Materiały źródłowe

• #1 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. […] To prevent hypoglycemia, much effort must be invested in patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage, together with setting personalized goals for glycemic control. […] Great effort must be invested in patient education on hypoglycemia prevention and management. […] The approach to hypoglycemia prevention includes patient education, appropriate dietary and exercise regimens, glucose monitoring, medication adjustment, and close clinical supervision. […] The patients and those around them should be educated to identify symptoms of hypoglycemia and given appropriate treatment as soon as possible.

• #2 Hypoglycemia Prevention in Hospital Patients: A Quality Improvement Project to Prevent Severe and Recurrent Hypoglycemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5070586/

  Hypoglycemia, defined as a blood glucose level 70 mg/dL (3.9 mmol/L), occurs frequently in hospitalized patients. […] After a hypoglycemic event, the likelihood of further episodes of low blood glucose is increased. […] Recent advances in health care quality and patient safety call for a change from reactive to preventive care. […] Avoiding circumstances that are frequently associated with low blood glucose levels is at the core of optimal glycemic management in the inpatient setting. […] Recent studies show that safe and effective glucose control can be facilitated and hypoglycemia can be prevented through tactics such as appropriate monitoring, ensuring adequate caloric intake, coordinating the timing and amount of insulin given with carbohydrate intake, and using basal-bolus insulin rather than oral antidiabetic medications in the hospital.

• #3 Hypoglycemia prevention practice and associated factors among diabetes mellitus patients in Ethiopia: Systematic review and meta-analyssis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0275786

  Hypoglycemia is an urgent, life-threatening condition that requires prompt recognition and treatment for diabetes mellitus patients to prevent organ and brain damage. […] To reduce the risk of hypoglycemia and calculate the combined prevalence of hypoglycemia prevention practices among diabetes mellitus patients, recognition of hypoglycemia is critical. […] The estimated overall practice for preventing hypoglycemia among diabetic patients in Ethiopia were 48.33% (95% CI (28.21%, 68.46%, I2 = 99.7%, p 0.001). […] This systematic review revealed that diabetic patients in Ethiopia had poor hypoglycemia prevention practices. […] This review implied the subsequent need for educational interventions for an individualized patient. […] Dietary control, taking medications as prescribed at the right times, engaging in regular physical activity, and self-monitoring blood glucose levels are all part of the prevention of hypoglycemia.

• #4 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter14

  It is important to prevent, recognize and treat hypoglycemic episodes secondary to the use of insulin or insulin secretagogues. […] It is safer and more effective to prevent hypoglycemia than to treat it after it occurs, so people with diabetes who are at high risk for hypoglycemia should be identified and counselled about ways to prevent low blood glucose. […] It is important to counsel individuals who are at risk of hypoglycemia and their support persons about the recognition and treatment of hypoglycemia. […] The goals of treatment for hypoglycemia are to detect and treat a low blood glucose level promptly by using an intervention that provides the fastest rise in blood glucose to a safe level, to eliminate the risk of injury and to relieve symptoms quickly. Once the hypoglycemia has been reversed, the person should have the usual meal or snack that is due at that time of the day to prevent repeated hypoglycemia. If a meal is 1 hour away, a snack (including 15g carbohydrate and a protein source) should be consumed.

• #5 Low Blood Glucose (Hypoglycemia) | ADA

  https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose

  Low blood glucose is when your levels fall below 70 mg/dL. […] It’s important to treat low blood glucose levels as soon as possible, as they can quickly become dangerous. […] Fast-acting carbs are the best choice to treat hypoglycemia and preventing a severe hypoglycemia incident. […] Understanding what causes your blood glucose to go down is important so you can steps to prevent lows from happening.

• #6 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. […] To prevent hypoglycemia, much effort must be invested in patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage, together with setting personalized goals for glycemic control. […] Great effort must be invested in patient education on hypoglycemia prevention and management. […] The approach to hypoglycemia prevention includes patient education, appropriate dietary and exercise regimens, glucose monitoring, medication adjustment, and close clinical supervision. […] The patients and those around them should be educated to identify symptoms of hypoglycemia and given appropriate treatment as soon as possible.

• #7 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. […] To prevent hypoglycemia, much effort must be invested in patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage, together with setting personalized goals for glycemic control. […] Great effort must be invested in patient education on hypoglycemia prevention and management. […] The approach to hypoglycemia prevention includes patient education, appropriate dietary and exercise regimens, glucose monitoring, medication adjustment, and close clinical supervision. […] The patients and those around them should be educated to identify symptoms of hypoglycemia and given appropriate treatment as soon as possible.

• #8 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. […] To prevent hypoglycemia, much effort must be invested in patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage, together with setting personalized goals for glycemic control. […] Great effort must be invested in patient education on hypoglycemia prevention and management. […] The approach to hypoglycemia prevention includes patient education, appropriate dietary and exercise regimens, glucose monitoring, medication adjustment, and close clinical supervision. […] The patients and those around them should be educated to identify symptoms of hypoglycemia and given appropriate treatment as soon as possible.

• #9 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036

  Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. […] To prevent hypoglycemia, much effort must be invested in patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage, together with setting personalized goals for glycemic control. […] Great effort must be invested in patient education on hypoglycemia prevention and management. […] The approach to hypoglycemia prevention includes patient education, appropriate dietary and exercise regimens, glucose monitoring, medication adjustment, and close clinical supervision. […] The patients and those around them should be educated to identify symptoms of hypoglycemia and given appropriate treatment as soon as possible.

• #10 Diabetic hypoglycemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

  Pay attention to the early warning signs of hypoglycemia and treat low blood sugar promptly. You can raise your blood sugar quickly by eating or drinking a simple sugar source, such as glucose tablets, hard candy or fruit juice. […] To help prevent diabetic hypoglycemia: […] Monitor your blood sugar. Depending on your treatment plan, you may check and record your blood sugar level several times a week or multiple times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. […] Don’t skip or delay meals or snacks. If you take insulin or oral diabetes medication, be consistent about the amount you eat and the timing of your meals and snacks. […] Measure medication carefully and take it on time. Take your medication as recommended by your health care provider.

• #11

  https://link.springer.com/article/10.1007/s11892-018-1065-6

  Prevention of hypoglycemia while achieving good glycemic control in type 1 diabetes. […] The study highlights the importance of the structured approach, patient education, and follow-up in specialized centers as the determining factor in reducing hypoglycemia and improving the awareness of hypoglycemia, even independent of technology. […] This study examines the effectiveness of predictive low glucose management (PLGM) system in preventing insulin-induced hypoglycemia. […] This study used real-time CGM as a strategy for prevention of hypoglycemia to assess whether such prevention could improve glucose counterregulation measured by the EGP response to insulin-induced hypoglycemia in patients with long-standing T1D complicated by hypoglycemia unawareness. […] A study describing the long-term outcomes of SAP therapy with low-glucose suspend feature (SAP+LGS) in hypoglycemia in a Colombian population with T1D and hypoglycemia unawareness.

• #12 Hypoglycemia Prevention and Management – Today’s Dietitian Magazine

  https://www.todaysdietitian.com/newarchives/0717p36.shtml

  Advise patients to educate those around them about diabetes and hypoglycemia symptoms. […] The best advice for reversing hypoglycemia unawareness is to avoid frequent low blood glucose levels. […] Frequent blood sugar monitoring, exercising earlier in the day, follow-up with an endocrinologist or health care provider, and visits with a dietitian and certified diabetes educator are recommended. […] Encouraging patients to enroll in approved diabetes self-care education programs (which may be covered by insurance) is key, as they provide much-needed support for those struggling with daily diabetes self-care management and offer peer support for problems associated with hypoglycemia or blood glucose fluctuations.

• #13 Treatment of Low Blood Sugar (Hypoglycemia) | Diabetes | CDC

  https://www.cdc.gov/diabetes/treatment/treatment-low-blood-sugar-hypoglycemia.html

  One of the best ways to prevent low blood sugar is to frequently monitor. This can help you to notice trends and adjust before your blood sugar drops too low. […] If you continue to have low blood sugar episodes, share your blood sugar, medicine routine, physical activity, and food patterns with your doctor. They may be able to identify patterns and help prevent lows by making adjustments. Do not make any changes to your medicines without talking to your doctor.

• #14 Causes and How to Prevent Hypoglycemia (Low Blood Glucose) | American Diabetes Association

  https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose/causes-prevention

  Your best bet is to keep your blood glucose in your target range. Keep track of your personal symptoms you feel when go low. If you start to recognize those feelings, you can act faster to treat your low glucose before it drops lower. […] Monitoring blood glucose, with either a blood glucose meter or a continuous glucose monitor (CGM) allows you to be aware of your blood glucose levels and take steps to prevent low blood glucose. Studies consistently show that the more a person checks blood glucose, the lower their risk of low blood glucose. […] Check more frequently if things around you change such as a new insulin routine, a different work schedule, an increase in physical activity, or travel across time zones.

• #15 Hypoglycemia Prevention and Treatment in the Ambulatory Care Setting

  https://www.uspharmacist.com/article/hypoglycemia-prevention-and-treatment-in-the-ambulatory-care-setting

  Monitoring via finger-stick glucose readings and a glucose meter or a continuous glucose monitor (CGM) is essential for the detection and avoidance of hypoglycemia. […] If a patient has level 2 hypoglycemia (glucose 54 mg/dL) without experiencing hypoglycemia symptoms, he or she likely has hypoglycemia unawareness. […] The ADA also recommends that insulin-treated patients with hypoglycemia unawareness be advised to raise their glycemic target to strictly avoid hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce the risk of future episodes.

• #16 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Continuous glucose monitoring (CGM), which measures the interstitial glucose in real-time, constitutes a potential tool to improve diabetes control and reduce hypoglycemic episodes. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] Much effort must be invested in hypoglycemia prevention, including patient education, appropriate dietary and exercise regimens, adjustment of the treatment regimen, and implementation of glucose monitoring systems as appropriate.

• #17 Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hypoglycemia-low-blood-glucose-in-people-with-diabetes-beyond-the-basics

  Hypoglycemia PREVENTION […] To prevent low blood glucose, it is important to monitor your blood glucose levels frequently and be prepared to treat it promptly at any time. Continuous glucose monitoring can help prevent hypoglycemia if you have type 1 diabetes or if you have type 2 diabetes and take insulin or other medication(s) that increases risk for hypoglycemia. Continuous glucose monitoring can alert you to a low or falling blood glucose level so that you can take action to avoid severe hypoglycemia. You and a close friend or relative should learn the symptoms of hypoglycemia and always carry glucose tablets, hard candy, or other sources of fast-acting carbohydrate so you can treat low blood glucose if it does happen. (See 'Hypoglycemia treatment’ below.) […] […] If you experience low blood glucose levels, let your health care provider know. They can help adjust your diabetes treatment plan to reduce the chances of hypoglycemia happening again. They can also talk to you about blood glucose awareness education. Blood glucose awareness training can improve your ability to recognize low blood glucose earlier, which will allow you to treat it quickly and avoid more serious symptoms. A trained diabetes educator can also work with you to help you anticipate when low glucose levels are more likely to happen. […]

• #18 Low Blood Sugar (Hypoglycemia) | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/low-blood-sugar-hypoglycemia.html

  Eating regular meals and not skipping them can help you avoid nighttime low blood sugar. […] If you meet one or more of the above and you have hypoglycemia unawareness, check your blood sugar more often. Checking is especially important to do before driving or being physically active.

• #19 Causes and How to Prevent Hypoglycemia (Low Blood Glucose) | American Diabetes Association

  https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose/causes-prevention

  Your best bet is to keep your blood glucose in your target range. Keep track of your personal symptoms you feel when go low. If you start to recognize those feelings, you can act faster to treat your low glucose before it drops lower. […] Monitoring blood glucose, with either a blood glucose meter or a continuous glucose monitor (CGM) allows you to be aware of your blood glucose levels and take steps to prevent low blood glucose. Studies consistently show that the more a person checks blood glucose, the lower their risk of low blood glucose. […] Check more frequently if things around you change such as a new insulin routine, a different work schedule, an increase in physical activity, or travel across time zones.

• #20

  https://link.springer.com/article/10.1007/s11892-018-1065-6

  In addition to assisting in achieving improved glucose control, continuous glucose monitoring (CGM) sensor technology may also aid in detection and prevention of hypoglycemia. […] Recent studies have found that the integration of CGM with continuous subcutaneous insulin infusion (CSII) therapy, a system known as sensor-augmented pump (SAP) therapy, very significantly reduces the occurrence of these conditions by providing real-time glucose readings/trends and automatically suspending insulin infusion when glucose is low (LGS) or, even, before glucose is low but is predicted to soon be low (PLGS). […] Sensor technology promises to continue to improve patients lives not only by attaining glycemic control but also by reducing hypoglycemia, a goal best achieved in conjunction with structured individualized patient education.

• #21 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] The use of continuous subcutaneous insulin infusion (CSII) prevented hypoglycemic episodes and improved the threshold of hypoglycemia awareness in patients with type 1 diabetes who suffered from recurrent episodes of non-severe or severe hypoglycemia.

• #22 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Continuous glucose monitoring (CGM), which measures the interstitial glucose in real-time, constitutes a potential tool to improve diabetes control and reduce hypoglycemic episodes. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] The use of an artificial pancreas can reduce the burden on patients by automatically adjusting the delivery of insulin based on sensor glucose levels.

• #23 Hypoglycemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypoglycemia

  Another cornerstone of prevention is strong self-monitoring of blood glucose, with consistent and frequent measurements. […] Research has shown that patients with type 1 diabetes who use continuous glucose monitoring systems with insulin pumps significantly improve blood glucose control. […] Insulin pumps help to prevent high glucose spikes, and help prevent inappropriate insulin dosing. […] Continuous glucose monitors can sound alarms when blood glucose is too low or too high, especially helping those with nocturnal hypoglycemia or hypoglycemic unawareness. […] In terms of medication adjustments, medication doses and timing can be adjusted to prevent hypoglycemia, or a medication can be stopped altogether. […] In those with hypoglycemia who do not have diabetes, there are a number of preventative measures dependent on the cause.

• #24 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] The use of continuous subcutaneous insulin infusion (CSII) prevented hypoglycemic episodes and improved the threshold of hypoglycemia awareness in patients with type 1 diabetes who suffered from recurrent episodes of non-severe or severe hypoglycemia.

• #25 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Continuous glucose monitoring (CGM), which measures the interstitial glucose in real-time, constitutes a potential tool to improve diabetes control and reduce hypoglycemic episodes. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] Much effort must be invested in hypoglycemia prevention, including patient education, appropriate dietary and exercise regimens, adjustment of the treatment regimen, and implementation of glucose monitoring systems as appropriate.

• #26 Diabetic hypoglycemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

  Pay attention to the early warning signs of hypoglycemia and treat low blood sugar promptly. You can raise your blood sugar quickly by eating or drinking a simple sugar source, such as glucose tablets, hard candy or fruit juice. […] To help prevent diabetic hypoglycemia: […] Monitor your blood sugar. Depending on your treatment plan, you may check and record your blood sugar level several times a week or multiple times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. […] Don’t skip or delay meals or snacks. If you take insulin or oral diabetes medication, be consistent about the amount you eat and the timing of your meals and snacks. […] Measure medication carefully and take it on time. Take your medication as recommended by your health care provider.

• #27 Hypoglycemia Prevention and Management – Today’s Dietitian Magazine

  https://www.todaysdietitian.com/newarchives/0717p36.shtml

  Hypoglycemia prevention should be addressed in this population. […] People with diabetes should prepare for delayed mealtimes or other possible scheduling conflicts following their insulin dosage (for example when eating out) to help prevent hypoglycemia. […] It may be prudent to adjust blood glucose goals to higher targets for 48 to 72 hours to help restore autonomic functions and reduce the emotional toll low blood glucose levels take on our patients. […] Physicians should refer our patients with diabetes to registered dietitians to assist with meal planning and snack adjustments to help combat the issue of hypoglycemia. […] Dietitians should advise their patients to carry a carbohydrate-containing snack with them, in case their usual meal is delayed, to prevent an unwanted drop in blood glucose.

• #28 Low Blood Sugar (Hypoglycemia) | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/low-blood-sugar-hypoglycemia.html

  Eating regular meals and not skipping them can help you avoid nighttime low blood sugar. […] If you meet one or more of the above and you have hypoglycemia unawareness, check your blood sugar more often. Checking is especially important to do before driving or being physically active.

• #29 Sweet dreams: avoiding nocturnal hypoglycemia – BETTER

  https://type1better.com/en/sweet-dreams-avoiding-nocturnal-hypoglycemia/

  Low blood sugar (hypoglycemia) can happen at any time of day, but it is specifically risky during sleep. […] Nocturnal hypoglycemia can be dangerous as up to 80% of the episodes can be asymptomatic (without symptoms). […] In addition, sleep is usually the longest time you go without eating or monitoring blood sugar levels. […] Whether severe or not, a nocturnal hypoglycemic episode disrupts sleep quality, productivity during the day, and can be associated with persistent fatigue. […] Monitoring blood sugar levels overnight is the best way to detect nocturnal hypoglycemia. […] Participants in the BETTER registry reported various strategies to prevent nocturnal hypoglycemia. […] Consider consuming a bedtime snack with carbohydrates (foods containing or that convert to sugars in our body) and protein, especially if bedtime glucose levels are low, you had a significantly active day, consumed alcohol, or were unusually physically active in the evening.

• #30 Hypoglycemia Diet Plans to Help Regulate Your Blood Sugar

  https://www.healthline.com/health/hypoglycemia-diet

  Your food choices are a big part of managing hypoglycemia. You can eat small, frequent meals with lean proteins and complex carbs. Foods high in soluble fiber, as will seafood and Greek yogurt, may stabilize blood sugar over time. […] No matter the reason, you can take steps to help manage and prevent hypoglycemia through your meal planning. This involves snacking, scheduled meals, and following a generally healthy eating pattern that your healthcare team can guide you on. […] Eating a light snack close to bedtime will help keep your blood sugar stable throughout the night. […] Eat small meals every 3 to 4 hours throughout the day rather than 3 large meals per day. Avoid foods high in saturated fats or trans fats. […] Choose foods with a low glycemic index score. […] Reduce or eliminate processed and refined sugars from your diet.

• #31 Hypoglycemia Diet Plans to Help Regulate Your Blood Sugar

  https://www.healthline.com/health/hypoglycemia-diet

  Choose complex carbohydrates over simple carbohydrates. […] Reduce or eliminate alcohol, and never mix alcohol with sugar-filled mixers, such as fruit juice. […] Eat lean protein. […] Eat foods high in soluble fiber. […] Your food choices are a big part of managing hypoglycemia. Try to eat small, frequent meals with lean proteins and complex carbs. Foods high in soluble fiber, such as Greek yogurt, oatmeal, salads, and seafood, may stabilize your blood sugar over time.

• #32 Hypoglycemia Prevention and Management – Today’s Dietitian Magazine

  https://www.todaysdietitian.com/newarchives/0717p36.shtml

  Hypoglycemia prevention should be addressed in this population. […] People with diabetes should prepare for delayed mealtimes or other possible scheduling conflicts following their insulin dosage (for example when eating out) to help prevent hypoglycemia. […] It may be prudent to adjust blood glucose goals to higher targets for 48 to 72 hours to help restore autonomic functions and reduce the emotional toll low blood glucose levels take on our patients. […] Physicians should refer our patients with diabetes to registered dietitians to assist with meal planning and snack adjustments to help combat the issue of hypoglycemia. […] Dietitians should advise their patients to carry a carbohydrate-containing snack with them, in case their usual meal is delayed, to prevent an unwanted drop in blood glucose.

• #33 Diabetic hypoglycemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

  Adjust your medication or eat additional snacks if you increase your physical activity. The adjustment depends on the blood sugar test results, the type and length of the activity, and what medications you take. Follow your diabetes treatment plan when making adjustments. […] Eat a meal or snack with alcohol, if you choose to drink. Drinking alcohol on an empty stomach can cause hypoglycemia. Alcohol may also cause delayed hypoglycemia hours later, making blood sugar monitoring even more important. […] Record your low glucose reactions. This can help you and your health care team identify patterns contributing to hypoglycemia and find ways to prevent them. […] Carry some form of diabetes identification so that in an emergency others will know that you have diabetes. Use a medical identification necklace or bracelet and wallet card.

• #34 Hypoglycemia (Low Blood Sugar Levels): Symptoms, Causes, Treatment

  https://www.webmd.com/diabetes/diabetes-hypoglycemia

  If you have diabetes, ways you can prevent hypoglycemia include: […] Follow your meal plan. […] Eat at least three evenly spaced meals each day with between-meal snacks as prescribed. […] Plan your meals no more than 4 to 5 hours apart. […] Exercise 30 minutes to 1 hour after meals. Check your sugars before and after exercise, and discuss with your doctor what types of changes can be made. […] Double-check your insulin and dose of diabetes medicine before taking it. […] If you drink alcohol, be moderate and monitor your blood sugar levels. […] Know when your medicine is at its peak level. […] Test your blood sugar as often as directed by your doctor. […] Carry an identification bracelet that says you have diabetes.

• #35 Preventing Hypoglycemia

  https://elsevier.health/en-US/preview/preventing-hypoglycemia

  Work with your health care provider to make and change your meal plan as needed. This can help prevent low blood sugar. […] Do not skip or delay meals or snacks. […] Work closely with your provider to manage your blood sugar. Make sure you know: What your blood sugar should be. […] Always check your blood sugar before, during, and after exercise. […] If you have low blood sugar, eat or drink something with sugar in it right away. […] If you’re alert and can swallow safely, follow the 15:15 rule: Take 15 grams of a fast-acting carb. […] After your blood sugar goes back to normal, eat a meal or a snack within 1 hour. […] If your blood sugar is less than 54 mg/dL (3 mmol/L), it’s an emergency. Get help right away.

• #36 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter14

  It is important to prevent, recognize and treat hypoglycemic episodes secondary to the use of insulin or insulin secretagogues. […] It is safer and more effective to prevent hypoglycemia than to treat it after it occurs, so people with diabetes who are at high risk for hypoglycemia should be identified and counselled about ways to prevent low blood glucose. […] It is important to counsel individuals who are at risk of hypoglycemia and their support persons about the recognition and treatment of hypoglycemia. […] The goals of treatment for hypoglycemia are to detect and treat a low blood glucose level promptly by using an intervention that provides the fastest rise in blood glucose to a safe level, to eliminate the risk of injury and to relieve symptoms quickly. Once the hypoglycemia has been reversed, the person should have the usual meal or snack that is due at that time of the day to prevent repeated hypoglycemia. If a meal is 1 hour away, a snack (including 15g carbohydrate and a protein source) should be consumed.

• #37 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] The use of continuous subcutaneous insulin infusion (CSII) prevented hypoglycemic episodes and improved the threshold of hypoglycemia awareness in patients with type 1 diabetes who suffered from recurrent episodes of non-severe or severe hypoglycemia.

• #38 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Continuous glucose monitoring (CGM), which measures the interstitial glucose in real-time, constitutes a potential tool to improve diabetes control and reduce hypoglycemic episodes. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] Much effort must be invested in hypoglycemia prevention, including patient education, appropriate dietary and exercise regimens, adjustment of the treatment regimen, and implementation of glucose monitoring systems as appropriate.

• #39 Preventing Hypoglycemia

  https://elsevier.health/en-US/preview/preventing-hypoglycemia

  Work with your health care provider to make and change your meal plan as needed. This can help prevent low blood sugar. […] Do not skip or delay meals or snacks. […] Work closely with your provider to manage your blood sugar. Make sure you know: What your blood sugar should be. […] Always check your blood sugar before, during, and after exercise. […] If you have low blood sugar, eat or drink something with sugar in it right away. […] If you’re alert and can swallow safely, follow the 15:15 rule: Take 15 grams of a fast-acting carb. […] After your blood sugar goes back to normal, eat a meal or a snack within 1 hour. […] If your blood sugar is less than 54 mg/dL (3 mmol/L), it’s an emergency. Get help right away.

• #40 Hypoglycemia (Low Blood Sugar Levels): Symptoms, Causes, Treatment

  https://www.webmd.com/diabetes/diabetes-hypoglycemia

  If you have diabetes, ways you can prevent hypoglycemia include: […] Follow your meal plan. […] Eat at least three evenly spaced meals each day with between-meal snacks as prescribed. […] Plan your meals no more than 4 to 5 hours apart. […] Exercise 30 minutes to 1 hour after meals. Check your sugars before and after exercise, and discuss with your doctor what types of changes can be made. […] Double-check your insulin and dose of diabetes medicine before taking it. […] If you drink alcohol, be moderate and monitor your blood sugar levels. […] Know when your medicine is at its peak level. […] Test your blood sugar as often as directed by your doctor. […] Carry an identification bracelet that says you have diabetes.

• #41 Diabetic hypoglycemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

  Adjust your medication or eat additional snacks if you increase your physical activity. The adjustment depends on the blood sugar test results, the type and length of the activity, and what medications you take. Follow your diabetes treatment plan when making adjustments. […] Eat a meal or snack with alcohol, if you choose to drink. Drinking alcohol on an empty stomach can cause hypoglycemia. Alcohol may also cause delayed hypoglycemia hours later, making blood sugar monitoring even more important. […] Record your low glucose reactions. This can help you and your health care team identify patterns contributing to hypoglycemia and find ways to prevent them. […] Carry some form of diabetes identification so that in an emergency others will know that you have diabetes. Use a medical identification necklace or bracelet and wallet card.

• #42 Exercise-induced hypoglycemia: Signs and prevention

  https://www.medicalnewstoday.com/articles/exercise-induced-hypoglycemia-what-to-know

  Mild EIH does not usually require treatment. In many cases, the condition occurs because a person did not eat enough food before working out. To avoid EIH, individuals should try eating a carbohydrate-rich meal 12 hours before a workout. […] The American Diabetes Association (ADA) recommends that people who take diabetes medications to control their blood glucose check their blood glucose levels before exercising. If the reading is below 100 mg/dl, they should have 1520 grams (g) of carbohydrates to increase their blood glucose. […] People without diabetes can usually prevent EIH by: gradually building up to new exercise routines to give the body time to adapt, eating regular meals throughout the day, avoiding drinking alcohol before a workout. […] Individuals who feel shaky or dizzy during a workout should stop and take a break. They should try drinking 4 oz (113 g) of juice or eating a piece of toast, then resuming their workout later.

• #43 Exercise-induced hypoglycemia: Signs and prevention

  https://www.medicalnewstoday.com/articles/exercise-induced-hypoglycemia-what-to-know

  Mild EIH does not usually require treatment. In many cases, the condition occurs because a person did not eat enough food before working out. To avoid EIH, individuals should try eating a carbohydrate-rich meal 12 hours before a workout. […] The American Diabetes Association (ADA) recommends that people who take diabetes medications to control their blood glucose check their blood glucose levels before exercising. If the reading is below 100 mg/dl, they should have 1520 grams (g) of carbohydrates to increase their blood glucose. […] People without diabetes can usually prevent EIH by: gradually building up to new exercise routines to give the body time to adapt, eating regular meals throughout the day, avoiding drinking alcohol before a workout. […] Individuals who feel shaky or dizzy during a workout should stop and take a break. They should try drinking 4 oz (113 g) of juice or eating a piece of toast, then resuming their workout later.

• #44 Exercise-induced hypoglycemia: Signs and prevention

  https://www.medicalnewstoday.com/articles/exercise-induced-hypoglycemia-what-to-know

  Mild EIH does not usually require treatment. In many cases, the condition occurs because a person did not eat enough food before working out. To avoid EIH, individuals should try eating a carbohydrate-rich meal 12 hours before a workout. […] The American Diabetes Association (ADA) recommends that people who take diabetes medications to control their blood glucose check their blood glucose levels before exercising. If the reading is below 100 mg/dl, they should have 1520 grams (g) of carbohydrates to increase their blood glucose. […] People without diabetes can usually prevent EIH by: gradually building up to new exercise routines to give the body time to adapt, eating regular meals throughout the day, avoiding drinking alcohol before a workout. […] Individuals who feel shaky or dizzy during a workout should stop and take a break. They should try drinking 4 oz (113 g) of juice or eating a piece of toast, then resuming their workout later.

• #45 Exercise-induced hypoglycemia: Signs and prevention

  https://www.medicalnewstoday.com/articles/exercise-induced-hypoglycemia-what-to-know

  Mild EIH does not usually require treatment. In many cases, the condition occurs because a person did not eat enough food before working out. To avoid EIH, individuals should try eating a carbohydrate-rich meal 12 hours before a workout. […] The American Diabetes Association (ADA) recommends that people who take diabetes medications to control their blood glucose check their blood glucose levels before exercising. If the reading is below 100 mg/dl, they should have 1520 grams (g) of carbohydrates to increase their blood glucose. […] People without diabetes can usually prevent EIH by: gradually building up to new exercise routines to give the body time to adapt, eating regular meals throughout the day, avoiding drinking alcohol before a workout. […] Individuals who feel shaky or dizzy during a workout should stop and take a break. They should try drinking 4 oz (113 g) of juice or eating a piece of toast, then resuming their workout later.

• #46 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] The use of continuous subcutaneous insulin infusion (CSII) prevented hypoglycemic episodes and improved the threshold of hypoglycemia awareness in patients with type 1 diabetes who suffered from recurrent episodes of non-severe or severe hypoglycemia.

• #47 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  Dietary intervention includes instruction regarding the amount of carbohydrates at meals and its effect on blood glucose concentration and building a personalized regular meal plan. […] Physical exercise increases glucose consumption and the risk of hypoglycemia. […] Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring constitute essential tools to diagnose hypoglycemia in the early stages. […] Continuous glucose monitoring (CGM), which measures the interstitial glucose in real-time, constitutes a potential tool to improve diabetes control and reduce hypoglycemic episodes. […] Some hypoglycemia episodes in diabetes are associated with the treatment itself; therefore, it is important to use drugs with a low risk of hypoglycemia. […] Much effort must be invested in hypoglycemia prevention, including patient education, appropriate dietary and exercise regimens, adjustment of the treatment regimen, and implementation of glucose monitoring systems as appropriate.

• #48 Diabetic hypoglycemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

  Pay attention to the early warning signs of hypoglycemia and treat low blood sugar promptly. You can raise your blood sugar quickly by eating or drinking a simple sugar source, such as glucose tablets, hard candy or fruit juice. […] To help prevent diabetic hypoglycemia: […] Monitor your blood sugar. Depending on your treatment plan, you may check and record your blood sugar level several times a week or multiple times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. […] Don’t skip or delay meals or snacks. If you take insulin or oral diabetes medication, be consistent about the amount you eat and the timing of your meals and snacks. […] Measure medication carefully and take it on time. Take your medication as recommended by your health care provider.

• #49 Hypoglycemia (Low Blood Sugar Levels): Symptoms, Causes, Treatment

  https://www.webmd.com/diabetes/diabetes-hypoglycemia

  If you have diabetes, ways you can prevent hypoglycemia include: […] Follow your meal plan. […] Eat at least three evenly spaced meals each day with between-meal snacks as prescribed. […] Plan your meals no more than 4 to 5 hours apart. […] Exercise 30 minutes to 1 hour after meals. Check your sugars before and after exercise, and discuss with your doctor what types of changes can be made. […] Double-check your insulin and dose of diabetes medicine before taking it. […] If you drink alcohol, be moderate and monitor your blood sugar levels. […] Know when your medicine is at its peak level. […] Test your blood sugar as often as directed by your doctor. […] Carry an identification bracelet that says you have diabetes.

• #50 Treatment of Low Blood Sugar (Hypoglycemia) | Diabetes | CDC

  https://www.cdc.gov/diabetes/treatment/treatment-low-blood-sugar-hypoglycemia.html

  One of the best ways to prevent low blood sugar is to frequently monitor. This can help you to notice trends and adjust before your blood sugar drops too low. […] If you continue to have low blood sugar episodes, share your blood sugar, medicine routine, physical activity, and food patterns with your doctor. They may be able to identify patterns and help prevent lows by making adjustments. Do not make any changes to your medicines without talking to your doctor.

• #51 Hypoglycemia – EMCrit Project

  https://emcrit.org/ibcc/hypoglycemia/

  Upon admission to the ICU discontinue any oral hypoglycemic medications. Hyperglycemia should be controlled with insulin therapy only. […] Be conservative with insulin dosing: Don’t try to achieve tight glycemic control. A glucose target of 220 mg/dL (11.1 mM) is fine for most patients. Patients with diabetes and elevated hemoglobin A1C 7 may do better if their glucose is allowed to drift higher (up to ~250 mg/dL)(13.9 mM). […] When in doubt, dose insulin conservatively. Hyperglycemia is less dangerous than hypoglycemia. […] Consider reducing the insulin dose if the patient becomes NPO, or if steroid doses are decreased. […] Insulin dosing can be tricky. Among all medications, insulin is one of the most prone to serious dosing errors. […] Patients with cirrhosis or acute hepatic failure tend to develop hypoglycemia, so monitor their glucose levels and avoid giving them insulin. Some patients with severe hepatic failure will require a continuous dextrose infusion to avoid hypoglycemia.

• #52 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter14

  It is important to avoid overtreatment of hypoglycemia, since this can result in rebound hyperglycemia and weight gain. […] In people with diabetes at increased risk of hypoglycemia, the following strategies may be used to reduce the risk of hypoglycemia: Avoidance of pharmacotherapies associated with increased risk of recurrent or severe hypoglycemia. […] A standardized education program targeting rigorous avoidance of hypoglycemia while maintaining overall glycemic control. […] Increased frequency of SMBG, including periodic assessment during sleeping hours. […] Less stringent glycemic targets with avoidance of hypoglycemia for up to 3 months. […] A psycho-behavioural intervention program (blood glucose awareness training). […] Structured diabetes education and frequent follow up. […] For people with diabetes at risk of severe hypoglycemia, support persons should be taught how to administer glucagon.

• #53 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter14

  It is important to avoid overtreatment of hypoglycemia, since this can result in rebound hyperglycemia and weight gain. […] In people with diabetes at increased risk of hypoglycemia, the following strategies may be used to reduce the risk of hypoglycemia: Avoidance of pharmacotherapies associated with increased risk of recurrent or severe hypoglycemia. […] A standardized education program targeting rigorous avoidance of hypoglycemia while maintaining overall glycemic control. […] Increased frequency of SMBG, including periodic assessment during sleeping hours. […] Less stringent glycemic targets with avoidance of hypoglycemia for up to 3 months. […] A psycho-behavioural intervention program (blood glucose awareness training). […] Structured diabetes education and frequent follow up. […] For people with diabetes at risk of severe hypoglycemia, support persons should be taught how to administer glucagon.

• #54 Hypoglycemia Prevention Initiative | Endocrine Society

  https://www.endocrine.org/hypoglycemia-prevention-initiative

  Hypoglycemia Prevention Initiative […] The Hypoglycemia Prevention Initiative is a multi-year joint effort of the Endocrine Society and Avalere Health to determine best practices in primary care to reduce the impact of hypoglycemia on older (65+) people with type 2 diabetes (T2D) who use insulin and/or sulfonylurea, have a recent A1c 7%, and are at increased risk of hypoglycemia. The initial effort of this initiative is the Hypoglycemia Prevention Study (HypoPrevent), an implementation research and quality improvement (QI) study designed to test an intervention in primary care settings to identify older people with T2D at risk of hypoglycemia and a clinical decision support tool designed to facilitate risk reduction. […] This study assesses various methods to decrease the risk of hypoglycemia on an individual basis through shared decision making (SDM), individualized A1c goals and/or changes to their glucose-lowering medications regimen. The diabetes educator, who is also the practice coordinator for this study, plays a key role with annual assessments and education on glucose-lowering medications and their mechanism of action.

• #55 Sweet dreams: avoiding nocturnal hypoglycemia – BETTER

  https://type1better.com/en/sweet-dreams-avoiding-nocturnal-hypoglycemia/

  Low blood sugar (hypoglycemia) can happen at any time of day, but it is specifically risky during sleep. […] Nocturnal hypoglycemia can be dangerous as up to 80% of the episodes can be asymptomatic (without symptoms). […] In addition, sleep is usually the longest time you go without eating or monitoring blood sugar levels. […] Whether severe or not, a nocturnal hypoglycemic episode disrupts sleep quality, productivity during the day, and can be associated with persistent fatigue. […] Monitoring blood sugar levels overnight is the best way to detect nocturnal hypoglycemia. […] Participants in the BETTER registry reported various strategies to prevent nocturnal hypoglycemia. […] Consider consuming a bedtime snack with carbohydrates (foods containing or that convert to sugars in our body) and protein, especially if bedtime glucose levels are low, you had a significantly active day, consumed alcohol, or were unusually physically active in the evening.

• #56 Sweet dreams: avoiding nocturnal hypoglycemia – BETTER

  https://type1better.com/en/sweet-dreams-avoiding-nocturnal-hypoglycemia/

  Low blood sugar (hypoglycemia) can happen at any time of day, but it is specifically risky during sleep. […] Nocturnal hypoglycemia can be dangerous as up to 80% of the episodes can be asymptomatic (without symptoms). […] In addition, sleep is usually the longest time you go without eating or monitoring blood sugar levels. […] Whether severe or not, a nocturnal hypoglycemic episode disrupts sleep quality, productivity during the day, and can be associated with persistent fatigue. […] Monitoring blood sugar levels overnight is the best way to detect nocturnal hypoglycemia. […] Participants in the BETTER registry reported various strategies to prevent nocturnal hypoglycemia. […] Consider consuming a bedtime snack with carbohydrates (foods containing or that convert to sugars in our body) and protein, especially if bedtime glucose levels are low, you had a significantly active day, consumed alcohol, or were unusually physically active in the evening.

• #57 Sweet dreams: avoiding nocturnal hypoglycemia – BETTER

  https://type1better.com/en/sweet-dreams-avoiding-nocturnal-hypoglycemia/

  You could adjust insulin doses depending on your evening activities (e.g., exercise) or consider a different type of insulin that was shown to reduce the risk of nocturnal hypoglycemia (e.g., long-acting insulin analogs). […] CGM technology equipped with alarms can alert you when there is an imminent nocturnal hypoglycemia episode. […] It is important to note that some of these strategies are based on the experiences of people with T1D and evidence supporting these recommendations remains limited, thus more research is needed to find the best approaches depending on the individual. […] A recent analysis using data from the BETTER registry found that the types of treatment used (injections, pumps, CGMs) can influence which nocturnal hypoglycemia prevention strategy one chooses. […] Additionally, people who report higher fear of hypoglycemia are more likely to use a nocturnal hypoglycemia strategy and also tend to use more strategies than those who have a lower fear of hypoglycemia.

• #58 Avoiding Nighttime Hypoglycemia | Joslin Diabetes Center

  https://joslin.org/news-stories/all-news-stories/education/2020/03/avoiding-nighttime-hypoglycemia

  Nighttime hypoglycemia can be the result of a number of factors in people with diabetes. It is important to learn what causes hypoglycemia (low glucose) in order to prevent it from happening. […] Check your glucose before going to bed. This could be either with your glucose meter or your continuous glucose monitoring device. Aim for a target of 90-150mg/dl. Know the signs and symptoms of nighttime hypoglycemia. Before you go to bed, consider all of the causes of nighttime hypoglycemia, and if you think you’re at risk, have a snack before heading to bed. Try to be consistent with your meals and/or snacks; skipping dinner or snacks you usually have can put you at risk. Eat a meal or snack when consuming alcohol. […] If you find yourself experiencing frequent nighttime hypoglycemia you may need to adjust your insulin doses. Speak to your diabetes care team about adjusting your insulin regimen or things that you can do to avoid hypoglycemia whether it be overnight or anytime during the day.

• #59 Avoiding Nighttime Hypoglycemia | Joslin Diabetes Center

  https://joslin.org/news-stories/all-news-stories/education/2020/03/avoiding-nighttime-hypoglycemia

  Nighttime hypoglycemia can be the result of a number of factors in people with diabetes. It is important to learn what causes hypoglycemia (low glucose) in order to prevent it from happening. […] Check your glucose before going to bed. This could be either with your glucose meter or your continuous glucose monitoring device. Aim for a target of 90-150mg/dl. Know the signs and symptoms of nighttime hypoglycemia. Before you go to bed, consider all of the causes of nighttime hypoglycemia, and if you think you’re at risk, have a snack before heading to bed. Try to be consistent with your meals and/or snacks; skipping dinner or snacks you usually have can put you at risk. Eat a meal or snack when consuming alcohol. […] If you find yourself experiencing frequent nighttime hypoglycemia you may need to adjust your insulin doses. Speak to your diabetes care team about adjusting your insulin regimen or things that you can do to avoid hypoglycemia whether it be overnight or anytime during the day.

• #60 Sweet dreams: avoiding nocturnal hypoglycemia – BETTER

  https://type1better.com/en/sweet-dreams-avoiding-nocturnal-hypoglycemia/

  Low blood sugar (hypoglycemia) can happen at any time of day, but it is specifically risky during sleep. […] Nocturnal hypoglycemia can be dangerous as up to 80% of the episodes can be asymptomatic (without symptoms). […] In addition, sleep is usually the longest time you go without eating or monitoring blood sugar levels. […] Whether severe or not, a nocturnal hypoglycemic episode disrupts sleep quality, productivity during the day, and can be associated with persistent fatigue. […] Monitoring blood sugar levels overnight is the best way to detect nocturnal hypoglycemia. […] Participants in the BETTER registry reported various strategies to prevent nocturnal hypoglycemia. […] Consider consuming a bedtime snack with carbohydrates (foods containing or that convert to sugars in our body) and protein, especially if bedtime glucose levels are low, you had a significantly active day, consumed alcohol, or were unusually physically active in the evening.

• #61 Sweet dreams: avoiding nocturnal hypoglycemia – BETTER

  https://type1better.com/en/sweet-dreams-avoiding-nocturnal-hypoglycemia/

  You could adjust insulin doses depending on your evening activities (e.g., exercise) or consider a different type of insulin that was shown to reduce the risk of nocturnal hypoglycemia (e.g., long-acting insulin analogs). […] CGM technology equipped with alarms can alert you when there is an imminent nocturnal hypoglycemia episode. […] It is important to note that some of these strategies are based on the experiences of people with T1D and evidence supporting these recommendations remains limited, thus more research is needed to find the best approaches depending on the individual. […] A recent analysis using data from the BETTER registry found that the types of treatment used (injections, pumps, CGMs) can influence which nocturnal hypoglycemia prevention strategy one chooses. […] Additionally, people who report higher fear of hypoglycemia are more likely to use a nocturnal hypoglycemia strategy and also tend to use more strategies than those who have a lower fear of hypoglycemia.

• #62 Hypoglycaemia (low blood sugar) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hypoglycaemia-low-blood-sugar/

  If you have diabetes that requires treatment with insulin, the safest way to avoid hypoglycaemia is to regularly check your blood sugar and learn to recognise the early symptoms. […] Missing meals or snacks or eating less carbohydrate than planned can increase your risk of hypoglycaemia. You should be careful when drinking alcohol as it can also cause hypoglycaemia, sometimes many hours after drinking. […] Always carry rapid-acting carbohydrate with you, such as glucose tablets, a carton of fruit juice (one that contains sugar), or some sweets in case you feel symptoms coming on or your blood glucose level is low. […] If you have diabetes, sticking to your medication plan and eating regular meals can help prevent hypoglycaemia. […] Regularly monitoring your blood glucose levels can help you keep your blood glucose as normal and stable as possible, and will help you spot the signs and symptoms of hypoglycaemia quickly. […] If you experience nocturnal hypoglycaemia, you can try: keeping something sugary by your bedside, having a snack before bedtime, such as biscuits and milk, checking your blood glucose levels between 3am and 4am, when hypoglycaemia is most likely to occur.

• #63 Preventing Hypoglycemia

  https://elsevier.health/en-US/preview/preventing-hypoglycemia

  Work with your health care provider to make and change your meal plan as needed. This can help prevent low blood sugar. […] Do not skip or delay meals or snacks. […] Work closely with your provider to manage your blood sugar. Make sure you know: What your blood sugar should be. […] Always check your blood sugar before, during, and after exercise. […] If you have low blood sugar, eat or drink something with sugar in it right away. […] If you’re alert and can swallow safely, follow the 15:15 rule: Take 15 grams of a fast-acting carb. […] After your blood sugar goes back to normal, eat a meal or a snack within 1 hour. […] If your blood sugar is less than 54 mg/dL (3 mmol/L), it’s an emergency. Get help right away.

• #64 Diabetic hypoglycemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

  Adjust your medication or eat additional snacks if you increase your physical activity. The adjustment depends on the blood sugar test results, the type and length of the activity, and what medications you take. Follow your diabetes treatment plan when making adjustments. […] Eat a meal or snack with alcohol, if you choose to drink. Drinking alcohol on an empty stomach can cause hypoglycemia. Alcohol may also cause delayed hypoglycemia hours later, making blood sugar monitoring even more important. […] Record your low glucose reactions. This can help you and your health care team identify patterns contributing to hypoglycemia and find ways to prevent them. […] Carry some form of diabetes identification so that in an emergency others will know that you have diabetes. Use a medical identification necklace or bracelet and wallet card.

• #65 Hypoglycemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoglycemia/diagnosis-treatment/drc-20373689

  If you have hypoglycemia symptoms, do the following: […] Once your blood sugar is back in the standard range, eating a healthy snack or meal can help prevent another drop in blood sugar and replenish your body’s glycogen stores. […] Preventing recurrent hypoglycemia requires your health care provider to identify the condition causing hypoglycemia and treat it. Depending on the cause, treatment may involve: […] If you have diabetes and you’re having repeated episodes of hypoglycemia, or if your blood sugar levels are dropping significantly, talk with your health care provider to find out how you might need to change your diabetes treatment plan. […] What self-care steps, including lifestyle changes, can I take to help improve my symptoms?

• #66 Talk with Your VA Provider to Avoid Low Blood Sugar – National Center for Health Promotion and Disease Prevention

  https://www.prevention.va.gov/Talk_with_Your_VA_Provider_to_Avoid_Low_Blood_Sugar.asp

  Bob talked with his provider about his health care preferences and goals. Together, they found a way to meet his health needs. He agreed to use the sliding scale, but with a reduced dose of insulin regular. […] The VA-DoD Clinical Practice Guideline (CPG) on Managing Diabetes Mellitus in Primary Care provides specific information for patients and family members as well as for the health care team. The CPG stresses the importance of working with your provider and health care team to select appropriate blood glucose ranges based on your goals, priorities, and lifestyle and design the best diabetes care plan for you.

• #67 Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/8/1/e001194

  It is important to inquire about all levels of hypoglycemia at each visit with an open, shame-free discussion. The HCP and patient should collaborate to troubleshoot causes and create solutions. The Hypoglycemia Work Group provides a Hypoglycemia Patient Questionnaire and a Hypoglycemia Provider Checklist to guide these discussions. The frequency of severe hypoglycemia in T2D can be significantly reduced after participation in structured interventions that include patient education. We advocate the training of providers (including primary care providers), staff, people with diabetes and their families on the creation of an action plan for timely and appropriate treatment of hypoglycemia. The use of oral glucose is preferred as first-line treatment when the person with diabetes is coherent and able to swallow. For anyone treated with insulin, a rescue treatment plan needs to be in place should the person with diabetes become unable to self-treat.

• #68 Hypoglycemia Prevention and Management – Today’s Dietitian Magazine

  https://www.todaysdietitian.com/newarchives/0717p36.shtml

  Hypoglycemia prevention should be addressed in this population. […] People with diabetes should prepare for delayed mealtimes or other possible scheduling conflicts following their insulin dosage (for example when eating out) to help prevent hypoglycemia. […] It may be prudent to adjust blood glucose goals to higher targets for 48 to 72 hours to help restore autonomic functions and reduce the emotional toll low blood glucose levels take on our patients. […] Physicians should refer our patients with diabetes to registered dietitians to assist with meal planning and snack adjustments to help combat the issue of hypoglycemia. […] Dietitians should advise their patients to carry a carbohydrate-containing snack with them, in case their usual meal is delayed, to prevent an unwanted drop in blood glucose.

• #69 Hypoglycemia Prevention and Management – Today’s Dietitian Magazine

  https://www.todaysdietitian.com/newarchives/0717p36.shtml

  Advise patients to educate those around them about diabetes and hypoglycemia symptoms. […] The best advice for reversing hypoglycemia unawareness is to avoid frequent low blood glucose levels. […] Frequent blood sugar monitoring, exercising earlier in the day, follow-up with an endocrinologist or health care provider, and visits with a dietitian and certified diabetes educator are recommended. […] Encouraging patients to enroll in approved diabetes self-care education programs (which may be covered by insurance) is key, as they provide much-needed support for those struggling with daily diabetes self-care management and offer peer support for problems associated with hypoglycemia or blood glucose fluctuations.

• #70 Hypoglycemia Prevention Initiative | Endocrine Society

  https://www.endocrine.org/hypoglycemia-prevention-initiative

  Hypoglycemia Prevention Initiative […] The Hypoglycemia Prevention Initiative is a multi-year joint effort of the Endocrine Society and Avalere Health to determine best practices in primary care to reduce the impact of hypoglycemia on older (65+) people with type 2 diabetes (T2D) who use insulin and/or sulfonylurea, have a recent A1c 7%, and are at increased risk of hypoglycemia. The initial effort of this initiative is the Hypoglycemia Prevention Study (HypoPrevent), an implementation research and quality improvement (QI) study designed to test an intervention in primary care settings to identify older people with T2D at risk of hypoglycemia and a clinical decision support tool designed to facilitate risk reduction. […] This study assesses various methods to decrease the risk of hypoglycemia on an individual basis through shared decision making (SDM), individualized A1c goals and/or changes to their glucose-lowering medications regimen. The diabetes educator, who is also the practice coordinator for this study, plays a key role with annual assessments and education on glucose-lowering medications and their mechanism of action.

• #71 Hypoglycemia Prevention Initiative | Endocrine Society

  https://www.endocrine.org/hypoglycemia-prevention-initiative

  Objectives […] 1: Increasing outpatient hypoglycemia surveillance risk assessment by integrating a risk assessment into primary care clinical workflow […] 2: Improving the management of older type 2 diabetes patients on insulin and sulfonylureas […] 3: Developing outpatient hypoglycemia quality measures and integrating them into primary care practices to incentivize high-quality care […] Hypoglycemia Prevention Initiative Overview […] Hypoglycemia Prevention Initiative: A Together 2 Goal webinar featuring Jeffrey Boord, MD […] The Endocrine Society and Avalere Experts Publish Findings on Hypoglycemia Prevention in Type 2 Diabetes Patients

• #72

  https://link.springer.com/article/10.1007/s11892-018-1065-6

  In addition to assisting in achieving improved glucose control, continuous glucose monitoring (CGM) sensor technology may also aid in detection and prevention of hypoglycemia. […] Recent studies have found that the integration of CGM with continuous subcutaneous insulin infusion (CSII) therapy, a system known as sensor-augmented pump (SAP) therapy, very significantly reduces the occurrence of these conditions by providing real-time glucose readings/trends and automatically suspending insulin infusion when glucose is low (LGS) or, even, before glucose is low but is predicted to soon be low (PLGS). […] Sensor technology promises to continue to improve patients lives not only by attaining glycemic control but also by reducing hypoglycemia, a goal best achieved in conjunction with structured individualized patient education.

• #73 A new injectable to prevent and treat hypoglycemia – UCLA

  https://www.chemistry.ucla.edu/news/a-new-injectable-to-prevent-and-treat-hypoglycemia/

  Prof. Heather Maynard is co-leader of a group of UCLA researchers who have developed glucose-responsive micelles that encapsulate and protect glucagon, releasing it only when blood sugar levels drop dangerously low, offering a potential new method to prevent hypoglycemia in people with diabetes. […] To prevent and treat this condition, researchers in ACS Central Science report encapsulating the hormone glucagon. […] To improve commercial glucagon stability and prevent hypoglycemia, Andrea Hevener and Heather Maynard looked to micelles: nanoscale, soap-like bubbles that can be customized to assemble or disassemble in different environments and are used for drug delivery. […] While more studies are needed, the researchers say their proof-of-concept is a first step toward a new on-demand and effective method for preventing or mitigating extremely low blood sugar levels.

• #74 Proof-of-Concept for Hypoglycemia Prevention – Breakthrough T1D

  https://www.breakthrought1d.org/news-and-updates/proof-concept-hypoglycemia-prevention/

  Hypoglycemia, or low blood sugar, can have serious effects, and it is, for most people with type 1 diabetes (T1D), the most feared complication of this disease. […] Prevention, therefore, is much better than rescuing from hypoglycemia, but there is nothing to prevent hypoglycemia occurrence. That makes hypoglycemia prevention a major unmet need in T1D management. […] Breakthrough T1D-funded researcher Shirley X.Y. Wu, Ph.D., at the University of Toronto, is an expert in material sciences and “smart” drug delivery systems, and has been working on a prevention tool for hypoglycemia: a patch, applied to the skin, which will be able to tell if blood sugar is getting low and deliver glucagon at the right time, preventing hypoglycemia altogether. […] “The development of hypoglycemia prevention therapies, such as this glucose-responsive glucagon patch, will be critical for people with type 1 diabetes,” says Jonathan Rosen, Ph.D., scientist at Breakthrough T1D. “In addition to preventing hypoglycemia, a dangerous acute complication of diabetes, we expect it will reduce the daily burden of disease management by automatically handling blood-sugar lows.”

• #75 Hypoglycemia Prevention Initiative | Endocrine Society

  https://www.endocrine.org/hypoglycemia-prevention-initiative

  Hypoglycemia Prevention Initiative […] The Hypoglycemia Prevention Initiative is a multi-year joint effort of the Endocrine Society and Avalere Health to determine best practices in primary care to reduce the impact of hypoglycemia on older (65+) people with type 2 diabetes (T2D) who use insulin and/or sulfonylurea, have a recent A1c 7%, and are at increased risk of hypoglycemia. The initial effort of this initiative is the Hypoglycemia Prevention Study (HypoPrevent), an implementation research and quality improvement (QI) study designed to test an intervention in primary care settings to identify older people with T2D at risk of hypoglycemia and a clinical decision support tool designed to facilitate risk reduction. […] This study assesses various methods to decrease the risk of hypoglycemia on an individual basis through shared decision making (SDM), individualized A1c goals and/or changes to their glucose-lowering medications regimen. The diabetes educator, who is also the practice coordinator for this study, plays a key role with annual assessments and education on glucose-lowering medications and their mechanism of action.

• #76 The Endocrine Society and Avalere Experts Publish Findings on Hypoglycemia Prevention in Type 2 Diabetes Patients

  https://advisory.avalerehealth.com/insights/the-endocrine-society-and-avalere-experts-publish-findings-on-hypoglycemia-prevention-in-type-2-diabetes-patients

  The findings, published in The Journal of Endocrinology Metabolism, will guide a pilot study to assess interventions to improve the identification and management of diabetes patients at high risk for hypoglycemia. […] In response to the prevalence and high burden of disease, especially among adults aged 65 years and older, the Endocrine Society is collaborating with Avalere to design and implement the Hypoglycemia Prevention Initiative, a pilot study that will assess interventions for improving earlier identification and management of hypoglycemia in high-risk patients with T2D. […] These findings confirm an urgent need to address key gaps in evidence around effective strategies for reducing hypoglycemia in patients with T2D. Through the Hypoglycemia Prevention Initiative, the Society and Avalere have a unique opportunity to increase hypoglycemia awareness among providers and patients, and ultimately, improve diabetes care.

• #77 Sweet dreams: avoiding nocturnal hypoglycemia – BETTER

  https://type1better.com/en/sweet-dreams-avoiding-nocturnal-hypoglycemia/

  You could adjust insulin doses depending on your evening activities (e.g., exercise) or consider a different type of insulin that was shown to reduce the risk of nocturnal hypoglycemia (e.g., long-acting insulin analogs). […] CGM technology equipped with alarms can alert you when there is an imminent nocturnal hypoglycemia episode. […] It is important to note that some of these strategies are based on the experiences of people with T1D and evidence supporting these recommendations remains limited, thus more research is needed to find the best approaches depending on the individual. […] A recent analysis using data from the BETTER registry found that the types of treatment used (injections, pumps, CGMs) can influence which nocturnal hypoglycemia prevention strategy one chooses. […] Additionally, people who report higher fear of hypoglycemia are more likely to use a nocturnal hypoglycemia strategy and also tend to use more strategies than those who have a lower fear of hypoglycemia.

• #78 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Hypoglycemia in diabetes is associated with increased morbidity and constitutes a barrier to glycemic control. Much effort must be invested in hypoglycemia prevention, including patient education, appropriate dietary and exercise regimens, adjustment of the treatment regimen, and implementation of glucose monitoring systems as appropriate.

• #79 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036

  Hypoglycemia in diabetes is associated with increased morbidity and constitutes a barrier to glycemic control. Much effort must be invested in hypoglycemia prevention, including patient education, appropriate dietary and exercise regimens, adjustment of the treatment regimen, and implementation of glucose monitoring systems as appropriate.

• #80 Hypoglycemia prevention practice and its associated factors among diabetes patients at university teaching hospital in Ethiopia: Cross-sectional study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238094

  Effective approaches known to reduce the risk of hypoglycemia include patient education along with self-monitoring of blood glucose (SMBG), dietary modifications and regular exercise, medication adjustment, careful glucose monitoring by the patient, and conscientious follow up by the clinician. […] Having good knowledge about hypoglycemia is positively associated with good hypoglycemia prevention practice. […] The current study showed that there are still gaps with respect to knowledge about hypoglycemia prevention and its practice. Therefore, we recommend providing education about hypoglycemia in general, its complication, its treatment, and prevention strategies when they came for follow up.

• #81 Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/8/1/e001194

  All people with diabetes should be encouraged to discuss their experiences with hypoglycemia without judgment or shame. HCPs (including primary care providers), clinical staff, people with diabetes and their families should be encouraged to work together toward creating an action plan for timely and appropriate treatment of hypoglycemia. The ongoing review of glucose level data should occur at every clinic visit. Glucose targets, testing schedule and the treatment plan should be reviewed often and individualized to minimize the risk of hypoglycemia. Finally, people with T2D on insulin should always be encouraged to have oral glucose and a rescue medication immediately available.

• #82 Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/8/1/e001194

  All people with diabetes should be encouraged to discuss their experiences with hypoglycemia without judgment or shame. HCPs (including primary care providers), clinical staff, people with diabetes and their families should be encouraged to work together toward creating an action plan for timely and appropriate treatment of hypoglycemia. The ongoing review of glucose level data should occur at every clinic visit. Glucose targets, testing schedule and the treatment plan should be reviewed often and individualized to minimize the risk of hypoglycemia. Finally, people with T2D on insulin should always be encouraged to have oral glucose and a rescue medication immediately available.

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