As a type 1 diabetic I try to do my best to keep my blood sugars under control.  I try to eat healthy foods, exercise when I can and adjust my insulin according to what I’m eating and what my day is like.  But no matter how well you try to control blood sugars, sometimes things just go wrong and hypoing (or having a hyperglycaemic attack) is an inevitable consequence for many diabetics.  But are some treatments for hypos better than others and is there a new problem with hypo treatments which we need to be aware of?

What are hypos?

When I was diagnosed I wasn’t told what to take for hypos, only that I had to treat it by eating more food.  I took that literally and decided to eat chocolate bars, cake, biscuits (cookies), anything that I craved at that moment.  For those that don’t know, hypos occur when there’s too much insulin in the body and blood sugars fall dangerously low.  This can happen if somebody injects too much insulin for the amount they are eating, or they forget to eat, or even occurs from things like doing exercise.  Hypos are an unnatural result of being medicated on insulin and diabetics have to treat them quickly or they can leave you unconscious or even put you in a coma – scary!

Hypo attacks feel horrible but thankfully many feel the symptoms and there’s a wide variety of them.  The most obvious ones are shaking, sweating and feeling weak – like you can’t stand.  There are also symptoms like irritability, and visual disturbances in the eyes – I won’t go into too much detail (save that for another post) but diabetics know that the one biggest symptom is usually hunger, and it’s very easy to go overboard and eat too much when in a hypo.

A variety of treatments

Treating a hypo is important and over the years I’ve been told to just eat some more carbohydrates to being told that I need to eat pure sugar, fast acting carbs, a then certain amount.  When I was young the advice wasn’t very clear and like I said, my go-to treatment was chocolate and biscuits (cookies).  I was never told exactly how much to eat, I wasn’t given a number of carbs to aim for, so when the crazy, insane hunger happened, I would eat a crazy and insane amount of carbs – basically eating until the hypo ended which often meant I could eat about four or even five carbohydrate portions (40-50g) before I felt steady on my feet and fine.

In the early 2000s I went on a DAFNE course.  DAFNE stands for Dose Adjustment For Normal Eating, and the course changed my life.  We were taught exactly how to manage our diabetes ourselves and given lots of information, things I’d never known about before.  One of the things we were taught was the type of things we should consume to fix a hypo.  Eating just anything wasn’t good enough and could lead to a slower recovery and deeper feeling hypo.  Fast acting carbs were the thing to eat and this meant sticking to things without fat: pure sugar, Lucozade and some fruit juices being the best treatments.

Being a super healthy person (and fruit lover), I opted for fruit juice and the standard treatment was a glass of juice, around 2 carbohydrate portions.  Given the fact that a portion of carbohydrates was between 10-12g of carbs, a glass of juice, or a small carton had just the right amount.

The problem with fruit juice

For years I treated my hypos with fruit juice, apple, orange, grape or pineapple.  I never had any problems taking one of those small lunchbox-sized cartons with me when I left home and it was the perfect solution to any hypos I had.  I wasn’t just following DAFNE rules, I could feel the treatment was working and it left my blood sugars in a perfect and stable level.  Just drinking one 250ml carton of fruit juice fixed any hypo within five minutes and I was able to get on with my day.  Of course I’d have to make sure I had some long-acting carbs in my system too, but the immediate threat of hypo was gone.  I never had any problems, any issues with the juices.  It was always the right amount and my hypos were always perfectly fixed.  But one day that changed, and it began with the recession.

In the last few years, people have felt the effects of the global recession.  It began quite a few years ago and despite what’s happened to individual countries, one thing I’ve noticed is the way companies who manufacture food and drink have managed to keep making money.  Gone are the days of charging people more for the same food, these days manufacturers make smaller portions of our favourite foods but try to sell them at the same price.  I’m sure you’ve all spotted that chocolate bar that’s many grams smaller than it used to be or that biscuit (cookie) packet that’s got two or three less biscuits than it used to.  It’s a clever tactic manufacturers are using on consumers and we aren’t really protesting all that much.  The companies get to sell less per packet which makes them more cash, and many people are fooled into buying smaller portions than they used to, or if we aren’t fooled then we’re left wondering if we imagined the bigger sizes or if they were always like this.

Fruit juice manufacturers are no different, many of them have reduced the sizes of their juices boxes and every single lunchbox-sized fruit juice I find on the shelves is now 200ml instead of 250ml.  It may not seem like much of a difference, and technically there is still 20g of carbohydrates per box.  But these new sized boxes are a big problem – at least for me – and it’s a problem that could be life-threatening.

When hypo treatments don’t work…

At first I didn’t notice the juice box change.  I just thought it was a new packaging and there was less air in the box.  I still thought that a box of juice would be enough for a hypo.  But after a few years of these new boxes, I’m noticing a scary and recurring problem.  One box of juice doesn’t always fix my hypo, and sometimes I need two.  Several times in the last year, I ‘ve sat down and drunk my juice and waited for those five minutes it’s supposed to take for my blood sugars to fix themselves.  But after waiting and waiting I realise something is wrong and my hypos aren’t gone…they’re getting worse.

The basic symptoms of hypos, the shaky feeling, the sweating, the hunger, they are still there but rather than just feeling them, I begin feeling new symptoms as well.  My eyesight starts to go weird, everything turns grey in colour, sounds get distorted sounding far away.  The longer I wait the worse it becomes culminating in an overwhelming urge to lie down and sleep.  These new symptoms are ones I never experienced before, because I never let my hypos go so low.  These are the symptoms I feel before I’m about to collapse from the hypo and it feels terrifying because along with them, I feel alone and scared.

One box of juice is no longer enough, I need to have a second one.  But by the time I realise this, my thinking impaired from the hypo, I’m already about to collapse to the floor.  I have to struggle to get more carbs into my system, sometimes it’s hard to even open the juice carton and straw, I’m shaking so much.  Now, you may ask why I don’t consume more carbs right away, after the first juice.  Why don’t I just eat something else after the juice and then I’ll be fine regardless?  But the problem is (in my own body I’ve noticed this issue) that not only do long-acting carbs not work for a while, but they also stop the juice working as quickly as it should.  I also go ridiculously high if I eat too many carbs in one go – especially if I was about to eat a meal and who wants to bloat up on sweets when you’re about to eat lunch of dinner.  I also don’t always have that many carbohydrates with me, especially if I’ve hypoed earlier that day, or was about to go to lunch.

Why should all diabetics be careful?

For me, the new lunchbox-sized cartons don’t have enough juice in them.  Although it’s supposed to have 20g of carbohydrates, there’s every chance that the manufacturers might have put a little less, or watered the juice down too much.  When the boxes were 50ml bigger, there was room for error and I could guarantee that I had the right amount for treating my hypos.  But now I have to carry double the amount of juice boxes with me in my daily life…just in case one isn’t enough – which looks great when I’m out, hoarding a load of juice cartons in my bag!

Although my juice issue is a permanent one, it does flag a big concern for all diabetics out there.  We need to be careful and constantly monitor and check the foods that we eat, especially if some of our hypo treatments are things we buy in shops like fruit juice or cookies.  We need to check the carbohydrate amount each time and check the manufacturer hasn’t reduced it.  We can’t trust what we knew before, because these days with low sugar initiatives and smaller portion sizes, we can’t be sure we’re getting the right amount and if you’re an insulin-dependant diabetic like me, you could be in real trouble if you don’t check what you eat!

Have you noticed portion sizes being reduced in you favourite foods?  What about more sweeteners or less sugar being added?  Has it affected your diabetes?  Let me know what you think in the comments below 🙂