Q: My brother is insulin dependent for the last 12 years. Few months ago, a new problem started. He started getting an attack of hypoglycaemia mostly at late night. The doctor confirmed a seizure. He is taking medicines for this as per doctor's prescription. Now, his sugar is fluctuating from the past 1-2 months. His sugar suddenly gets low at 40-50 and sometimes suddenly shoots up to 300-400. He is very careful about his diet, dose and medicines and has left no scope for this to happen. But this happens mostly at night. The doctor rescheduled his dose, but the problem is still the same. Even doctors can't understand why is this happening. Please advise.

A:Hypoglycaemia is a common problem faced by patients taking insulin. Three obvious things that take part are: food intake which increases blood sugar, exercise and drugs which lower the blood sugar. Inter-play between these, controls the blood sugar level. But in addition to these many other factors play role, which are not under our control completely. Most important is absorption of insulin from subcutaneous tissue i.e. site where insulin is injected. Newer insulins have the advantage of being more predictable in absorption from site of injection. Incidence of hypoglycaemia hcan be significantly reduced by the use of these newer insulins. Use of newer basal insulins can also help in reducing hypoglycaemia. Most importantly, regular small and frequent meals, planned physical activity, can help in preventing hypoglycaemia. For nocturnal hypoglycaemia. A snack before sleep can be very useful. A diabetic has to learn to be ready to face and treat hypoglycaemia. Better the blood sugar control; more are the chances of developing hypoglycaemia. This price has to be paid for good glycaemic control, but basic knowledge can prevent most of them.