How Hypoglycemia Can End a Tennis Game
19 Mar 2004
Moments before meeting a friend for a tennis game, all hell suddenly broke out. Firemen began arriving at my friend’s home, and police sirens were getting closer and closer. To my dismay they were racing to my friend’s side. A sad way to put an abrupt end to our game.
I arrived to find my friend pale, perspiring and incoherent. The police and firemen questioned whether he had suffered a heart attack. I suspected another possibility, but it wasn’t due to any diagnostic brilliance on my part. I had the advantage of knowing that my friend had type 2 diabetes. Like many others with this disease he was experiencing a severe attack of hypoglycemia (low blood sugar).
Low blood sugar can result from several causes. Diabetes patients may skip a meal which depresses blood sugar. In this instance my friend had taken his oral medication to treat his diabetes without eating.
Today five per cent of Canadians suffer from this disease. According to the World Health Organization a new diabetes patient is diagnosed every 45 seconds in North America. Since there’s never been a chronic epidemic of this magnitude we will see more cases of hypoglycemia.
Blood sugar (glucose) is controlled by a delicate mechanism. Following a meal glucose molecules are absorbed into the bloodstream and carried to cells where they’re used for energy. It is the insulin produced by the pancreas that helps glucose enter cells.
If a meal contains excessive amounts of glucose it’s stored in the liver and muscles as glycogen. Later, if blood glucose drops, another hormone glucagon, also produced by the pancreas, signals the liver to breakdown glycogen into glucose to restore blood sugar to normal levels.
Mild cases of hypoglycemia cause sudden hunger, dizziness, increased agitation, drowsiness, a pounding heartbeat and sweating. If the blood sugar drops further, patients exhibit personality changes, headache, blurred vision, confusion and slurred speech. And without treatment symptoms progress to unconsciousness and convulsions.
Type 1 diabetes usually begins early in life requiring regular insulin injections to maintain normal blood sugar levels. How often and when injections are given varies. But many doctors are now advising patients that it is better to control blood sugar by multiple daily injections.
Type 2 diabetes occurs later in life and 90 per cent is due to obesity. These patients lack adequate amounts of insulin in response to a meal and their cells become resistant to the effects of insulin, a bad combination. But fortunately many of these patients can control blood sugar by oral medication.
The standard treatment has been to prescribe long-acting drugs, sulfonylureas, such as Glyburide and Gliclazide. These are taken twice daily in an attempt to regulate blood sugar levels. But taking a long acting medication twice a day has its drawbacks. Long-acting medication continues to stimulate insulin release between meals and if a meal is missed there may be a hypoglycemic attack. Moreover, it’s unrealistic to expect patients to eat meals at the same time every day.
Now there’s a new class of short-acting oral anti-diabetic agents, such as GlucoNorm, to treat Type 2 diabetes. GlucoNorm is taken within 30 minutes before meals and due to its rapid action provides insulin when you need it most at mealtime. This allows patients to eat according to their own lifestyle and eating schedule rather than being tied down to a strict one.
Studies show that GlucoNorm reduces the highs and lows of blood sugar so there’s less risk of hypoglycemia. Clinical trials show it is well tolerated and since it’s metabolized by the liver it can be used safely by patients with diabetes who have reduced kidney function.
Living with diabetes has never been easy. But the availability of GlucoNorm allows people with diabetes to follow a more relaxed eating schedule. And decreases the number of frantic rushes to hospital emergency rooms to treat hypoglycemia which burden our healthcare system.
Fortunately a sugar-laden drink quickly eased my friend’s plight. But it will take more than a sugary drink to end the perfect storm of diabetes that is ravaging society. How could it be otherwise when obesity, even in young children, is increasing at such an alarming rate in this country? A sad commentary on our lifestyle.
