Living With Diabetes: Sudden Low Sugars Are More Dangerous Than Abrupt Spikes, Experts Say

Over 500 million people worldwide are living with diabetes, a chronic disease occurring either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces, resulting in high levels of glucose in the bloodstream. People with diabetes, or diabetics, must ensure that they maintain the optimum sugar levels.

An important thing to note while a diabetic is undergoing treatment is that the risk of hypoglycemia (low sugar) must be minimised.  In order to reduce the risk of hypoglycemia, the fasting blood sugar level should be between 100 and 110 milligrams per decilitre and the postprandial level should be between 140 and 180 milligrams per decilitre,” Dr Sachin Kumar Jain, Head, Department of Endocrinology, Amrita Hospital, Faridabad, told ABP Live.

Sudden low blood sugar level is more dangerous than an abrupt spike: experts

Sudden low sugars are much more dangerous than high spikes, according to experts. “Not that high spikes are good, but the lesser of the two evils is high spike in sugar levels. So, if the sugars go low, they can cause a variety of problems right from a heart attack to a stroke. If for prolonged time, the glucose supplied to the brain is not adequate, one may have permanent brain damage. For instance, if someone has low sugar, and due to vertigo, falls and breaks his hip bone, or the femur or bangs his head against the wall, it can be a huge problem. In my opinion, sudden drastic lowering of sugars is much more dangerous,” Dr Dheeraj Kapoor, Chief – Endocrinology, Artemis Hospital, Gurugram, told ABP Live.

If one has low blood sugar, that is much more dangerous, because once the blood sugar starts decreasing below 70, most people begin to experience some kind of symptoms. These include sweating, palpitations and feeling unwell. They can experience tremors on the hands, which refers to shaking of the hands, and generally might feel hungry and unwell. As a result, hypoglycemia causes one to feel sick. As the sugar levels drop further, one might go into a state of altered conscious level, or altered sensorium. One may even go into a stage of becoming semi-conscious. If the blood sugar goes very low, one might even become unconscious, or have seizures,” Dr. Harish Kumar, Clinical Professor and Head, Centre for Endocrinology and Diabetes, Amrita Hospital, Kochi, told ABP Live.

What makes sudden sugar spikes less dangerous than sudden low sugars?

When a diabetic has sudden high blood sugar levels for a short time, it is unlikely to cause symptoms.

“Low blood sugar can be clearly quite dangerous, especially when it becomes very low. High blood sugar, on the other hand, is very unlikely to cause symptoms, if it goes up high for a short time. If the blood sugar is persistently high for an individual, say for a few weeks at a stretch, it may result in weight loss, and may cause the patient to feel increased thirst, or increased appetite, and so on. However, those are the only kinds of symptoms. There is nothing of immediate threat to health, or to life, whereas severe hypoglycemia can be much more dangerous,” Dr Kumar added.

Causes of sudden low sugar in diabetics

The blood sugar of diabetics is unlikely to become low suddenly. “It usually falls down gradually. In particular, if one has been taking medicines like a group of drugs called sulphonylureas, their blood sugar levels might decrease abruptly. The common types of sulphonylureas available in the market are glimepiride and glibenclamide. The latter is sold as Daonil, the common brand name for glibenclamide. These drugs stimulate insulin release from the pancreas. So, if one takes these tablets, and does not have their food on time, then the blood sugar might drop quite significantly. So this is one situation where a diabetic is likely to get low blood sugar,” Dr Kumar said.

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“There are certain medicines that can cause low sugars. Insulin can also result in low blood glucose levels. The predominant cause of low sugars which we see in our society is either a delayed meal or a skipped meal or a meal consisting of a small quantity of carbohydrates (may be the chapati or the rice). Otherwise, if the patient exercises more than usual, performs physical labour more than usual, does not consume the appropriate amount of food, or vomits after the consumption of food, his or her blood glucose levels might fall. Basically, if there is a mismatch in the calorie intake or calorie expenditure, and on top of that, the patient has taken tablets which are oral hypoglycemics or insulin, it can cause low sugars in the patient,” Dr Kapoor explained.

“Another reason why a person with diabetes might get low sugar, is that the dose of insulin might be higher than required. Also, the person may take insulin, and then forget to eat food, or not consume the normal amounts of food that he or she eats every day. The person may have performed unusual physical exertion. All of these can actually trigger hypoglycemia. But it is unlikely to be very sudden. Usually the hypoglycemia sets in gradually,” Dr Kumar said.

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“You have warning symptoms. As the blood sugar goes below 70, 60, and 50, one will have a set of warning symptoms, and towards the end, they become quite ill and maybe even unconscious,” he added.

Since there is a fairly gradual reduction in blood sugar, one must train the patient and his or her caregivers to be aware of the symptoms, so that corrective action can be taken. “As soon as symptoms arrive, one must check their blood sugar using the equipment they have at home. If not, they must not waste time. They should consume something sweet, say, a sweet drink, or a banana. If one is feeling quite ill, they can even consume glucose powder mixed in water, so that the blood sugar can come back up again,” Dr Kumar said.

What leads to a sudden sugar spike in diabetics?

The different factors which can lead to a sudden sugar spike in diabetics are skipping medicines and dietary indiscretion. For instance, if a diabetic consumes sweets, fried food and sweet juices, their sugar levels might increase, according to Dr Kapoor.

“Fried food generally may not cause sudden spikes, but in the long run, it is more detrimental. Fruit juice also can cause a spike in glucose levels,” Dr Kapoor added.

“If the diabetic patient eats the type of food that he or she is not supposed to eat, or eats a large quantity of food, consumes a lot of sweets, sweet-dishes and direct sugar, it might cause a sudden spike in blood sugar levels,” Dr Kumar said.

Steps diabetics should keep in mind to prevent sudden low sugar

Diabetics must take certain steps to prevent low blood sugar levels. These include having meals on time, and avoiding skipping meals. “The carbohydrate intake should technically be the same every day. This means that the quantity of roti or rice consumed should be the same each day. Also, diabetics should not overexert in terms of exercise. If one has vomiting or diarrhoea, they should make sure that they hydrate themselves well,” Dr Kapoor said.

How can diabetics prevent a sudden sugar spike?

Diabetics should follow their prescribed diet, and not adopt binge eating, in order to prevent a sudden sugar spike.

“Diabetics, on going out for dinner, must not eat the foods they are not supposed to have, especially desserts and sweets. Such foods will trigger a spike in blood sugar levels. So, by keeping the diet strictly controlled, diabetics can avoid large sugar spikes,” Dr Kumar said. “Diabetics can prevent a sudden spike in sugar levels by not eating sweets, by observing diet controls, by taking medicine on time, and by not skipping medicine,” Dr Kapoor said.

Optimum sugar intake for diabetics

Diabetics are advised to avoid all kinds of direct sugars, and hence, must refrain from adding direct sugar to tea, or coffee. They should also avoid sweets.

“The recommended calorie intake for a diabetic patient would depend on how much physical activity the person is doing and also on the type of lifestyle the patient is leading. Whether a diabetic patient is active or sedentary, obese or underweight will determine the recommended calorie intake for that person. In general, it can be said that a diet of about 1000 kilocalories to 1300 kilocalories is recommended for patients with diabetes,” Dr Kumar said.

However, calorie intake that is advised would depend on the baseline weight of the patient, and his or her physical activity.

“First of all, a diabetic patient ideally should not consume direct sugars, simple sugars, or refined sugar. If we are equating carbohydrates to sugar, then complex carbohydrates should be taken by the patient,” Dr Kapoor said.

The recommended calorie intake for a diabetic patient varies from person to person, depending on weight, daily activity, whether the person has a sedentary lifestyle, or if the patient performs a lot of physical labour, he explained.

“However,it is important to note that 50 to 55 per cent of calories should come from carbohydrates, around 30 per cent from fats, and the rest in the form of proteins,” Dr Kapoor added.

What foods should diabetics consume in a day to maintain the right sugar levels?

The foods that a diabetic patient should consume to maintain the right sugar levels are called standard diabetic diet prescriptions, Dr Kumar said.

Diabetics should avoid high carbohydrate foods or consume them in limited quantities, and avoid all direct sugars and sweets.

“One question which patients frequently ask is whether they should eat fruits. It is recommended that for a balanced diet, one must consume at least one fruit a day. The fruits allowed are apples, oranges, mosambi, papaya, and guava.These fruits work well for patients with diabetes. So, diabetics should consume a certain type of fruit each day, along with plenty of vegetables. Diabetics should avoid tubers like potatoes, and sweet potatoes and other tubers like tapioca, which are very high in calories,” Dr Kumar added.

“Diabetics should consume lots of fibre, and green leafy vegetables, except for those with kidney problems or kidney damage. For these people, green vegetables are not allowed. For all diabetics, 50 to 55 per cent of their calorie intake should come from carbohydrates, 30 per cent from fats. Of this, seven per cent should come from saturated fats. Protein intake should be around 20 per cent. Most importantly, diabetics should include lots of fibre, and green leafy vegetables in their diet, because this would help control sugars as well as cholesterol levels,” Dr Kapoor said.

“Also, 100 to 200 grams of fruits should be fine. Diabetics should avoid mangoes, grapes, cheeku (sapodilla) and bananas. The patient can consume apple, guava, papaya, orange, tangerine, pear and plum,” Dr Kapoor added.

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