How to prevent and manage hypoglycaemia Flashcards
What is hypoglycaemia a dangerous side effect of?
- Insulin therapy and diabetes medications such as – gliclazide, glipizide, glimepiride, glibenclamide
What is hypoglycaemia caused by?
A mismatch of plasma insulin and glucose concentration
Define hypoglycaemia
Blood glucose levels below 4mmol/L
Liver acts as a store for glucose and can release glucose from glycogen stores when blood glucose is low, when glycogen levels are low the release of glucose will be impaired – which patients is this likely in?
- If they are malnourished
- Have had repeated hypoglycaemia
- Have severe liver disease
- Who have consumed alcohol to excess
What are the symptoms associated with hypoglycaemia?
Autonomic symptoms (firstly as blood glucose starts to falls):
- Trembling
- Anxiety
- Palpitations
- Numbness or tingling around the lips and fingertips
- Irritability
- Hungry
- Pale and sweaty
- Vulnerable and afraid
Neuroglycopenic symptoms (as blood glucose falls further and the brain becomes short of glucose usually occurs around 2mmol/L):
- Problems with weakness, concentration, co-ordination
- Slurred speech
- Problems with vision
- A loss of consciousness
- Seizures
What does the treatment of hypoglycaemia depend on?
The condition of the patient and their ability to eat or drink
What is the treatment of hypoglycaemia in patients who are able to swallow ?
Give 15-20g of quick acting carbohydrate:
- 60ml of glucojuice or
- 4-5 glucotabs or
- 90-120mls original lucozade or
- 150-200mls pure fruit juice (avoid fruit juice in patients with renal failure)
In patients who are experiencing hypoglycaemic attack but are confused/drowsy but can still swallow what is the treatment ?
1.5-2 tubes of glucose gel e.g. glucoboost
It is squeezed into the mouth between teeth and gums, glucose is absorbed through the buccal mucosa on the inside of the cheek
In patients experiencing a hypoglycaemic attack that are unconscious what is the treatment ?
- Do ABC urgently (airways, breathing, circulation)
- Contact a doctor immediately
- Stop any IV insulin if still running
Then give either:
- IV glucose or
- S/C or intramuscular glucagon
What are the different concentrations of IV glucose that could be used for unconscious hypoglycaemic patients ?
- 75ml 20% glucose
- 150ml 10% glucose - caution for those with fluid restriction, e.g. for renal impairment and cardiac failure patients
- 30ml 30% glucose - caution for risk of extravasation (the process by which any liquid (fluid or drug) accidentally leaks into the surrounding tissue)
When may glucagon be ineffective ?
In undernourished patients, patients with severe liver disease, repeated hypoglycaemia and oral hypoglycaemic agent-induced hypoglycaemia (do not use it for this last one)
What is the dose of glucagon given to adult patients (>25kg)
and what is the dose given to kids under 8 (<25kg)?
- For adults (>25kg) 1mg
- For kids under 8 (<25kg) 500mg
After treatment for a hypoglycaemic attack when is blood glucose then monitored to assess if their is need for further treatment ?
15mins after - if blood glucose less than 6mmol/L then further treatment is required
After initial treatment of hypoglycaemia what should be done ?
- 20grams of a more complex carb should be given e.g. 2 slices of bread or 2 biscuits
- Consider IV glucose infusion for patients who cant swallow or are ‘nil by mouth’
- Patients fed by ‘PEG tube’ rapid acting glucose treatments can be administered by the tube
What should be available in all wards for treament of hypoglycaemia ?
hypo box
