If you’re treating patients with diabetes, chances are very good that you’ve also got patients with hypoglycemia.
Many patients with diabetes are so accustomed to their symptoms that they don’t pay attention to the subtle changes that can present with hypoglycemia. Often, they won’t have the very dramatic symptoms like loss of consciousness or diabetic coma.
More often, they have milder symptoms like
∙ Heart palpitations
None of these are that severe and they might just write them off as a response to something going on in their everyday lives. No big deal…nothing to worry about.
But they do have a problem and a potentially serious one.
That problem is hypoglycemia.
Hypoglycemia can occur in anyone with diabetes if they’re taking medication to lower their blood glucose. If you have type 1 diabetes and you’re insulin dependent, you stand a good chance of developing hypoglycemia.
So how do you get these patients to come to you when they first notice these symptoms so you can help them with a proactive approach to their illness?
Educate your diabetes patients on the signs and symptoms of hypoglycemia and make sure they understand that the symptoms may appear to be mild but they can be physically devastating.
Understanding Why They May Not Recognize Symptoms
If your patient has type 1 diabetes, when their blood glucose levels fall, their insulin levels don’t decrease and their glucagon levels don’t increase. They just reflect the body’s absorption of insulin. It gives the body a false sense that all is right when all is wrong. Because their body doesn’t register a problem, it loses its first two lines of defense against the imbalance in your system. Their body’s normal response is impaired.
What Causes the Impairment?
Several things –
∙ The brain may have become used to hypoglycemia because it’s been dealing with it for awhile. If they’ve had frequent episodes, the system in the body responsible for transporting adrenaline to where it’s needed no longer senses a great need. It just doesn’t respond.
∙ They may be using medications that mask their hypoglycemia symptoms and not even know it. For example, if they take medications that are beta blockers, they’re designed to lessen the effects of adrenalin on the body. They may not experience the tremors or heart palpitations that a normal person would during a hypoglycemic episode. Beta blockers also block the liver from producing glucose so they’re giving the body a double whammy to deal with. Always ask your diabetic patients if they’re taking beta blockers as part of your history and physical.
∙ They may have autonomic neuropathy. Explain to them that it’s a type of peripheral neuropathy that affects the nerves that control involuntary body functions like heart rate, blood pressure, digestion and perspiration. The nerves are damaged and don’t function properly leading to a breakdown of the signals between the brain and the parts of the body affected by the autonomic nervous system like the heart, blood vessels, digestive system and sweat glands. And, in their case, it may be inhibiting their liver from producing insulin.
Diagnosing and Treating Autonomic Neuropathy
Once you take a very thorough history and physical (preferably one following the NeuropathyDR® protocol for hypoglycemic and diabetic patients), you’ll have a better handle on your patient’s condition. Pay particular attention to their symptoms, when they began, the severity of the discomfort, and any and all medications they currently take (including over the counter medications, herbal supplements or vitamins).
Watch for signs that they are not being completely up front about their diet, alcohol intake, frequency of exercise, history of drug use and smoking. If they don’t tell the truth, you don’t have a clear picture of your physical condition.
Treatment and Prognosis
If you use the NeuropathyDR® protocol, you will find the treatment regimen ideally suited to treating diabetes, hypoglycemia and autonomic neuropathy.
Diabetes, hypoglycemia and autonomic neuropathy are chronic conditions but they can be treated and your patient can do things to help relieve their symptoms.
You can help them by offering:
∙ Diet Planning and Nutritional Support
The body needs the proper the nutrition to heal.
If they have gastrointestinal issues caused by autonomic neuropathy, they need to make sure they’re getting enough fiber and fluids to help the body function properly. Provide them with a diet plan that ensures they get enough fiber, whole grains and drink enough water.
If they have diabetes, work with them on a diet to control their blood sugar.
Devise a meal schedule as part of their dietary planning to keep their blood sugar levels as steady as possible.
∙ Individually Designed Exercise Programs
If your patient experiences exercise intolerance or blood pressure problems resulting from autonomic neuropathy, develop an exercise regimen for them that will allow them to take things slowly but still work some physical activity into their daily routine. Treating neuropathy patients requires specialized training in the design and monitoring of exercise programs. The NeuropathyDR® clinicians are specially trained in designing exercise programs to meet the needs of the neuropathy patient.
Early intervention with a physician well versed in treating diabetes, hypoglycemia and autonomic neuropathy, like a NeuropathyDR® clinician, is still the best course of action. While you can’t reverse your patient’s condition if they have already developed neuropathy, you can help them achieve a better quality of life and lessen the chance of severe and possibly fatal complications.
When you’re trained and ready to work with them, let them know you’re there.
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