This more serious hypoglycemic state is often characterized by extreme tiredness and inability to communicate. You may be sitting and banging your hand on a table, walking around in a daze, or merely failing to respond to questions. It’s important that those who live or work with you learn that this is a fairly severe stage of hypoglycemia. The likelihood that it’s hypoglycemia is so great that valuable time may be wasted if treatment is delayed while someone fumbles about trying to measure your blood sugar. It’s quite possible that if you’re given glucose tablets you will not chew them, and may even spit them out.
The treatment at this stage is glucose gel by mouth.
Glucose prepared as a syrupy gel is sold in the United States under several brand names.At least one of these products is not pure glucose (dextrose) but contains a mixture of long- and short-acting sugars, and therefore will not exert its full effect as rapidly as we’d like.At present, I ask my patients to purchase a product called Glutose 15 (Paddock Laboratories, Minneapolis, MN 55427; available from Rosedale Pharmacy). Glutose 15 is packaged in a plastic tube (like toothpaste), with a twist-off cap. Each tube contains 15 grams of glucose. From Table 20-1 (page 325), we see that this amount will raise the blood sugar of a 140-pound person by 75 mg/dl (15 x 5). An appropriate dose for most adults in this condition would be 1. tubes. These would typically raise one’s blood sugar by about 110 mg/dl.
Some of the tubes of decorative icing used to write on birthday cakes contain almost pure glucose (dextrose), so you might save money by purchasing those. Look in the baking section of most supermarkets, but make sure of the contents and weight. To convert ounces to grams, multiply by 30.Make sure that the major ingredient is glucose, as some brands are mostly sucrose, which works too slowly.
We recommend that two tubes of Glutose 15, secured together with a rubber band, be placed at strategic locations about the house and place of work, as well as in luggage when you travel with a companion. It should not be refrigerated, as it may harden when cold. To administer, someone should insert the tip of an open tube into the corner of your mouth, in between your lower gum and your cheek, and slowly squeeze out a small amount. You will probably swallow this small amount. After you swallow, a bit more of the gel should be gently squeezed from the tube.Within 5 minutes of ingesting, you should be gently squeezed from the tube. Within 5 minutes of ingesting, you should be able to answer questions.
When you have fully recovered, check and correct your blood sugar to your target. Since you may have wiped the sticky gel off your mouth with your hands, you should wash them before sticking your finger.
Although glucose gels may not be available in many countries, they are available on the Internet. Most industrialized nations have pharmacies and surgical dealers that sell flavored glucose drinks to physicians for performing oral glucose tolerance tests. These are usually bottled in 10-ounce (296 ml) screw-top bottles that contain 100 grams of glucose. A dose of 2 fluid ounces (60 ml) will provide about 20 grams of glucose, enough to raise the blood sugar of a 140-pound person by 100 mg/dl. Tiny amounts can be administered with the help of a plastic squeeze bottle. Whoever feeds you the liquid or gel must exercise caution, as the possibility exists that you could inhale some of it, causing you to choke. The use of liquid is potentially much more hazardous than the gel in this respect, so administer only a tiny amount for each swallow.
