Richardson Eating Disorder Service – Hypoglycaemia in adult eating disorders

You have been given this leaflet as people with eating disorders are at risk of experiencing low blood sugar (hypoglycaemia). This leaflet should help you to notice when you might experience low blood sugar and what to do about this. The information in this leaflet may raise questions that you may wish to discuss with your doctor.

In people with eating disorders, hypoglycaemia is common. Hypoglycaemia is a condition characterised by an abnormally low level of blood sugar (glucose), your body’s main energy source. Hypoglycaemia occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body’s needs e.g. for your brain and other organs to function properly.

• Confusion, abnormal behaviour (e.g. irritability) or both, such as the inability to complete routine tasks
• Visual disturbances, such as double vision and blurred vision
• Seizures
• Pallor (paleness of skin)
• Loss of consciousness and risk of death
• Heart palpitations
• Tremor
• Anxiety
• Sweating
• Hunger

In eating disorders, low blood sugar levels can result from starvation but can also occur during re-feeding at unexpected times for example after meals. If we restrict carbohydrate in our diet, then we may experience low blood sugars. You can also experience low glucose levels after meals even when you have started to eat regularly, which can be explained as follows: –
• Carbohydrate is taken in as a meal and this is broken down into glucose
• The pancreas releases insulin, which helps cells to take up and use glucose but this in turn, lowers blood sugar levels
• The liver tries to respond to the low levels of glucose by releasing stored glucose but because stores are low the liver is not able to make the necessary correction
• An episode of hypoglycaemia can occur up to two hours after eating

In starvation, your body has little or no emergency stores of carbohydrate in the liver, otherwise known as glycogen. If you avoid eating carbohydrate for more than 2-3 hours, then you are likely to experience low blood sugars, as your body has no emergency stores of glucose (sugar) in the liver. Those at a healthy weight, will have enough glycogen in the liver, and therefore will not experience low blood sugar if they haven’t eaten for more than 2-3 hours. Remember, your family and friends will have enough emergency stores of glycogen, and therefore they remain well even if they have missed a snack.

If you are informed that your blood glucose reading is below 4mmol/l, or you feel you are experiencing the effects of a low blood glucose, please ensure you follow the treatment below. If you are feeling acutely unwell, and if any concerns please call 999 or go to your nearest Accident and Emergency Department.

Please be aware that you should not drive if experiencing low blood sugar.

• 200mls pure fruit juice e.g. orange juice or
• 350-450ml Lucozade Energy Original® or
• 5-7 dextrose tablets

Lucozade Energy Original 350ml-450ml is required (equivalent to 15-20g of fast acting carbohydrate).

As product recipes may change, please ensure you check the nutritional label, ensuring that the treatment contains 15-20g of fast acting carbohydrate ‘sugar’. This guidance is for service users only. Health professionals must refer to their own Hospital Trust Hypoglycaemia protocol to ensure the most appropriate treatment is offered depending on product availability.

From 15 minutes up to 30 minutes after initial treatment, please then follow with a slow releasing carbohydrate:
Sandwich (2 slices of bread) or
2 x digestive biscuits or
1 x medium banana or
The next carbohydrate containing meal if it is due.

Long term stability of blood glucose can only occur through working to full recovery and following your meal plan, eating carbohydrates at regular intervals through the day is important as is avoiding excessive exercise.

• MARSIPAN Guidelines: Management of Really Sick Patients with Anorexia Nervosa (2014) http://www.rcpsych.ac.uk/files/pdfversion/CR189.pdf
• Mehler PS, Brown C. Anorexia Nervosa – medical complications. Journal of eating disorders, 2015; 3:11.
• NHS Choices https://www.nhs.uk/conditions/low-blood-sugar-hypoglycaemia. August 2017.
• CNTW Clinical Policy. Treatment Algorithm for Acute Hypoglycaemia. Appendix 3. Issue 1. October 2017.

If you want to make a comment, suggestion, compliment or complaint you can:
• talk to the people directly involved in your care
• ask a member of staff for a feedback form, or complete a form on the Trust website www.cntw.nhs.uk/contact/complaints/
• telephone the Complaints Department Tel: 0191 245 6672
• email [email protected]

We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.

You can provide feedback in the following ways:
– the quickest way for you to do this is to complete our short online survey at www.cntw.nhs.uk/yourvoice
– complete a Your Voice survey, available on wards, reception areas or from staff
– other options for sharing your feedback and experience www.cntw.nhs.uk/yourfeedback

Patient Advice and Liaison Service (PALS)
PALS provide confidential advice and support, helping you to sort out any concerns that you may have about any aspect of your or your loved ones care.

We act independently when handling patient and family concerns, liaising with staff, managers and, where appropriate, relevant organisations, to negotiate prompt solutions. If necessary, we can also refer patients and families to specific local or national-based support agencies.

PALS
Tel: 0800 032 0202
Email: [email protected]
Post: FREEPOST PALS

9.00 am – 4.30 pm, Monday to Friday
An answerphone is available at all times for you to leave a message. A member of the PALS team will aim to return your call as soon as possible.

Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre Tel: 0191 246 7288

Published by the Patient Information Centre
2021 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Ref, PIC/801/0324 April 2024 V3

www.cntw.nhs.uk Tel: 0191 246 7288

Review date 2027