Eating too little after taking insulin, or waiting too long after it to eat, is among the most common causes of low blood sugar. For a husband with type 2 diabetes who takes insulin with his evening meal, a dinner you now cook smaller, lighter or later for your own weight care can be both at once, and shaking and sweating an hour after it can be the signs of that low. Until his prescriber, the doctor or office that prescribes his insulin, has heard about the new dinners, serve his to his own diabetes meal plan, in size and in timing, whatever yours does.
Was the shaking and sweating after dinner a low?
The shaking and sweating may have been a low, since common symptoms of low blood sugar can include both, along with a fast heartbeat, nervousness or anxiety, irritability or confusion, dizziness and hunger. How a low feels can differ from one person to the next, and an evening when he is well is the time to hear from him what his own lows feel like. A reading at the time is what tells a low from anything else: he should check his blood sugar whenever he has symptoms of a low.
Lows are common in people with type 2 diabetes who take insulin. In a large study across many countries, nearly half of the people with type 2 diabetes on insulin reported at least one low over four weeks, so be ready for another evening like that one.
He may also have lows he does not feel. Some people have no symptoms at all when their blood sugar is low, which makes a low harder to treat early and raises the risk of severe ones. That is more likely in someone who has had diabetes for 5 to 10 years or longer, often has low blood sugar, or takes certain medicines, such as beta blockers for high blood pressure. For lows he does not feel, or lows that come often, a continuous glucose monitor, which can sound an alarm when his level drops below his target range, may be a good option, and his prescriber can say whether one would suit him.
A low can also cloud the thinking needed to deal with it. Confusion or brain fog is a symptom in its own right and could impair his ability to think quickly and make decisions about treating the low. If he is confused but can still check and treat it himself, he should check his blood sugar even if he waves it away at the table. If he is too muddled to check and treat it himself, it has become a severe low, and the help he needs from you is set out further down.
Lows can come at night too, and you may be the one who sees the signs. His blood glucose can fall while he sleeps and stay down for several hours, which can cause serious problems, and signs of a low during sleep can include crying out or having nightmares, sweating enough to leave his pajamas or the sheets damp, and waking tired, irritable or confused. The low may not wake him, and it may bring no symptoms he is aware of; lows during sleep can also make him less likely to pick up and respond to the symptoms of a low during the day. If you try to wake him and cannot, that is a medical emergency: call 911 right away. He can also ask his prescriber whether he needs a bedtime snack to prevent a low during the night, and what kind.
How changing what and when you cook can lower his blood sugar
A smaller, later or lighter dinner can push his blood sugar down, because several of the most common causes of a low in someone taking insulin come from the meal or the evening around it:
- not eating enough at meals or snacks after taking insulin
- waiting too long after taking the insulin to eat
- taking the insulin at the wrong time
- exercising a lot, or at a time that is unusual for him
- drinking alcohol
Not eating enough carbohydrates for how much insulin he takes is one of the many reasons for a low, and the amount of fat, protein and fiber in the meal can play a part too. If he does not eat enough carbohydrates, or a meal is skipped or delayed, his blood glucose could fall lower than is healthy for him. A new dinner can be several of these at once, and his prescriber can use his readings to work out whether that is what happened.
A walk after dinner that is new for him counts as exercise at an unusual time, and a drink with the meal can lower blood sugar too (see One drink can hit harder when you are eating less).
His regular eating plan needs meals, snacks and drinks with enough carbohydrate to help keep his blood glucose in his target range, so one dinner can still feed you both: give him the same food with the carbohydrate his diabetes meal plan calls for, at the time his insulin expects it, until his prescriber has said otherwise.
His insulin stays as prescribed while this is worked out. Any change to his medicines needs talking through with his prescriber first, and moving the time he takes his insulin to suit a later dinner is one of those changes. Whichever dinners he eats from here, he, or you with him, should tell his prescriber about them: if he often has mild or moderate lows, his prescriber may change his diabetes meal plan, his physical activity plan, his diabetes medicines, or more than one, and can weigh the meal plan only if they know what he is eating.
If he has another low at the table, and when to call 911
If he has another low at the table and is awake and able to swallow, your help is a fast sugar in his hand while he checks his blood sugar. For a low he can manage himself, he takes a measured amount of fast sugar and then rechecks, or uses the amount his prescriber gave him if that differs; the amounts, and how long to wait before the recheck, are in our article for people who take a weight medicine alongside diabetes medicines (see A weekly weight medicine can change how some of your other tablets work).
During a low, sugar needs to be absorbed as quickly as possible, and foods high in fiber, such as fruit, beans or lentils, or high in fat, such as chocolate or baked goods, can slow that down, so the chocolate in the cupboard can be slow to work. Keep at least one of these at home:
- juice, or regular soda that is not diet
- sugar, honey or syrup
- hard candies, jellybeans or gumdrops
- glucose tablets or glucose gel
A kitchen restocked with diet drinks for your weight care can be short of the first of these: the juice has to be one that is not low-calorie or reduced-sugar, and the soda the same. If he has kidney disease, leave out orange juice, which has a lot of potassium; apple, grape or cranberry juice are good options. If he takes a diabetes medicine that slows the digestion of carbohydrates, he needs glucose tablets or gel right away during a low, because other carbohydrates will not raise his blood glucose quickly enough, and his prescriber can tell him whether anything he takes works that way.
A low he cannot treat himself is a severe one. As a low gets worse, the more serious symptoms can include feeling weak, trouble walking or seeing clearly, acting strangely or seeming confused, and seizures, and blood sugar that low may make him pass out. If he is awake and able to swallow but too weak, unsteady or muddled to deal with it, give him a fast-acting sugar, such as regular soda or fruit juice, then have him eat something longer-acting with protein, such as crackers and cheese or a sandwich with meat. If his signs are no better after he has eaten something with sugar, call 911, and do not let him drive while his blood sugar is low.
Call 911 right away if he is not alert, cannot be woken, has passed out or had a seizure, or cannot swallow, and if he has a glucagon kit and you have been taught to use it, give it to him first and make that call straight after. A low that leaves someone not alert, or impossible to wake, is a medical emergency, and food or drink is only for someone awake and able to swallow.
Glucagon is the best treatment for a severe low; it comes as an injection or a nasal spray, and a kit is available by prescription. If he has one, find out where it is kept and check the date on the package so it has not expired, and ask his prescriber to show you when and how to use it.
What his prescriber needs to hear from you
From you, his prescriber needs what changed in his meals and when, because you are the one who cooks them. When lows keep happening, sharing his blood sugar readings, medicine routine, physical activity and food patterns with his prescriber may let them identify patterns and help prevent lows by making adjustments, and the food patterns are yours to give.
Ask him to ring his prescriber's office about that evening now, while the new dinners are still being served, and offer to join the call or the visit. Between you, tell them:
- what changed in the dinners, such as smaller portions, less carbohydrate or a later time, and roughly when the change began
- when he took his insulin that evening and when the meal reached the table
- what he ate and drank, and whether he had been more active than usual that day
- any reading he took, what he did about the low and how long it lasted
- anything you have seen at night, such as crying out in his sleep or damp sheets
The question underneath all of this is whether his insulin, or the time he takes it, should change to fit the new dinners. Only his prescriber can decide that, so put it to them plainly. While he has them, he can also ask whether any of his diabetes medicines can cause lows and how to prevent and treat them, what kind of food you should give him during a low, and how much, and whether he should have a glucagon kit.
If your own weight care is through NicoCares, your care team answers messages in Spruce, the secure app you joined from its email invitation, but Spruce gives no time for an answer, so never use a message for a low. Questions about his insulin go to his prescriber. Tell your care team if his prescriber's advice changes the dinners again, because that changes what you eat too.
