FREQUENTLY ASKED QUESTIONS

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The recommended and evidence based treatment for hypoglycaemia (hypo) involves two steps:

1. Have 15g of fast-acting carb (depending on the level of hypo and individual needs)

  • Wait 15 minutes for this to absorb into the blood and then recheck your blood glucose level (BGL) to see if you are back in your safe, target range.
  • If your BGL is still low, repeat step 1 (have another 15g of fast-acting carb) and wait another 15 minutes before checking BGL.
 

2. When your BGL is in your safe, target range, have 15g of a long-acting carb to maintain your BGLs in a safe range.

Having long-acting carb when your hypo has resolved, will help to keep your BGL in a safe range for longer. Long-acting carbs take longer to break down in the stomach, which causes the glucose to enter the bloodstream slowly over time. 

HYPO DUO Step 2 contains long-acting carbohydrate, including fibre, contributing to a more gradual release of glucose. Other examples of long-acting carbohydrates include yoghurt, fruit, milk, and muesli bars.

If your blood glucose is at the lower end of your usual target range, a small amount of long-acting carbohydrate may be considered. Individual needs may vary.

When you’re out and about, HYPO DUO Step 2 provides a convenient source of long-acting carbohydrate to carry with you. Other portable options include fruit, dried fruit, or a muesli bar.

At home or if your shopping, options such as fruit, a small milk-based drink, or a half sandwich may also be suitable.

Hypos can happen when you least expect, and often for no apparent reason. Some common situations where blood glucose levels may drop include:

  • After exercise (particularly 6 hours after exercise when your muscles are refuelling with glucose the most)
  • If you have over-calculated your mealtime insulin, or you don’t end up eating the amount of carb you intended to when you had your pre-meal insulin dose
  • When you’re unwell
  • When you’ve skipped or delayed meals
  • After drinking alcohol, especially if you hadn’t been eating

Hypos shouldn’t be a regular occurrence. Most hypos can be prevented, and understanding why they are happening can help you plan ahead. Speak to your Diabetes Health Professional who may review your prescribed insulin or medication dose, particularly the days you plan to exercise or expect to be more active than usual.

Prevent hypos by:

  • Eating regular meals
  • Ensure medication is taken as prescribed
  • Ensure BGL is in your target range, as discussed with your Diabetes Health Professional, before exercise
  • Avoid alcohol on an empty stomach
 

Tip: If you’re using a continuous glucose monitor, consider setting your low alert to 4.5 mmol/L. This early warning can help you act in time to prevent a hypo by consuming long-acting carb (HYPO DUO Step 2).

< 4mmol/L or < 70mg/dL is usually referred to as hypoglycaemia (a hypo). Exercise should be postponed until you have treated your hypo and your BGL is back in your safe target range.

4mmol/L or 70mg/dL – 5mmol/L or 90mg/dL: Have a serve of long-acting carb. I.e consume HYPO DUO Step 2. (Some other long-acting carb options are: one piece of fruit or one cup of fruit juice) before you start exercising.

5mmol/L or 90mg/dL – 10mmol/L or 180mg/dL is the ideal BGL range to exercise.

10mmol/L or 180mg/dL – Caution needs to be taken with BGLs consistently above this level; consider gentle exercise and see your Diabetes Health Professional to discuss ongoing management.

>15mmol/L or 270mg/dL: If your BGL is above this level, postpone strenuous exercise. This is considered hyperglycaemia (high BGL) and can cause your BGLs to rise further and lead to dehydration. Exercising when BGLs are above this level can also lead to the production of ketones for people with type 1 diabetes.

People with type 2 diabetes taking insulin injections can experience hypoglycaemia, for the same reasons as people with type 1 diabetes.

Oral medication for type 2 diabetes, Sulphonylureas (e.g. Gliclazide, Glipizide), also referred to as Sulphs, can also contribute to a hypo event. Sulphonylureas stimulate the pancreas to produce more insulin throughout the day, even if you are not eating or drinking. Because of this continuous release of insulin, it’s important to eat regularly to ensure adequate glucose is in your bloodstream for insulin to act on. If there’s not enough glucose available in your bloodstream, your BGLs could go too low.

If you’re regularly having hypos and feel you need to eat to ‘keep up with your medication’, you may need your dose reviewed – discuss with your Diabetes Health Professional.

Other oral diabetes medications have different actions to lower BGLs; you’ll only be at risk of a hypo if you are also taking Sulphonylureas or insulin.

It can be helpful to check your blood glucose level (BGL) in real time to understand what your BGL actually is, especially if you’re not experiencing any hypoglycemia symptoms. Continuous glucose monitors (CGMs) can sometimes be displaced, and therefore inaccurate if they get knocked. In some cases, your actual BGL may be lower than what the CGM shows – or you might not be having a hypo at all.

Finger prick checks – A measurement of glucose in your blood, from capillaries in your fingertip.

CGMs – These devices measure real-time glucose levels in the interstitial fluid, the fluid surrounding the cells just under the skin.

The lag time – Glucose travels from the blood to the interstitial fluid, so there’s a time delay (lag time) between the two.

Rapid glucose changes can cause the CGM reading to lag behind the finger prick reading. It is best to use a finger prick measure during a hypo event, if possible, for a more accurate reading.

In some situations, long-acting carbohydrates may be considered when blood glucose levels are at the lower end of an individual’s usual target range.

For example, if blood glucose levels are above the low range but trending downward (e.g. following insulin administration or a missed meal), a long-acting carbohydrate may be consumed. HYPO DUO Step 2 provides a convenient source of long-acting carbohydrate in these situations.

Long-acting carbohydrates may also be considered:

  • Before or during physical activity, depending on individual needs
  • Prior to driving, in line with local guidance and individual management plans

A range of long-acting carbohydrate options may be suitable, including HYPO DUO Step 2, fruit, dairy products, or grain-based snacks.

 

Just because a food or drink contains sugar, it may not bring your BGLs up fast enough.

Here are some common examples of foods you may consider when you have a hypo, that may not have the effect you’re wanting quickly.

Chocolate bars, cakes and sweet biscuits are generally high in sugar, but are also high in fat. Fat takes a long time to digest causing the absorption of the sugar in the particular food to be delayed.

Be aware of diet soft drinks and diet cordials, or ‘no sugar’ sweets and desserts to treat your hypo. These foods and beverages contain sweeteners which our bodies cannot breakdown. Therefore, the sweetener will not be absorbed into your bloodstream like sugar (glucose) to raise your BGLs.

Milk drinks and yoghurt contain lactose (a sugar), but they also contain protein and fat which slows down digestion of the sugar. Therefore, these types of foods are considered a long-acting carb and won’t raise your BGLs fast enough initially.

Although fruit juice (containing the sugar fructose) is widely used initially to treat hypos, it is broken down more slowly than glucose and can result in consumption of large volumes in an attempt to raise BGLs more quickly. This can lead to a delayed rise in BGLs and spikes later.

HYPO DUO Step 1 is a pre-packaged gel containing glucose, a form of carbohydrate that is rapidly absorbed by the body.

Follow your plan. Many adults start with Step 1 (15g), recheck in 15 minutes, and use Step 2 to follow-up. Your needs may differ based on insulin, activity, and size.
HYPO DUO is IDDSI Level 3. Always confirm texture needs with your clinician or speech pathologist.

Yes! HYPO DUO is convenient, portable, and aligned with anti-doping requirements (HASTA testing completed; certification available).

This information has been created by Credentialed Diabetes Educators (CDEs) and Dietitians for HYPO DUO.