• What are the main causes of hypoglycaemia?
  
  
• How should hypoglycaemia be treated?
  
  
• What should I do if I am unwell?
  
  
• Do I need to tell my employer that I have diabetes?
  
  
• How common is impotence/erectile dysfunction among men with diabetes?
  
  
• Diabetes and Ramadan/Fasting

QUESTION: What are the main causes of hypoglycaemia?

ANSWER: These are usually one or more of; too much insulin of hypoglycaemic agent, too little food, delay/omission of a meal and increased exercise.

Hypoglycaemia is often the result of a combination of several factors, and careful history taking will usually highlight the problem. Particular issues include:
? Too much treatment: the dose of insulin or oral hypoglycaemic agent
• Food: frequently being late for or missing a meal, a small rushed meal or too little carbohydrate.
• Exercise: this increased basal metabolic rate, often causing delayed hypoglycaemia many hours later
• Inappropriate timing of insulin or tablet taking
• Injection site problems such as injecting into the muscle which causes an unusual absorption of insulin

Hypos on insulin is predictably most common before lunch, then before dinner and then overnight (especially between 0300 and 0700 hours).

A lie-in with a delayed breakfast will often cause it, especially after a day's exercise.

Similar times are high risk with oral agents, though this will vary depending upon the agent used and its peak/duration of action together with dosing and meal timing. Long-acting sulphonylureas (eg glibenclamide) may often cause overnight hypoglycaemia

Patients performing blood glucose measurements should be encouraged to test at times of high risk for hypoglycaemia or in the event of possible symptoms.

QUESTION: How should hypoglycaemia be treated?

ANSWER: First it has to be recognised, then
• Immediately eat/drink a limited amount of glucose (eg 2 glucose tablets or a small glass of ordinary lemonade)
• Retest blood glucose if possible/practicable, after 5-10 minutes
• Eat some longer-acting carbohydrate (eg a banana or two biscuits) to maintain blood glucose at safe levels until the next meal.

Afterwards think about why it happened and how similar episodes could be prevented. If it happens frequently or badly talk to your nurse or doctor.

QUESTION: What should I do if I am unwell?

ANSWER: Physical and mental illness can lead to raised or variable blood glucose levels, partly due to increased stress hormones such as cortisol and adrenaline which impair the glucose response to insulin. Even a trivial upper respiratory tract infection can cause this. Here are Sick Day Rules as a guideline.

SICK DAY RULES
During illness or infection your blood glucose can often rise even through you are not eating as much as normal:
• Test your blood glucose more often than normal: about 4 times a day is sensible; if levels are continuing to rise despite the advice below, contact your GP
• Never stop or reduce taking your insulin or tablets without medical advice; this is the commonest mistake made. In this situation the body often needs more insulin, not less.
• If you cannot eat normally, substitute meals with simple foods, such as

Soups and bread
Milk puddings, custard or yoghurt
Breakfast cereals and milk

If you can only manage fluids, sip one of the following every 2 hours or so:

• A glass of ordinary lemonade (not diet)
• A glass of fruit juice (eg orange or apple)

An adequate fluid intake is vital you need at least 3 litres of fluids daily - water is the best additional one. If you cannot maintain this, or are vomiting or have severe diarrhoea, then get medical help quickly.

If things aren't getting better quickly, call your GP

Question: Do I need to tell my employer that I have diabetes?

Answer: It is illegal in the UK and other countries to discriminate against people with diabetes for employment except for specified occupations such as the airline industry. Honesty and full disclosure are, however, essential when completing any job application form with health questions, as it forms part of a legal contract. Obviously if the occupation could pose risks in someone liable to hypoglycaemia (eg machinery work) then disclosure is imperative for everyone's protection. If diabetes is well controlled, then it can be declared as •well controlled type 2 diabetes•. Diabetes Uk have publications relating to this

Question: How common is impotence/erectile dysfunction among men with diabetes?

Answer: There is no doubt that men with diabetes, both type 1 and type 2, have a higher rate of erectile dysfunction compared non-diabetic men. It appears that smoking, poor glycaemic control and other microvascular complications are all associated with the problem

What are the usual causes of impotence?

Answer:
• Neurological causes: autonomic neuropathy
• Vascular causes; arterial disease
• Drugs; multiple antihypertensives
• Recreationals: excessive alcohol use, drug misuse (eg cannabis)
• Psychological causes