Serious gestational diabetes hypoglycaemia but no action taken?

[LegoVsFoot]

Hi, a relative has been diagnosed gestational diabetes since her booking appointment at 6 weeks. She is now 21 weeks and diet controlled. She has been given a blood sugar monitor and after the diet everything has been in range, but twice after eating she has felt really unwell and looked pale and sweaty, and checked her blood sugar and it has been extremely low - 2 and 2.1 mmol.

I looked it up and under 3 mmol is considered a medical emergency but when we called the MFAU emergency line they said it's fine because it's not too high. And that low isn't a problem, only high is. This isn't right is it?

I was told it‘s only a problem if you‘re injecting insulin. Did she take other readings to confirm the low readings? I wonder if there is something else going on that is making her ill and making her readings inaccurate at the same time.

It’s high sugars I suspect they are on the lookout for

yes if her sugar has dropped she will feel unwell - a spoonful of sugar should help

With gestational diabetes lows are only concerning when on insulin, without insulin these lows are known as 'fake hypos'.

Make sure she's having some carbs with every meal (balanced with fat and protein) and they should stop.

But I'm assuming she then ate something and brought her levels up? So she felt ok and it wasn't a medical emergency, guessing she is not currently in a diabetic coma? It's a medical emergency if it's not resolved and the person is unconscious.

It's high sugars which can over time affect the fetus and cause macrosomia, etc.

Saying that she should discuss it at her next appointment as to why it may be happening. Is she getting seen regularly in clinic?

With lows that low, she should eat 15g of carbs and test again after 15 mins, repeat as necessary until normal (4-7 mmols/l). Always carry snacks. Best are medjool dates (very fast acting, 1 or 2 should do it,), small banana, a biscuit or 2 or small cereal bar, individual snack size pack of skittles from a multipack - these are 15g a pack and the packs are virtually indestructible in a handbag or pocket, whereas fruit & biscuits tend to get smushed if carried

(advice from a T1 diabetic)

This might be too much sugar as she's not injecting insulin like you are.

15g carb to treat a low is standard (but you can halve the quantities to be sure), if I was in the 2 something range I would probably need to repeat. Although I inject insulin, I mainly eat lowish carb so don’t use large quantities of insulin, when I was at a medical appointment recently the person next to me injected 34 units of insulin for a snack, I used 3! As always, and as bodies differ with their response, the advice is always to treat and retest.

She should have an obs-diabetes team or dietitian & it might be more use to talk to them. It’s unusual to have hypos with diet controlled GDM (sounds like she’s diet controlled from your OP) so they may want to review what she’s up to with diet/see if there’s anything else they need to think of (particularly if it’s been after food both times).

She is not on insulin. When we looked it up it looks like reactive hypoglycaemia, as it is right after eating, including carbs. She didn't eat anything, she went to sleep both times and then felt better and had a higher reading later in the evening. She has also had periods of getting ill and dizzy when she hasn't eaten, and this is fixed by eating something sugary. It's just very strange that it would also happen immediately after eating

Is she being strict with what she is eating? She could be having a sugar crash. Which is when blood glucose spikes after eating then crashes. I had gestational diabetes twice and checked my bm before meals and either 1 or 2 hours afterwards depending on what I'd eaten. Some people react differently to different carbs. I couldn't eat carbs in the morning but could tolerate later in the day if I paired with fat and protein/drank lots of water. I used to get hypos frequently. I was diet controlled too and wasn't an issue, although you do feel awful while its happening.

A PP makes a good point, have you noted what was eaten prior to the crash? As she could've spiked really quickly and crashed after.

Also she has to eat regularly. Meals and snacks. Trying to keep sugars stable rather than peaking and dropping through the day is key.

Check out the gestational diabetes uk website. Its a goldmine.