2.2mmol/L blood sugar (glucose) in the morning… what should I do?

How to manage a low blood sugar (hypoglyceamia) level in Africa.

So I got this call from a friend living in Nigeria. The fact that I had several missed call from her in a short space of time, was worrying.

When I then spoke to her she summarised her situation. She was worried that she had woken up with a very low blood sugar readings. She was a diagnosed none insulin dependent diabetic…. and she was worried.

Normal blood sugar levels
For the majority of healthy individuals, normal blood sugar levels are as follows: Between 4.0 to 5.4 mmol/L (72 to 99 mg/dL) when fasting. Up to 7.8 mmol/L (140 mg/dL) 2 hours after eating. Therefore a reading of 2.2 mmol/L was way below the normal range.

Medical mission in diabetes

She remembered the danger of a low sugar level (hypoglycaemia). she learnt this while assisting me in the diabetes and hypertension medical mission I organised and managed in Nigeria. At this point I am smiling when I realised that my health promotion in self- care/management did not actually fall on deaf ears.

Life or death

First of all waking up in the morning with a blood sugar reading this low is a medical emergency. The simple truth is, if the level gets any lower, then you are most likely not going to wake up at all. You will simply slip into a diabetic coma. And for my friend who lives alone (like millions of people all over the world). she will not have the ability to make any phone call to me, ever.

Emergency management

As an emergency, you need to get your sugar level up immediately. Acute management in other words, the first thing you do is to drink anything that contains high sugar. E.g coke, glucose, sugar tablets or sugar, fruit juice. This is not the time to think about your diet or waistline. Eating chocolate will not raise the sugar immediately. Stick to drinking rather than chewing as drinks will get quickly absorbed into your blood stream. Chewed food would need to go through the process of digestion which can take upto 4 hours.

What next

Once your blood glucose has returned to a none life threatening level, then you may now have your breakfast as you would normally. It is advisable to eat food that will release energy slowly as they help maintain the blood sugar level for a longer period of time, these are the low GI (glycaemic index) foods, e.g oats https://www.google.co.uk/amp/s/www.diabetes.org.uk/guide-to-diabetes/enjoy-food/carbohydrates-and-diabetes/glycaemic-index-and-diabetes%3famp

You also need to seek medical advice to investigate the cause of the low blood glucose reading. Especially if this is happening frequently.

What is eat well

In the case of my friend, her recent tests/investigations were clear. She did not quite understand the meaning of eating well, as far as her condition was concerned. So she continued with her diet and food plan which included eating beans before going to bed. By morning the beans had expired and resulted in the low sugar level reading.

Symptoms

She always knew when her blood glucose level was low as she would feel shaky, light headed, dizzy, sweaty and confused.

Everyone has a different reaction to low blood glucose. It is important to learn your own signs and symptoms of when your blood glucose is low

Other signs and symptoms included:

Being nervous or anxious
Sweating, chills and clamminess
Irritability or impatience
Confusion
Fast heartbeat
Hunger
Nausea
Color draining from the skin (pallor)
Feeling Sleepy
Feeling weak or having no energy
Blurred/impaired vision
Tingling or numbness in the lips, tongue, or cheeks
Headaches
Coordination problems, clumsiness
Nightmares or crying out during sleep
Seizures

Eat well at night means….

In the case of my dear friend, I advised her to make sure carbohydrate is part of her last meal before bed. And in her case, I suggested yam. The idea is to maintain your blood sugar level until morning.

When choosing your diet, it needs to be easily available to buy, local and affordable.

Avoid processed foods if you can- it is more complicated than you think.

Emergency snack

Diabetes as a long term condition needs self management. Once you have no underlying cause for a low sugar level in the morning then you may wish to include the following:

Try and keep an energy snack around your bedside

When you wake at night, to use the toilet, have a snack if you feel any of the symptoms as above.

Test your sugar first thing in the morning which may determine your breakfast choice

Morning after the yam at bedtime

My friend sent me a whatsapp message to say that she ate yam as her last meal before bed suggested and her blood sugar reading the following morning was 5.8 mmols/L. This is well within the normal range of 4 – 6 mmols/L.