn behavior is part of the physiological part of hypoglycemia. You can say "I'll get you what you want, but will you take this while I go get it?" And, then watch to make sure they take it. If you are not sure of the situation, don't leave them alone.
You need to stay calm – and not argue. Actions are better than words – handing her a glass of orange juice or sugary soda pop (Not Diet – they need sugar and food!) is better than talking a lot. Even if she is very nasty (sarcastic, throwing things at you), you have a fully working brain – and she doesn't. Your job is to stay calm, kind and firm, and get her what she needs. Some people may respond well to two choices – and it's best if you open or unwrap them. When blood sugar gets low, sometimes it is hard to unwrap or open packages of food.
If your friend absolutely refuses to eat, and you believe that he is in danger, you can tell him that he has a choice – he can eat something, or you can call the paramedics. This is not a time for you to be meek. You need to be calm , but in charge. This is one of the few times when I would even advocate "guilt inducement" as a choice – "Do it for me."
Medical Note: This is a web site about psychology, not medicine. That was a brief overview of insulin reactions – if you live with someone with diabetes, you need to know exactly how your loved one's medical team wants insulin reactions handled. Your loved one may have very occasional brief episodes of low blood sugar, or rapidly dropping, severe reactions – or both. Talk to their doctor or diabetes educator about handling these reactions.
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