Hypoglycemia Preparedness: How to Know Before You Go Low

By Lorena Bergstrom

A new awareness campaign helps people with diabetes recognize and plan for low blood sugar with emergency toolkits, discussion prompts, journaling, and a support network  

Low blood sugar can be a scary thing – it often sneaks up when people least expect it, quickly shifting from a minor annoyance to a potentially dangerous situation. In fact, a Canadian study found that people with diabetes (type 1 and type 2) experience severe hypoglycemia an average of 2.5 times each year. While type 2 diabetes typically presents a lower hypoglycemic risk than type 1, insulin and oral medications can still cause low blood sugar. However, you can take many steps to protect yourself. 

We spoke with endocrinologist Dr. Gregory Dodell (with Mount Sinai in New York) and singer Crystal Bowersox about Lilly’s new Know Before the Low campaign, an important initiative to raise awareness about hypoglycemia. Bowersox and Dr. Dodell hope this program will empower people with diabetes to recognize signs of low blood sugar, start conversations with their peers, and prepare for emergencies before they happen.

Know Before the Low offers information about managing hypoglycemia; it includes a chart of physical and cognitive symptoms, a tip list for emergency planning, and a guide for building a support network. Dr. Dodell said that unfortunately most diabetes literature focuses on controlling high blood sugar – even though low blood sugar can be more dangerous. He said that the campaign aims to address this information gap by “helping people and healthcare professionals talk about low blood sugar and prevent future episodes.”

To start, every person with diabetes should build an emergency toolkit, including:

• Glucose tablets or sugary snacks

• Glucagon – read about emergency nasal glucagon (Baqsimi) and ready-to-use autoinjector pens (Gvoke)

• Glucose monitor (continuous glucose monitor or fingerstick blood glucose meter)

• Emergency contact information

Bowersox makes her emergency pouch easily accessible to her friends and family: “My family, including my 11-year-old son, knows what to do if I have a hypoglycemic episode or emergency. I think it’s important for an individual’s entire support network to be aware of this.” Of course, it may seem inconvenient to carry around an entire toolkit when going out, but many of the new glucagons (like Gvoke and Baqsimi) are much more portable and easier to use than the glucagon previously available. 

Keep in mind that for many people with diabetes, nighttime is both the most dangerous and the most common time to experience hypoglycemia. Dr. Dodell shared some useful advice: “If you see a downward trend before bed, you should eat a snack. It’s better to wake up high and correct during the day than have a low blood sugar episode overnight, which could cause many more complications and inconveniences. It's also important for people with diabetes to know the triggers that can cause lows at night.” In short: check blood glucose before bed, play it safe, and know your risk factors. Additionally, daily routines have changed during COVID-19; you may be eating different foods, exercising more or less, and experiencing higher stress. All these factors may affect your blood sugar, especially at night. 

Everyone’s body is different, but common risk factors for hypoglycemia include:

• Exercise

• Too much insulin

• Fasting or low carbohydrate intake

• Alcohol 

• Medications

• Stress

• Hormonal fluctuations

• Illness

For a full list, check out Adam Brown and diaTribe’s 42 factors that affect blood glucose from his book Bright Spots & Landmines.

Hypoglycemia is different for everyone, so it is essential to be aware of your own body. Try to observe the symptoms you experience, and make note of potential triggers. Bowersox recommended keeping track of patterns: “Keeping a log or journal of things such as physical or emotional activity and comparing it to your blood sugar data could be a good way to see if there are trends that are causing you to go low. Ultimately, it’s important to share that information with your support network.” Know yourself – there are many factors that can lead to hypoglycemia, so it’s important to learn your own patterns of low blood sugar so that you can avoid these experiences. 

Perhaps the most critical part of Know Before the Low is its emphasis on connecting with your support network – family, friends, coworkers, teachers, and others. Bowersox said that she once had to ask her audience for candy to raise her blood sugar; fans were supportive and thanked her for raising awareness about diabetes. However, it can sometimes be difficult or uncomfortable to start conversations about diabetes and hypoglycemia with the people around us. Dr. Dodell explained that keeping the dialogue casual yet informative can be an opportunity to teach people something new: “You’re not putting a burden on them, but just explaining how diabetes affects your life. By broaching the topic casually, you can treat the conversation as more of a heads up than bestowing a responsibility. Just make sure to explain that you are carefully managing your diabetes, but there is a chance of an emergency. Not everyone has met someone with diabetes, but just explaining it and educating them can be a great preventive step.” 

By sharing information about hypoglycemia signs, symptoms, and treatments, you can empower your peers to step in during an emergency. As Bowersox said, “Knowledge is power! When your network has information, they are empowered to help you, especially with low blood sugar. When I travel, my quality of life is improved by just educating and speaking up. Practice with your mirror, practice with your pet, but make sure your support network is there for you.” 

As this project raises awareness of hypoglycemia, we hope it encourages people with diabetes, their healthcare professionals, and their support networks to engage in valuable discussions. As Dr. Dodell so perfectly concluded, “This campaign is one of the first to address the dangers of hypoglycemia. It is groundbreaking, and allows people to get needed resources. Diabetes experts and endocrinologists know that high blood sugar can sometimes be better than low blood sugar.” 

For more information, read diaTribe’s article on hypoglycemia unawareness.