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HYPOGLYCEMIA

HYPOGLYCEMIA. 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. SYMPTOMS OF HYPOGLYCEMIA. Neurogenic (autonomic) Neuroglycopenic trembling difficulty concentrating palpitations confusion sweating weakness anxiety drowsiness

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HYPOGLYCEMIA

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  1. HYPOGLYCEMIA 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

  2. SYMPTOMS OF HYPOGLYCEMIA Neurogenic (autonomic)Neuroglycopenic trembling difficulty concentrating palpitations confusion sweating weakness anxiety drowsiness hunger vision changes nausea difficulty speaking tingling headache dizziness tiredness

  3. SEVERITY OF HYPOGLYCEMIA MILD Autonomic symptoms are present Individual is able to self-treat MODERATE Autonomic and neuroglycopenic symptoms are present Individual is able to self-treat SEVERE Individual requires assistance of another person Unconsciousness may occur Plasma glucose is typically < 2.8 mmol/L

  4. TREATMENT GOALS: To detect and treat a low blood glucose level promptly by using an intervention that provides a rapid rise is blood glucose to a safe level, eliminating the risk of injury, and relieving symptoms quickly. It is also important to avoid over-treatment with resulting rebound hyperglycemia and risk of weight gain. • 15 g of glucose will usually increase blood glucose by 2.1 mmol/L within 20 minutes with adequate symptom relief for most people. • 20 g will usually increase blood glucose by 3.6 mmol/L within 45 minutes.

  5. TREATMENT Mild to moderate hypoglycemia • 15 g of oral carbohydrate (CHO), preferably as glucose or sucrose tablets or solution. Retest blood glucose in 15 minutes; repeat treatment if BG still < 4.0 mmol/L Severe hypoglycemia, conscious • 20 g of oral CHO (glucose tablets or equivalent); retest in 15 minutes, repeat treatment if BG still < 4.0 mmol/L Severe hypoglycemia, unconscious adult • 1 mg glucagon subcutaneously or intramuscularly or 10 to 25 g of glucose intravenously (20 – 50 cc of D50W) Severe hypoglycemia, unconscious child • 0.5 mg glucagon (if < 5 years old) or intravenous glucose (0.5 – 1.0 g / kg body weight)

  6. TREATMENT Examples of 15 g of CHO for the treatment of mild to moderate hypoglycemia: • 15 g of glucose in the form of glucose tablets • 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water • 175 mL (3/4 cup) of juice or regular soft drink • 6 Life Savers • 15 mL (1 tablespoon) of honey

  7. HYPOGLYCEMIA- RECOMMENDATIONS • In hospitalized patients, efforts must be made to ensure that patients using insulin have ready access to an appropriate form of glucose at all times, particularly when NPO or during diagnostic procedures [Grade D, Consensus]. • In adults, mild to moderate hypoglycemia should be treated by the oral ingestion of 15 g of carbohydrate, preferably as glucose or sucrose tablets or solution. These are preferable to orange juice and glucose gels [Grade B, Level 2]. Patients should be encouraged to wait 15 minutes, retest BG and retreat with another 15 g of carbohydrate if BG level remains < 4.0 mmol/L. In smaller children (< 5 years of age or < 20 kg), 10 g of carbohydrate may be used initially [Grade D, Consensus].

  8. HYPOGLYCEMIA- RECOMMENDATIONS • Severe hypoglycemia in a conscious adult should be treated by the oral ingestion of 20 g of carbohydrate, preferably as glucose tablets or equivalent. Patients should be encourage to wait 15 minutes, retest BG and retreat with another 15 g of glucose if the BG level remains < 4.0 mmol/L [Grade D, Consensus]. • Severe hypoglycemia in an unconscious individual  5 years of age, in the home situation, should be treated with 1 mg of glucagon subcutaneously or intramuscularly. In children < 5 years of age, a dose of 0.5 mg of glucagon should be given. Caregivers or support persons should call for emergency services and the episode should be discussed with the diabetes healthcare team as soon as possible [Grade D, Consensus].

  9. HYPOGLYCEMIA- RECOMMENDATIONS • In the home situation, support persons should be taught how to administer glucagon by injection [Grade D, Consensus]. • For severe hypoglycemia with unconsciousness in adults, when intravenous (IV) access is available, glucose 10 to 25 g (20 to 50 cc of D50W) should be given over 1 to 3 minutes. The pediatric dose of glucose for IV treatment is 0.5 to 1 g/kg [Grade D, Consensus].

  10. HYPOGLYCEMIA- RECOMMENDATIONS • In hospitalized patients, a PRN order for glucagon should be considered for any patient at risk for severe hypoglycemia (i.e. requiring insulin and hospitalized for concurrent illness) when IV access is not readily available [Grade D, Consensus]. • To prevent repeated hypoglycemia, once the hypoglycemia has been reversed, the person should have the usual meal or snack that is due at that time of day. If a meal is > 1 hour away, a snack (including 15 g of carbohydrate and a protein source) is recommended in the absence of complicating factors [Grade D, Consensus].

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