|Year : 2013 | Volume
| Issue : 2 | Page : 61-62
Nutritional therapy for hypoglycemia
Sanjay Kalra1, Bharti Kalra2, Manash P Baruah3
1 Department of Gynaecology, Bharti Hospital and BRIDE, Karnal, Haryana, India
2 Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
3 Department of Endocrinology, Excel Hospitals, Guwahati, Assam, India
|Date of Web Publication||6-Jul-2013|
Department of Gynecology, Bharti Hospital and BRIDE, Karnal, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kalra S, Kalra B, Baruah MP. Nutritional therapy for hypoglycemia. J Med Nutr Nutraceut 2013;2:61-2
As an understanding of the benefits of glycemic control grows, more and more people with diabetes and their physicians try to achieve tight control of the condition. Aggressive control however, is linked with an enhanced risk of hypoglycemia. This risk of hypoglycemia is a significant barrier to the achievement of euglycemia in people with diabetes, and hampers efforts to attain optimal clinical outcomes. While global literature focuses on the risk factors, pathogenesis, clinical features and pharmacological management of hypoglycemia,  hardly any emphasis is laid on the prevention of management with simpler, nutrition-based, strategies.
Hypoglycemia may be precipitated by medical illness which increases insulin bioavailability or reduces insulin clearance (renal impairment, hepatic impairment), endocrine illness, which impairs counter - regulatory defense against low glucose levels (hypopituitarism, hypothyroidism, hypoadrenalism), or concomitant use of drugs which impact glucose metabolism (alcohol, salicylates, sulfonamides). 
The vast majority of hypoglycemic episodes, however, linked to errors or mismatch in drug dosage, drug administration, calorie intake and calorie consumption (exercise). In clinical practice, the commonest cause of hypoglycemic in people with diabetes is a delayed or inadequate meal, with failure to modify the dose of insulin or oral anti - diabetic drugs. 
Hypoglycemia becomes more dangerous in patients with hypoglycemia unawareness or unavailability to recognize symptoms of low blood glucose. This phenomenon is more commonly seen in people with long standing diabetes, with tightly controlled diabetes, children, the elderly, those who abuse alcohol or sedatives, and persons with autonomic neuropathy.
Many strategies have been proposed, both pharmacological and otherwise, to prevent hypoglycemia. These include choosing safer insulin analogues, insulin sensitizers or incretin based therapy, and short-acting or safer secretagogues. One may also choose to alter the time of administration of drugs prescribed for diabetes. Similarly, pharmacological means of managing hypoglycemia include oral glucose, intravenous dextrose and muscular or subcutaneous glucagon.
The simplest method of preventing and managing hypoglycemia, however, is nutritional. A 3 + 3 meal pattern, compromising of three major meals interspersed with three minor meals or snacks must be an integral part of every diabetes prescription. Intake of small, frequent meals helps in ensuring a stable glycemic level with minimal hyperglycemic excursions and hypoglycemic dips. This nutritional prescription is especially salient in persons on intensive insulin therapy or on long-acting secretagogues, as well as those with comorbid medical or endocrine illness which puts them at greater risk of hypoglycemia. In patients who do not wish to take frequent meals, low calorie, low glycemic index food supplements or can be used as meal replacements or meal substitutes. This provides an easy, convenient, and measurable means of providing healthy calories.
Early detection of impending hypoglycemia can be improved by hypoglycemia awareness training, and may be facilitated by the use of trained sniffer dogs. High calorie foods with high glycemic index can be used to prevent worsening of hypoglycemia, either alone or in conjunction with intravenous glucose or subcutaneous/intramuscular glucagon. Nutraceuticals such as glucose tablets and energy drinks can also be used.
Current diabetes - specific nutrition algorithms, which promote a trans-cultural program to optimize care for people with diabetes appreciate that medical nutrition therapy (MNT), including diabetes - specific formulae is necessary for management. However, though they cover management of chronic complications such as obesity, hypertension, and dyslipidemia, they do not highlight the utility of MNT in hypoglycemia.  The patient-cent red transcultural algorithm bases its inputs on ethno cultural ground realities, including geographic location and ethno-cultural classification. This can be extended, from a hypoglycemia perspective, to include awareness of the cross-cultural differences in hypoglycemia symptom perception.  The various cultures and languages express hypoglycemia in different manners, and utilize unique food stuffs to manage the condition. In North-west India, for example, jaggery (gur) (unrefined sugar) is considered a diabetes-neutral food while sugar or glucose is thought to be appropriate for hypoglycemia correction. Similarly, processed juices are (erroneously) thought to be sugar-free as opposed to 'sinful' aerated soft drinks.
Appropriate prescription of medical nutritional therapy is the cornerstone of prevention and management of hyperglycemia. All diabetes care providers must be made aware of the importance of nutrition and nutraceuticals. Simple advice, provided in an easy-to understand manner, as proposed in the weight/10, 2 min diet,  can help avoid considerable morbidity, reduce medical costs, and prevent mortality.
The Journal of Medical Nutrition and Nutraceuticals promotes the realization that hypoglycemia can be prevented and managed by skillful use of nutritional therapy.
| References|| |
|1.||Heller SR. Hypoglycemia and diabetes. In: Pickup JC, Williams G, editors. Textbook of Diabetes. 3 rd ed. Malden, Massachusetts: Blackwell Science; 2003. p. 33.1-9. |
|2.||Mechanick JI, Marchetti AE, Apovian C, Benchimol AK, Bisschop PH, Bolio-Galvis A, et al. Diabetes-specific nutrition algorithm: A transcultural program to optimize diabetes and prediabetes care. Curr Diab Rep 2012;12:180-94. |
|3.||Kalra S, Balhara YPS, Mithal A. Cross-cultural variation in symptom perception of hypoglycemia. J Midlife Health 2013;[In press]. |
|4.||Kalra S, Kalra B, Jena B. The two minute weight ÷ 10 diabetes diet. J Med Nutri Nutraceuticals 2013;2 [In press] |