Hypoglycemia is an abnormally low blood sugar level. This can be caused by too much insulin, too little food, or too much physical activity. Most incidents occur before meals but they may occur at any time of the day or night. Anything under 75 mg/dl (4 mmol/l) is too low; this is when symptoms start to show.

There is nothing available like our body which constantly measures our blood glucose and responds with the appropriate amount of insulin.

The most common cause for the level to drop is through the use of injectable-insulin or insulin-stimulating pills. So you need to co-ordinate the time of your food intake with your medications, especially injections.

Different drugs are potent at different times:

• rapid onset: (eg.Humalog, Novolog), acts within five minutes, peak action is between one and two hours, duration is up to five hours. As it wears off quickly, there is less chance of hypoglycemia.
• short-acting or soluble: (eg. Actrapid, Humulin R), starts to lower blood-sugars in thirty minutes, peaks at three hours and stops acting at about six to eight hours. It’s a good idea to have a snack two to three hours after your meal.
• intermediate-acting NPH or Lente: (eg. Humulin NPH, Isophane NPH, Humulin L), begins lowering glucose within two hours and continues to be active for ten to twelve hours. This means there is always a low level of insulin in your body. You may need a morning and afternoon snack.
• long-acting Ultralente: (eg. Hypurin Isophane, Humulin UL), begins to act within a period of six hours and a low level of activity remains for up to thirty-six hours.

There are also mixed-insulins available; the peak and duration is a combination of both drugs and, if you use this type, you most likely will need to snack between meals and before bedtime.

Consistency in mealtimes and meal sizes:

• it is better to space your meals and snacks throughout the day rather than skip them and just eat one or two large meals.
• your diet plays a major role in helping you to avoid hypoglycemia. Have a snack mid-morning and one mid-afternoon, as well as your usual three meals.
• include sufficient carbohydrate in your meal plan.
• you are likely to require a lower dose when fasting (eg. during Ramadan). You would need to work this out with your health care provider.

Check your blood sugar level before exercising:

• exercise generally lowers your level also
• check before starting to exercise
• if it’s low, have a snack before commencing

Weight loss:

• this is when your insulin dose will need to be reduced as it works more effectively when you have less body fat.

If you have managed to lose weight, congratulations! A healthy diet, weight loss and exercise is still the first choice of treatment for type 2 diabetes.

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