A fall in blood sugar is a condition common in diabetics with fluctuating sugar levels, especially those who take insulin to reduce their sugar levels. The condition, called hypoglycemia, occurs when the level of sugar in one’s blood drops below the healthy range needed for one’s body to function. But it may also be experienced by people who are not diabetic.
“Factitious or drug-induced hypoglycemia is a serious medical condition where a person intentionally induces low blood sugar. This is typically done through the covert, surreptitious use of insulin. Prolonged fasting is another trigger for hypoglycemia,” said Dr Tapas Bandyopadhyay, an internal medicine and endocrinology specialist, who was addressing a session on recurrent hypoglycaemia in non-diabetics at Hyatt Regency.
The occasion was a symposium on cardiometabolic diseases, a group of health conditions characterised by high blood pressure, elevated blood sugar, waist fat, and abnormal cholesterol/ triglycerides, organised by The Indian College of Cardiometaboly and Metabolic Diseases.
“Those who work out intensely to gain weight may find their muscle mass not building according to their expectations. Some then resort to insulin injections without medical advice. Since insulin is an anabolic hormone, it reduces muscle breakdown and can make the body appear more muscular,” Dr Bandyopadhyay said, adding that such people might need counselling to get them off insulin.
This attribute of insulin also makes doctors monitor the weight of their diabetic patients. “We have to see that our patients do not exceed their ideal weight, as obesity brings its own set of problems, from fatty liver disease to joint pain,” he said.
Hypoglycaemia caused by fasting is a much rarer occurance, though not an impossibility. “It may happen due to really prolonged fasting. The body is equipped to deal with shorter bouts of fasting as it has a glycogen store which it can break down to form glucose to prevent hypoglycaemic attacks. So it takes close to 72 hours for inset of hypoglycaemia caused purely by the body’s own endogenous insulin production, without injected insulin or drugs and if one is not doing any strenuous job while fasting,” he said. That is why marathon runners are given glucose drinks intermittently if they are running distances as long as five to 10 km.
Even if a diabetic person takes an oral medicine that stimulates insulin secretion and then does not eat for a long time, the risk of hypoglycaemia is lower with many newer drugs such as Dapagliflozin, he said, adding that some older medicines that are still widely used, such as Gliclazide and Glimepiride, do carry some risk.
The doctors also discussed another boon of modern research — sensors for continuous glucose monitoring. This allows a patient to scan the sensor with an external reader to get an instant sugar reading without having to prick the skin every time to draw blood. But with each sensor costing about Rs 4,000 for a fortnight of use, they are still not widely prescribed in India though they are efficient as alerts for dips in sugar levels as well as spikes.
“It allows patients to understand variations in sugar levels with intake of food and activity. But unless one is experiencing highly fluctuating sugar levels, including frequent episodes of hypoglycaemia, it is not essential for most diabetic patients,” Dr Bandyopadhyay said.