Hypoglycaemia

Diabetes Outreach(June 2011)

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Hypoglycaemia

Learning outcomes

> Can state what hypoglycaemia is

> Be able to assess who is at risk of hypoglycaemia

> Be able to recognise a hypo event

> Can state the treatment of a hypo in a health service and in the community

> Is aware of the ways that hypo’s can be prevented.

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> In people with diabetes who are at risk, hypoglycaemia can cause signs and symptoms.

> Hypoglycaemia is usually defined as a BGL less than 4mmol/L.

> The BGL at which signs and symptoms occur can vary from person to person.

What is hypoglycaemia?

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Features of hypoglycaemiaSymptoms of hypoglycaemia occur as a response to adrenaline (pale skin, sweating, shakiness, palpitations, tingling especially around the lips, feeling of anxiety).

Due to decreased glucose in the brain (hunger, confusion, behaviour changes & psychological reactions, seizures and coma).

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Signs and symptoms

Signsblood glucose level < 4.0mmol/LSymptomatic (sometimes)unconscious

Symptoms:hunger / sweatingfaintness / dizzinesstremblingpalpitationsheadacheirritability / confusionunconsciousness

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Causes of hypoglycaemia

> missing or delaying a meal or snack> inadequate carbohydrate intake> over-administration of insulin/OHA> prolonged exercise> excessive alcohol> vomiting.

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Who’s at risk?Consider> types of diabetes> age of the person> duration of diabetes> type of medication> hypo awareness> diabetes complications> weight> exercise> excessive alcohol intake.

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Treatment of conscious person

Step 1

BGL <4.0mmol/L give 15g fast acting carbohydrate (CHO) eg 90ml Lucozade, or15g glucose tablets or equivalent.

Step 2

Test BGL at 10 mins. If over 4 proceed to step 3, if under repeat step 1.

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Treatment of conscious person

Step 3

Give slow acting CHO eg 2 biscuits or 1 piece of fruit or 1 cup (250ml) of milk or equivalent or the person’s regular meal if available.

Step 4

Ensure person receives and eats a normal meal (adequate CHO serves) when next due.

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Unconscious hypoglycaemia

> If the person is unable to safely swallow then glucagon needs to be administered either IM or SC.

> People at significant risk of unconscious hypo need to receive education about glucagon. A caregiver or family member will require training.

> In a hospital or health service, nurses can administer glucagon using a standing order.

> If no response to glucagon 50% IV glucose will need to be ordered by MO.

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Administration of:

Glucagon (IM) is used when a person is unconscious. Given intramuscular (but can be given subcutaneous or intravenously).

Requires approx 6-10 minutes for peak onset of action.

Glucose (IV) given as 10ml of 50% glucose intravenously.

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Diabetes Manual 2010

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Follow up

Follow-up post severe ‘hypo’:> reassess person 15-30mins post hypo> check BGL after 30mins from initial time

if level is <4mmol/L repeat step 1 & 2

> may need IVT (5% Dextrose)> BGL 2-4 hourly for 12-24 hours (depending

on severity and duration)> documentation of event.

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‘Hypo’ kit for health services

A ‘hypo’ emergency kit can be assembled and placed in every ward or community health area and should contain at least the following:

Quickly digested CHO: 1 bottle 50g Lucozade (90ml = 15g CHO)

Slowly digested CHO: Biscuits.

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‘Hypo’ kit for health services

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Hypo action plans in the community

> All people at risk of hypo should have an action plan.

> A hypo kit is central to this action plan.> Ask the person what foods they would like to

keep in their hypo kit.> A hypo kit makes sure the person has

planned for a hypo in various situations.

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Case scenario

Lucy is 70yrs old. She has had type 2 diabetes for 20yrs. She is on a reduced dose of Metformin, Daonil (sulphonylurea) and a basal insulin. Over the past 4 years her weight has dropped slightly from 63kgs to 57. She lives alone.

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My ‘hypo’ plan

BG ___________________________

Step 1 at home ___________________________

out / car ___________________________

Step 2 monitor BG – 10-15 min and repeat step 1 until BG over 4

or ____________________________

Step 3 at home ____________________________

out / car ____________________________

Step 4 monitor BG – 1-2 hour increasing gap time until happy no repeat hypo

or ____________________________

NB ________________________________________ ___________

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Question

> Is Lucy at risk of hypoglycaemia?> What makes her high risk?> How would you address the risk factors?> Use the hypo action plan on the next slide to

assist with the discussion.

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Summary

> Important that nurses assess the persons knowledge and self care of hypoglycaemia.

> People should have an action plan in place for hypoglycaemia.

> All health services and hospitals should have a protocol in place for treatment of hypo and a hypo kit that is easily accessible in all patient care areas.

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References

> Cryer P E, Davis S N, and Shamoon H S (2003) Hypoglycemia in diabetes. Diabetes Care, 26(6): p1902-1912.

> Diabetes Outreach (2009) Diabetes Manual, Section 4: Hospitalisation, Section 11: Unstable diabetes.

> Diabetes Outreach (2011) Low blood glucose in type 2 diabetes (hypoglycaemia) factsheet. http://diabetesoutreach.org.au/consumer/default.asp

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