A to E: Disability - Hypoglycaemia Flashcards
Define hypoglycaemia
List four causes
Blood glucose <4 mmol/L
ExPLAINEd causes
- Exogenous insulin
- Pituitary failure
- Liver failure
- Addison’s disease
- Insulinoma
- Neoplasm
- Exogenous drugs: eg. sulfonylreas; alcohol
Give four clinical features of hypoglycaemia
- ‘Adrenergic’ features
- Sweating; tremor
- Palpitations
- Pins and needles
- Double vision
- Pallor; cold sweat
- Hunger
- Altered behaviour; consciousness; convulsions
When are diabetic patients most at risk of hypoglycaemia?
- Before meals
- During the night
- During exercise
What is hypoglycaemic unawareness?
Reduced awareness and warning signs of hypoglycaemia.
Associated with longer duration of diabetes, and recurrent hypoglycaemia.
Define mild, moderate, and severe hypoglycaemia
- Mild:
- Conscious
- Orientated
- Able to swallow
- Moderate:
- Conscious
- Confused/disorientated or aggressive
- Able to swallow
- Severe (any of):
- Unconscious/having a fit
- Very aggressive
- NBM
What should be given to a symptomatic pt with blood glucose >4 mmol/L?
Give a small carbohydrate snack for symptom relief
Outline the initial management of mild hypoglycaemia
- Stop any IV insulin
- 20g of fast-acting glucose: eg. juice; tablets
- Reassess CBG at 10 mins, if still <4 mmol/L
- Repeat fact-acting glucose up to 3 times
- Consider: IV glucose 10% 200ml over 15min or 1mg glucagon IM
Do not omit subsequent doses of insulin
Outline the initial management of moderate hypoglycaemia
If capable and cooperative ➔ treat same as mild
- Stop any IV insulin
- 2 tubes of GlucoGel/Dextrogel
- Reassess CBG at 10 mins, if still <4 mmol/L
- Repeat GlucoGel/Dextrogel up to 3 times
- Consider 1mg glucagon IM
Outline the management of severe hypoglycaemia
- ABC assessment
- Stop any IV insulin
- IV glucose 10% 150-200ml or IM glucagon 1g
- Reassess CBG at 10 mins, if still <4 mmol/L
- Repeat IV glucose
Outline the further managment of hypoglycaemia once hypoglycaemia is corrected
Once BM >4 mmol/L:
- 20g long acting carbohydrate
- 40g if glucagon IM used
- IV glucose if NBM
- Monitor BM over 48h
- Hypoeducation or refer to diabetes nurse
- Medication/insulin review
Do not omit subsequent doses of insulin
Restart any IV insulin
How can nocturnal hypoglycaemia be minimised?
- Bedtime snack
- If taking BD mixed insulin
- NPH at bedtime rather than before dinner
- Reduce dose of insulin before dinner
- Change rapid insulin to long-lasting at night
- Insulin infusion pump: can give infusion at night
Advise how to avoid hypoglycaemic episodes
- Carry glucose - liquids can be taken when drowsy
- Education for patient and relatives
- Reduce alcohol
- Avoid heavy carbohydrate intake
- Avoids rebound hyperglycaemia