Hypoglycaemia {Update#1} (低血糖症)

Hypoglycaemia {Update#1} (低血糖症)

In this update, I wish to share my recent experience of hypoglycaemia and what is the appropriate ways to treat it under different circumstances.

In one of my meals, I took slice fish and vegetable soup WITHOUT any carbohydrates items, such as brown rice and wholemeal bread, to go along.  At exactly two hours after my meal, my glucose level was 3.9mmol/L.  Please read on how to treat Hypoglycemia.

According to the Dietitian, I have to include a portion of carbohydrates item in all my meals to avoid Hypoglycaemia.  Without any carbohydrates item, the system/insulin will use up the any carbohydrates item as store in my body.

What is Hypoglycaemia?

It is a medical term for Low Blood Sugar.  The principal problems arise from an inadequate supply of glucose to the brain.  The most common forms of hypoglycemia occur as a complication of treatment of diabetes mellitus with insulin.

What is the acceptable glucose level?

In local term, the acceptable glucose is above 4.0 mmol/L. Symptoms of hypoglycaemia will develop when the glucose falls below 4 mmol/L

Symptoms of hypoglycemia that I have experienced:

·      Sweating

·      Shaking or trembling

·      Hunger

·      Mood changes such as sad or angry

·      Confusion

·      Anxiety

Other reports mentioned that if blood sugar drops very low, the person may not be able to respond, becomes unconscious or has a seizure.

How to treat hypoglycaemia under following circumstances:

·      If you experience hypoglycaemia symptom with a blood sugar that is 4.0mmol/L and above, treat it with a small carbohydrates snack.

Blood Sugar Level	4.0mmol/L and above	<4.0mmol/L		<2.8mmol/L
Treatments	Take a small carbohydrates snack	Take 15-20g of rapid-acting carbohydrates, e.g.: Ø Take 3-4 teaspoons of sugar / glucose power Ø 4-5 glucose tablets Ø 150-200ml sweetened soft drinks / juice		Take 30g of rapid-acting carbohydrates, e.g.: Ø Take 6 teaspoons of sugar / glucose power Ø 8 glucose tablets Ø 300ml sweetened soft drinks / juice
Further actions	No further actions are required	Re-test after 15 minutes – is the blood sugar >4.0mmol/L?
Follow-up actions	Not Applicable	YES – Depend on when is the next as a starchy carbohydrate may be necessary		NO!! Ø Repeat the above step until blood sugar >4.0mmol/L Ø Seek treatment immediately if blood sugar <4.0mmol/L for 2 cycles
Follow up treatment POST hypoglycaemia
Within 1 hour			NO additional carbohydrates snack.  Go ahead to have meal.
More than 1 hour			Take long acting carbohydrates, e.g.: biscuits or bread. Personally, I take one slice of wholemeal bread.
Do note that this is only a general guideline.  Discuss with your doctor and adjust according to requirements.

As a diabetic, I always carry my Nano, needed strips and lancets wherever I go.

My other Relevant Posts for your Reading (您能读其他相关的博克):

·      Post-Transplant, Osteoporosis & Right Diet (后移植、骨质疏松症 & 正确的饮食)

·      Eating Healthy to Lower Your Blood Pressure {Update#1} (吃健康降低您的血压)

·      Type 2 Diabetes - Myths& Facts [神话&事实关于第二类型糖尿病]

·      How Will a 15 Minutes of Walking Improve Quality of Life (15分钟走步行怎么将改进生活水平?)

·      Difference between Glycosylated Hemoglobin (HbA1c) and Blood Glucose (葡基化的血红蛋白 (HbA1c) 和血糖之间的别)

Disclaimer: I am not a Medical Doctor. All my blog postings are based on my personal experience that I've went thru and what I've read up from the internet. If you've any symptoms of diabetes OR want to better manage your health, I strongly urge you to have regular medical-ups to avoid future complications. In addition, control your diet portions and have regular exercise. 

(我不是一位医生。所有我的博克投稿是我的个人经验，并且我从互联网读了。如果您有糖尿病的任何症状或要更好处理您的健康，我强烈敦促您有规则健康检查以避免未来复杂化。另外，控制您的饮食部分并且有定期运动.)

FDA Approved Humalog KwikPen® for Type 1 & 2 Diabetes (粮食与药物管理局批准Humalog KwikPen® 治疗糖尿病)

In May 2015, The U.S. Food and Drug Administration (FDA) approved Eli Lilly’s Humalog U-200 KwikPen (insulin lispro 200 units/mL; U-200) for people with type 1 and type 2 diabetes.  It is a prefilled insulin pen containing a double strength formulation of the rapid acting insulin Humalog – This offers patients a pen that lasts longer between pen changes, allowing for fewer changes every month.

According to David Kendall, M.D., Vice President of Medical Affairs, at Lilly Diabetes. "Humalog U-200 KwikPen represents a new option for people with diabetes. Fewer pen changes per month may help people who require higher daily doses of mealtime insulin better fit their treatment in their daily lives."

The approval of Humalog U-200 KwikPen was based on a demonstration of the bioequivalence of Humalog 200 units/mL relative to Humalog 100 units/mL in a pharmacokinetic / pharmacodynamic study. The most common side effect of Humalog is Hypoglycemia (low blood sugar) that may be severe and cause unconsciousness, seizures and death.  See my post on Hypoglycemia.

Once opened, Humalog prefilled pens should be thrown away after 28 days, even if insulin remains.

Humalog U-200 KwikPen was approved in the European Union since October 2014.

The Humalog U-200 KwikPen is expected to hit the shelves of U.S. pharmacies in August 2015.

For more information about the Humalog U200 KwikPen, click here for Full Prescribing Information from Eli Lilly.

My other Relevant Posts for your Reading (您能读其他相关的博克):

·      Post-Transplant, Osteoporosis & Right Diet (后移植、骨质疏松症 & 正确的饮食)

·      Eating Healthy to Lower Your Blood Pressure {Update#1} (吃健康降低您的血压)

·      Type 2 Diabetes - Myths& Facts [神话&事实关于第二类型糖尿病]

·      How Will a 15 Minutes of Walking Improve Quality of Life (15分钟走步行怎么将改进生活水平?)

·      Difference between Glycosylated Hemoglobin (HbA1c) and Blood Glucose (葡基化的血红蛋白 (HbA1c) 和血糖之间的别)

Disclaimer: I am not a Medical Doctor. All my blog postings are based on my personal experience that I've went thru and what I've read up from the internet. If you've any symptoms of diabetes OR want to better manage your health, I strongly urge you to have regular medical-ups to avoid future complications. In addition, control your diet portions and have regular exercise. 

(我不是一位医生。所有我的博克投稿是我的个人经验，并且我从互联网读了。如果您有糖尿病的任何症状或要更好处理您的健康，我强烈敦促您有规则健康检查以避免未来复杂化。另外，控制您的饮食部分并且有定期运动.)

Post Transplant, Osteoporosis & Right Diet (后移植、 骨质疏松症 & 正确的饮食)

Post Transplant, Osteoporosis & Right Diet (后移植、 骨质疏松症 & 正确的饮食)

Why this topic – Post Transplant & Osteoporosis?

I hope by sharing my experience on this topic will benefit many other post-transplant friends as many doesn’t even aware of the importance of Bone Mineral Density (BMD) test (骨密度测试).  One of the post-transplant complications is osteoporosis. Post-transplant osteoporosis and fracture occur in a substantial proportion of patients.

Many patients who had undergoing kidney dialysis prior to undergoing transplantation are already having low bone mineral density and vitamin D deficiency.

So what is BMD test? 

BMD Test

It is a test using X-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone.

Purposes of BMD Test

·      Identify decreases in bone density before you break a bone

·      Determine the risk of broken bones (fractures)

·      Confirm a diagnosis of osteoporosis

·      Monitor osteoporosis treatment

The higher your bone mineral content, the denser your bones are (骨矿物含量越高，骨头的密度越大). And the denser your bones, the stronger they generally are and the less likely they are to break (密度越大的骨头，更不容易破裂).

My doctor orders test on my spine and hip twice a year.

Relationship of Osteoporosis and Post-Transplant

Transplant patients are highly recommended to have periodic BMD test because of:

·      Taking steroid medications such as prednisolone interferes with the bone-rebuilding process and will lead to osteoporosis.

·      Anti-rejection drugs taken by transplant patients interfere with the bone-rebuilding process and thus we are at higher risk of osteoporosis

In addition, I strongly recommend you taking a BMD Test prior to transplant if you are undergoing dialysis now.  Such test will give you a base line to measure against post-transplant.  Those had dialysis for many years tend to have higher risk of osteoporosis as against those with shorter period of dialysis.

How is BMD being measured? 

Results are reported in two numbers:

·      T-score

·      Z-score

T-score – The bone density as compare to what is normally expected in a healthy young adult of same sex. T-score is the number of units — called standard deviations — that is above or below the average population.

T-score	What your score means
-1 and above	Your bone density is considered normal.
Between -1 and  -2.5	Your score is a sign of osteopenia, a condition in which bone density is below normal and may lead to osteoporosis.
-2.5 and below	Your bone density indicates you likely have osteoporosis.

 

Z-score – It is the number of standard deviations above or below what's normally expected for someone of your age, sex, weight, and ethnic or racial origin. If your Z-score is -2 or lower, it may suggest that something other than aging is causing abnormal bone loss. If your doctor can identify the underlying problem, that condition can often be treated and the bone loss slowed or stopped.

Symptoms

Osteoporosis is being nicknamed as the ‘silent disease’ because bone loss occurs without symptoms and is painless. The condition often is not detected until it is quite advanced. Some signs in the advanced stages may include:

·      Fracture of the hip, spine and wrists

·      Back pain

·      Loss of height over time

What is the right diet?

Taking calcium-rich foods like milk and soya products can grow strong bones to protect against osteoporosis developing later (吸收象牛奶和大豆产品的钙丰富的食物可能生长强的骨头以防止受到后期骨质疏松症).

Vegetables:

1.   Kai Lan (Kale)

2.   Chinese and English Spinach (菠菜)

3.   Chye Sim (菜心)

4.   Long and French bean (长和扁豆)

5.   Broccoli (绿花椰菜)

Fish:

1.   Salmon (鲑鱼)

2.   Cooked Sardine once a week (1 sardine = 190mg of sardine) {煮熟的沙丁鱼每星期一次 (1个沙丁鱼沙丁鱼=190mg)}

3.   Anchovies (aka Ikan Bilis) soup and eat the bones which has the calcium that is essential for the growth and maintenance of strong bones

Others:

1.   High calcium but low fat milk such as HL Milk (高钙，但是低脂牛奶例如HL Milk)

2.   Four tea-spoons of milk powder (四个茶匙奶粉)

3.   Wholemeal bread (全麦面包)

4.   Packed soy milk (包装的豆奶)

5.   Exposed your hands to sunlight for 10 minutes between 10am to 3pm

6.   Palm full of almond or peanuts daily (每日吃小部分杏仁或花生)

For the past one year, I have been following the above diet though I don’t take milk power that much nowadays.  So how’s my HydroxyVitamin D serum test result?  Here you go:

·      February 2015 – 30.5 MCG/L

·      May 2014 – 21.2 MCG/L

The acceptable reference range is 10.1 – 41.3 MCG/L

Calcium Supplements

Some doctors suspect that calcium supplement may increase risk of heart attack.  A recent study from the National Institutes of Health suggests there is an increased risk of heart attack, stroke or other cardiovascular diseases from taking calcium supplements for men only. Other studies suggest there is an increased risk for both men and women.  As such, further researches are necessary.  I am glad that I have stopped taking the supplements one year ago.

Underlying message of my post to you:

·      One can change the diet to achieve the desirable results – It’s Your Life

·      Have regular check up to ensure one is healthy

·      Exercise regularly to build up strong bones – Engage in regular weight-bearing exercise

Other Relevant Posts for your Reading (您能读其他相关的博克):

·   Eating Healthy to Lower Your Blood Pressure {Update#1} (吃健康降低您的血压)

·   Type 2 Diabetes - Myths & Facts (神话&事实关于第二类型糖尿病)

·  How Will a 15 Minutes of Walking Improve Quality of Life (15分钟走步行怎么将改进生活水平?)

·  Blood Test Report & Creatinine (验血报告&肌氨酸酐)

·  Difference between Glycosylated Hemoglobin (HbA1c) and Blood Glucose (葡基化的血红蛋白 (HbA1c) 和血糖之间的别)

Disclaimer: I am not a Medical Doctor. All my blog postings are based on my personal experience that I've went thru and what I've read up from the internet. If you've any symptoms of diabetes OR want to better manage your health, I strongly urge you to have regular medical-ups to avoid future complications. In addition, control your diet portions and have regular exercise. 

(我不是一位医生。所有我的博克投稿是我的个人经验，并且我从互联网读了。如果您有糖尿病的任何症状或要更好处理您的健康，我强烈敦促您有规则健康检查以避免未来复杂化。另外，控制您的饮食部分并且有定期运动.)