Low Blood Sugar (Hypoglycemia) after Bariatric Surgery

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Surgical Program

What is hypoglycemia?

Hypoglycemia = Low blood sugar = a blood sugar level < 4.0 mmol/L

What are the signs and symptoms of hypoglycemia?

When your blood sugar drops below 4.0 mmol/L, the supply of sugar to

the brain reduces. As your body tries to x this, you may feel:

Sweating Trembling Palpitations Anxiety

Hunger Nausea Headache Tingling

Disturbed

sleep

Weird dreams

Weakness/

Dizziness

Diculty

concentrating

Vision

Changes

Drowsiness

Diculty

speaking

Unconsciousness

Low Blood Sugar (Hypoglycemia)

after Bariatric Surgery

What causes

hypoglycemia?

The following are

some possible reasons

for a low blood sugar:

• Taking too much

diabetes medicine

• Not eating enough

carbohydrate food

• Skipping a meal

or snack

• Delaying your

next meal

• Exercising more

than usual

• Drinking alcohol

Hypoglycemia

(below

4.0 mmol/L)

may become

a medical

emergency

if you do not

treat it quickly.

Nightmares, sleep walkng, early morning sweats, or headaches at night

may tell you that a low blood sugar happened while you were sleeping.

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EAT 15 g of a fast-acting carbohydrate

= 4 glucose tablets

(such as Dex4 tablets)

= 15 g fast-acting sugar

(such as 6 Life Savers® or

2 rolls Rocket Candy)

WAIT 15 minutes and CHECK blood sugar

mmol/L

How do I treat hypoglycemia?

Always test your blood sugar, if possible. If you are

experiencing any hypoglycemia symptoms or your

blood sugar is below 4.0 mmol/L, treat this low blood

sugar by following these steps:

Your next meal is

within the hour

Blood sugar is ABOVE 4.0 mmol/L

Blood sugar is BELOW 4.0 mmol/L

Eat your next meal

REPEAT

Your next meal is

MORE than 1 hour away

AFTER TREATING your low blood sugar:

• Record your blood sugar readings in your log book (see page 8 for Blood Glucose Log Sheet).

• Tell your doctor or diabetes nurse educator if you have low blood sugars more than 2 times a week.

We may need to adjust your diabetes medicine.



Never use honey, juice, regular

soft drinks, or table sugar to treat

hypoglycemia. It may cause dumping

syndrome in post-bariatric patients.

EAT a snack of 15 g carbohydrate + protein:

7 Premium Plus™ crackers

1 slice whole wheat bread

1 oz low-fat cheese

30 ml (2 tbsp) low-

fat peanut butter

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How do I treat severe hypoglycemia?

Severe Hypoglycemia = a blood sugar level < 2.8 mmol/L

If your blood sugar is below 2.8 mmol/L, treat this severe low

blood sugar by following these steps:

If you experienced severe hypoglycemia before, ask your doctor about using glucagon in the future.



Never use honey, juice, regular

soft drinks, or table sugar to

treat severe hypoglycemia. It

may cause dumping syndrome

in post-bariatric patients.

EAT 15 g of a fast-acting

carbohydrate

= 4 glucose tablets

(such as Dex4 tablets)

EAT 20 g of a fast-acting carbohydrate

= 5 glucose tablets (such as Dex4 tablets)

WAIT 15 minutes and CHECK blood sugar

mmol/L

Blood sugar is ABOVE 4.0 mmol/L

Blood sugar is BELOW 4.0 mmol/L

Your next meal is

within the hour

Eat your next meal

Your next meal is

MORE than 1 hour away

EAT a snack of 15 g carbohydrate + protein:

7 Premium Plus™ crackers

1 slice whole wheat bread

1 oz low-fat cheese

30 ml (2 tbsp) low-

fat peanut butter

It is important to have a snack after treating a low

blood sugar to prevent a low from occurring again.

At this level, you may experience a loss of consciousness, poor coordination, and unusual

behaviour. If this happens, you will need someone to help you get your blood sugar level back up.

If you are UNCONSCIOUS, your family and friends must call 9-1-1.



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How do I prevent hypoglycemia?

To prevent hypoglycemia:

• Never skip meals.

• Do not go more than 4 hours without eating food, especially if you are physically active.

• Eat well balanced meals, with carbohydrate and protein choices.

• If you are doing vigorous physical activity for more than 1 hour, eat a small snack with a carbohydrate and

protein of choice.

How do I prevent hypoglycemia from happening overnight?

If you are on insulin and your blood sugar before bed is less than or equal to 7.0 mmol/L, you can prevent

overnight hypoglycemia by having an evening snack that contains carbohydrate WITH protein.

The following guidelines and examples can help you choose your evening snack.

EAT 1 carbohydrate serving (15 g) WITH protein

15 g Carbohydrate example Protein example

1 slice whole grain bread 30 ml (2 tbsp) low-fat peanut butter

250 ml (1 cup) 1% milk 8 to 10 almonds

7 Premium Plus™ crackers 1 oz low-fat cheese

If your blood sugar before bed is between 6.0 to 7.0 mmol/L:

EAT 2 carbohydrate servings (30 g) WITH protein

30 g Carbohydrate example Protein example

1 medium banana 30 ml (2 tbsp) low-fat peanut butter

3 plain digestive cookies 1 oz low-fat cheese

If your blood sugar before bed is between 4.0 to 5.9 mmol/L:

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Always keep a fast-acting sugar and other snacks within reach; not in the back seat.

STOP the vehicle in a safe location if you feel symptoms of low blood sugar while

driving. Remove keys from the ignition and put on your hazard lights.

After treating a low, WAIT until your blood sugar is ABOVE 5.0 mmol/L to start

driving. Wait 40 minutes to recover fully from low blood sugar.

mmol/L

above

5.0

5.0 to Drive!

Be aware of your blood sugar level. Test your blood sugar level right before driving.

For long drives, check your blood sugar at least every 4 hours.

If your blood sugar before driving is

below 4.0 mmol/L

Do not drive. Follow the instructions on

page 2 to treat the low blood sugar.

If your blood sugar before driving is

between 4.0 and 5.0 mmol/L

Eat a carbohydrate snack (such as a

granola bar, sandwich, crackers and

cheese, etc.) BEFORE you begin to drive.

If you have a history of recurrent severe low blood sugars (where you lost consciousness

or needed help from another person), or have hypoglycemia unawareness, you must test

your blood sugar before driving and at least every 2 hours while driving.

How do I prevent hypoglycemia while driving?

To prevent low blood sugar while driving, please follow these

diabetes driving guidelines:

Tell your healthcare provider as soon as possible if your sugar went below

2.8 mmol/L while driving, or if someone had to help you treat your low blood sugar.



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What is hypoglycemia unawareness?

Symptoms from low blood sugars are helpful as they

tell you that your blood glucose is low and that you

need to take action to bring it back into a safe range.

However, many people can have low blood sugars

and feel NO symptoms. This is called hypoglycemia

unawareness.

People with hypoglycemia unawareness:

• Cannot tell when their blood sugar gets low, so

they do not know they need to treat it. This puts

them at an increased risk for severe low blood

sugars and may need help from others to treat

their low blood sugar.

• Are less likely to be awakened from sleep when a low

occurs at night.

• Need to take extra care to check blood glucose often.

This is especially important before and during critical

tasks such as driving.

Regaining the early warning signs:

You can regain your early warning symptoms by avoiding

any hypoglycemia, even mild, for several weeks. This helps

your body re-learn how to react to low blood sugar levels.

To do this, you may have to raise your target blood

glucose level. You may end up with a higher A1C level, but

regaining the ability to feel symptoms of lows is worth the

temporary rise in blood glucose levels.

Did you know?

Hypoglycemia unawareness occurs

more often in those who:

• Frequently have low blood sugar

episodes, as this can cause you to

stop sensing the early warning signs

of hypoglycemia

• Have had diabetes for a long time

• Tightly control their diabetes.

If you think you have hypoglycemia

unawareness, speak with your health

care provider.

They may adjust or raise your blood

glucose targets to avoid further

hypoglycemia and reduce the risk of

future episodes.



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Remember...

• Listen to your body’s warning signs of falling blood sugars.

• Always carry a “fast acting sugar” source, such as glucose tablets, in your purse, pocket,

briefcase, and car in case you have low blood sugar.

• When out, carry some food (such as fruit, plain cookies, or a granola bar), Dex4 tablets or

glucose tablets, and a source of portable protein food, so that if a meal is delayed, you

can have your snack to prevent low blood sugar.

• Keep identication on you that shows you have diabetes, such as a MEDIC ALERT®

bracelet, wallet card, or set up your smart phone’s Medical ID.

• At work, home, or school, teach someone how to identify and treat low blood sugars.

• Try to gure out what caused the low blood sugar so that you can prevent future low

blood sugars.

• If you do not have your meter with you, treat the symptoms anyway. It is better to

be safe.

For further information on diabetes and hypoglycemia, please refer to

the Diabetes Canada website.

English: This information is important! If you have

trouble reading this, ask someone to help you.

Italian: Queste informazoni sono importanti! Se ha

dicoltà a leggere questo, chieda aiuto a qualcuno.

Spanish: ¡Esta información es importante! Si tiene

dicultad en leer esto, pida que alguien le ayude.

The information provided in this booklet is for educational purposes. It does not replace the advice or specic instructions from your doctor, nurse, or other

healthcare provider. Do not use this information to diagnose or treat. If you have questions about your own care, please speak with your healthcare provider.

Keep a record of your blood sugar levels. You do not need to ll out all spaces. Only check and record your

blood sugar test results when needed or according to your schedule.

DATE

(dd/mm/yyyy)

BREAKFAST LUNCH DINNER

BEDTIME NOTES

Before 2 Hr After Before 2 Hr After Before 2 Hr After

21/09/2020

5.3

mmol/L

8.5

mmol/L

4.9

mmol/L

6.1

mmol/L

5.4

mmol/L

Went for jog this

morning

BLOOD GLUCOSE LOG SHEET