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Recurrent hypoglycemia can be distressing.
These episodes can be related to: (1) increased sensitivity to insulin due to weight loss
(2)decreased oral intake or decreased food/drink, missed meals
(3)excess insulin given compared to carbohydrates used
(4)alcohol use because it reduces the glucose made in the body
(5)reduced removal of insulin from the body because of kidney disease
(6)physical activity
(7)imperfections of man made insulin

For an acute hypoglycemic episode it is recommended that if the level is less than 70 mg/dl (3.9 mmol/l) that a quick acting carbohydrate should be used that is equal to 15 to 20g of carbohydrates ( 1- 2 tsp of sugar, honey, 1/2 cup of regular soda, 1 cup of milk, glucose tablet, 5 to 6 pieces of hard candy)

The blood sugar should be retested in 15 minutes, if it is still less than 70 then another 15 g of carbs should be used

If it is greater than 70 and you are within an hour till next meal then a snack can be used that has starch and protein (crackers and cheese, crackers and peanut butter, half a sandwich, crackers and milk)


To prevent recurrent episodes: (1) the insulin regimen may need adjusting
NPH should be switched to long acting insulin analogs like lantus or detimir because these cause less hypoglycemia
Also regular insulin should be switched to rapid acting insulin like aspart,lispro, glulisine because these also cause alot less hypoglycemia

If the low levels are in the night or early morning, it is more likely related to the basal insulin so these levels may need lowering.

If the low levels are in the daytime ,it is related to the bolus insulin so these levels need adjusting.

(2)carbohydrate counting- it is important to count the carbohydrates with each meal and to learn how your body reacts to insulin given, for example for some persons one unit of insulin decreases the blood sugar by 3 but for others it decreases it by less or more.
If you can count the carbs in each meal then you would know how much insulin to give yourself
There are lists online (american diabetic association and USDA) that say how many carbs in various foods

(3)before planned exercise you would need to either reduce the insulin dose or increase the amount of carbohydrates used or both. The basal may need to be reduced by 2 to 4 units.
If the activity is unplanned then you would need to monitor your levels carefully and use carb replacement if necessary

In terms of the meal plan , the general recommendation is increased use of fruits and vegetables, decreased use of sodas/fruit drinks and replacement with water.
Some diabetics reduce their carbohydrates but to do this you would have to alter your insulin used as well.
Protein can be used in any quantity you wish, it does not affect the blood sugar.

Monitor the times and meals when you have the episodes, keep a diary so you know when the episodes are occurring and which insulin levels need adjusting.

I hope this helps, feel free to ask any other questions

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