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Nicole Cleaver with her husband Chris and children (left to right) Samantha, Elizabeth and Benjamin


Low blood sugar episodes (hypoglycemia) are a well-known side-effect of diabetes treatment, including insulin and some oral medications, and they can be very unpleasant and dangerous if not managed properly.

Despite the fact that many people with diabetes experience hypoglycemia, it remains underappreciated, underdiagnosed and, often, a source of stigma.

A recent Canadian-led research project and a public information campaign ( aim to uncover more about the “hidden burden” of hypoglycemia – with a focus on family members trying to help individuals manage their “hypos” and their diabetes.

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“Our study was the first global study to capture the degree of burden on family members of those at risk for hypoglycemia, and how it also affects their lives,” says Dr. Stewart Harris, a professor at the Schulich School of Medicine and Dentistry at Western University in London. Dr. Harris and his co-lead, PhD (c) Alexandria Ratzki-Leewing from the Department of Epidemiology at Western, led the research project, which was done by Novo Nordisk – a leading health-care organization with a 95-year history in the management of diabetes.

The study included a survey of 4,300 family members of people with type 1 or type 2 diabetes in Canada and eight other countries. One key finding: 64 per cent of family members said they are worried or anxious about the risk of low blood sugar affecting their relative.

“You can imagine your loved one having a severe hypo and how terrifying that can be,” says Dr. Harris. According to the Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, a hypo is considered severe when the individual is unable to self-treat and needs someone else to help them. Without treatment, the person can go unconscious or have seizures, and complications can be life-threatening.

“Even if the hypos are mild or moderate, they can be a source of great stress for a family,” he adds.

Severe hypoglycemia is more widely recognized as a risk for people with type 1 diabetes, says Dr. Harris. “In fact, our previous research showed that severe hypos are just as common for people with type 2 diabetes – and that is very much underappreciated in the clinical community.”

Dr. Stewart Harris professor at the Schulich School of Medicine and Dentistry at Western University in London


Our study was the first global study to capture the degree of burden on family members of those at risk for hypoglycemia, and how it also affects their lives.

— Dr. Stewart Harris professor at the Schulich School of Medicine and Dentistry at Western University in London

Nicole Cleaver and her family, who live in Ontario, were part of the Talk About Hypos study and broader campaign. Mrs. Cleaver, who has type 2 diabetes, says dealing with hypoglycemia episodes is particularly challenging when she is caring for her children, the youngest of whom is now six.

“You can’t plan for everything, especially with young kids – sometimes you may end up exerting more energy than you expected, which can trigger an episode.”

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She has always tried to keep her youngsters informed about her diabetes, and they know that if she has a hypo attack, they can help by bringing her a glucose tablet or orange juice.

“But especially when they were younger, it was tough trying to care for them when I had an episode, when all I wanted to do was lie down and try to recover.”

Taking part in the study was an “eye opener,” says Mrs. Cleaver, who learned that her children worried about her hypos and weren’t sure if they were supporting her enough.

“It’s true that you feel like you don’t want to burden your family, but I’ve learned that we have to make sure our families are aware of what we are going through.”

Health-care practitioners don’t fully appreciate their patients’ hypoglycemia risks, says Dr. Harris, and research shows that many of them don’t probe to gather relevant information.

“Patients often don’t tell their doctors because they are embarrassed or worried that they are not managing their diabetes well, and may also have concerns about losing their driver’s licence, which can happen in some provinces for people with severe hypos,” he says.

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“Our study found that candidly talking to your family can produce new strategies for reducing hypos and can lead family members to play a more active role in ensuring conversations around hypo happen when patients visit their doctors.”

Learn more at

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Produced by Randall Anthony Communications. The Globe’s editorial department was not involved in its creation.

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