Hypos and hypers

When you have diabetes, there will be moments when your blood glucose is too low or too high.
A hypo is a blood glucose level lower than 3.9 mmol/L.
A hyper is a blood glucose level higher than 11.1 mmol/L.

It is important to avoid hypos and hypers as much as possible.
They can be dangerous for the body.

GoOD TO KNOW

A hypo (low blood sugar) can be recognized by symptoms such as feeling hungry, shaky hands, or dizziness.
There are also other possible signs.

When experiencing a hypo (low blood sugar), the body urgently needs glucose. The quickest way to restore blood sugar levels is by consuming something that contains fast-acting carbohydrates.

A hyper (high blood sugar) can be recognized by symptoms such as intense thirst, fatigue, frequent urination, and headache. There are also other possible signs.

A hyper (high blood sugar) means there is too much glucose in the blood. This usually happens when there isn’t enough insulin to help move glucose into the body’s cells.

With type 1 diabetes, it’s impossible to keep blood glucose levels perfectly balanced at all times. However, frequent episodes of high or low blood sugar can have long-term consequences.

Hypo: Symptoms

When blood sugar is low, there is not enough glucose (sugar) in the blood. As a result, the body doesn’t get enough energy to keep all cells functioning properly. This can be noticed through various signs. Symptoms that may indicate a hypo include:

Feeling hungry
Feeling tired or sleepy
Shaking
Sweating more than usual
A pounding heart
Tingling in the lips, tongue, or fingers
Feeling weak
Poor or blurry vision
Headache
Dizziness
Difficulty concentrating
Mood swings

What someone experiences during a hypo can vary from person to person. Some people recognize several of these symptoms, while others may have additional symptoms not listed above.

What to do during a hypo?

It’s important to resolve a hypo quickly. That way, the unpleasant feeling passes more quickly. You should also try to prevent a severe hypo.

In a severe hypo, someone loses consciousness. They are no longer alert and cannot speak or respond.

Fast-acting carbohydrates

During a hypo, the body needs glucose. This glucose comes from fast-acting carbohydrates. The amount of carbohydrates needed during a hypo varies from person to person.

If you use an insulin pen: take 0.5 grams of carbohydrates per kilogram of body weight, up to a maximum of 20 grams.
If you use an insulin pump: take 0.3 grams of carbohydrates per kilogram of body weight, up to a maximum of 12 grams.

The most effective options during a hypo are glucose tablets (like Dextro or powder), sports drinks, or regular soft drinks with sugar. A spoonful of sugar or a sip of undiluted lemonade syrup can also help during a hypo.

Types of fast-acting carbohydrates during a hypo

Pay close attention to the type of sugar in a product. Avoid products with sweeteners, as they contain little or no fast-acting carbohydrates.

You can look for these types of fast-acting carbohydrates:

Glucose: This is the best option during a hypo. Glucose raises blood sugar within 10 to 20 minutes. One glucose tablet often contains 2 to 3 grams of glucose.
Fructose: Less suitable for a hypo. Fructose causes a delayed rise in blood sugar. Many fruit juices and lemonade syrups contain fructose.
Sucrose: This consists of part glucose and part fructose. It can help during a hypo, but often you need more of it before it becomes effective.

Glucose per glucose product

How much glucose is in each brand’s tablet?

Glucose Product	Form	Amount of Glucose per Tablet
Dextro	1 tablet	3 grams glucose
Dextrose Kruidvat	1 tablet	2,2 grams glucose
Glucopep	1 tablet	2,2 grams glucose
Dex4	1 tablet	4 grams glucose
Glucosepoeder Dextropur	1 tablespoon dissolved in water	10 grams glucose

Exercise and the risk of hypoglycemia

A common fear among people with diabetes is getting a hypo from exercising. We’re happy to offer tips and support to encourage our patients to stay active. Physical activity and sports are important for feeling well and play a key role in insulin sensitivity. At Diabeter, we always advise continuing to exercise.

If you have questions or concerns about diabetes and sports, be sure to discuss them with your care team. Read more

Tailored Care

The physicians and diabetes nurses at Diabeter, who specialize in type 1 diabetes, support people with type 1 diabetes every day.
If you experience frequent hypos, they will work with you to find solutions that help reduce your symptoms.
Their advice is always tailored to you, your lifestyle, and your personal preferences.

Hyper: Symptoms

When blood sugar is high, there is too much glucose in the blood. There isn’t enough insulin to move all the glucose into the body’s cells. As a result, the cells can’t function properly. This can be noticed through various symptoms. Signs that may indicate a hyper include:

Feeling thirsty
Frequent urination
Feeling tired and sleepy
Irritability
Headache
Difficulty concentrating
Poor or blurry vision

What someone experiences during a hyper can vary from person to person. It also depends on how high the blood glucose level is. Some people recognize one or more of these symptoms, while others may have additional symptoms not listed above.

Nausea and Vomiting

A person may also feel nauseous or vomit during a hyper. This happens when ketones are present. The body burns fat to produce energy, releasing substances called ketones, which acidify the blood.

Sometimes, a person may also have difficulty breathing.
Diabeter’s Emergency Line is always available in such situations for patients treated at our diabetes center. Through the Emergency Line, you can reach one of our professionals specialized in type 1 diabetes 24 hours a day.

What to do during a hyper?

It’s important to lower high blood glucose quickly. This usually requires extra insulin. However, the best course of action depends on your glucose level. You’ll make specific agreements about this with your diabetes care team. They can also help with advice if you experience hypers frequently.

What to do at each glucose level?

Diabeter distinguishes between different levels of high blood sugar. This is the advice for patients treated at our diabetes center:

7,8 – 11,0 mmol/l: Elevated blood glucose. Adjust insulin dose the next day if needed. Advice is available in the Diabeter app.
11,1 – 14,9 mmol/l: Hyper. Administer extra insulin according to the schedule discussed with your diabetes team. This is also in the Diabeter app. Check glucose after 2 hours. Contact your diabetes team with questions.
15,0 – 19,9 mmol/l: Risk of dysregulation. Administer extra insulin as per your team’s schedule (see Diabeter app). Call your diabetes team during office hours. Avoid exercise. Check glucose after 1–2 hours. If still high, call the Emergency Line and report your total daily insulin dose.
20,0 mmol/l of hoger: Risk of ketoacidosis. Call the Emergency Line immediately and report your total daily insulin dose. Administer extra insulin as advised by the on-call physician or diabetes nurse. This aligns with the Diabeter app advice. Check glucose after 30–60 minutes. Avoid exercise.

A person with type 1 diabetes who has prolonged high glucose levels may develop diabetic ketoacidosis (DKA). DKA is life-threatening and can lead to brain swelling or coma. That’s why early recognition of prolonged high glucose is so important.

Consequences of hypos and hypers

It’s understandable that with type 1 diabetes, it’s not always possible to keep blood glucose levels perfectly balanced. It’s impossible to prevent hypos and hypers entirely.
Still, it’s important to try to avoid them as much as possible.
Hypos and hypers can have consequences—even later in life.

Damage Caused by High Blood Sugar (Hypers)

Persistently high glucose levels can be harmful to the body—especially when they continue for weeks or months.

Over time, hypers can damage blood vessels, leading to serious complications such as kidney problems, vision issues, nerve damage, and heart disease. That’s why it’s essential to minimize frequent hypers as much as possible.

At Diabeter, we help prevent this by continuously monitoring your blood glucose remotely. We receive your data through your insulin pump system or glucose sensor. If your readings show frequent highs or lows, you can work with your care team to make adjustments.

Together, we keep a close watch on your health.

Reduced Awareness of Hypos

Hypos can have serious consequences. When the body experiences low blood sugar frequently or over extended periods, it may become less sensitive to the warning signs. This condition is known as hypo unawareness.

In people with hypo unawareness, a hypo no longer triggers noticeable physical symptoms—such as trembling, sweating, or dizziness.
This lack of warning can be dangerous, as it increases the risk of severe hypoglycemia without timely intervention.

Physical Effects of Hypos

Hypoglycemia (low blood sugar) lasting longer than 30 minutes can lead to the release of harmful substances in the body. These substances negatively affect blood vessels and may cause the blood to become thicker in certain areas. This increases the risk of small clots forming in a vein—known as thrombosis.

That’s why it’s so important to prevent hypos as much as possible.
The healthcare professionals at Diabeter are here to support you in doing just that.