Hypo/Hyperglycemia

Question 1

Definition - Hypoglycemia

Answer 1

Low glucose level (< 4mmol)

Question 2

Definition - Hyperglycemia

Answer 2

Elevated glucose level ( > 11mmol)

Question 3

Goal of Care - Hypo

Answer 3

Restore normal glucose levels in the field

Question 4

Goal of Care - Hyper

Answer 4

Restore normal glucose levels in hospital

Question 5

S&S - Hypo

Answer 5

• Sweating
• Anxious
• Dizziness
• Impaired vision
• Rapid heart rate
• Weakness and/or fatigue
• LOC drops as the glucose falls

(symptomatic hypoglycemia does not occur unless glucose is less than 4mmol)

Question 6

S&S - Hyper

Answer 6

• Blurred vision
• Drowsiness
• Nausea

(Symptoms are unusual if glucose is less than 11mmol but many NIDDM tolerate higher levels w/o symptoms)

Question 7

Guiding Principles

Answer 7

although many hypoglycemic diabetics decline transport, care must be taken to ensure a reasonable underlying cause of the event has been identified. **these pts should be left in care of another responsible adult

NIDDM on oral hypoglycemic agents who require treatment in the field should be transported to hospital. Oral hypoglycemic have a very long duration of action and so the pts hypoclycemia is very likely to recur (these pts are commonly observed for 24hrs in hospital)

Question 8

Hypoglycemia History

Answer 8

history frequently reveals an imbalance of insulin or oral hypoglycemics by:

• Missing a meal
• Insulin dosing not monitored over time
• Over exertion w/o matching food intake
• A recent change of diabetic medication
• An overdose of insulin or oral hypoglycaemics, accidental or intentional

Question 9

Hyperglycemia History

Answer 9

history and examination may reveal

• Recent infection or illness
• Gradual onset of symptoms of dehydration lethargy, confusion
• Excessive urine output
• Insulin dependent diabetics in DKA may smell ketotic (fruity)

NIDdm can have high blood sugars, dehydration but no ketosis

Question 10

Special notes

Answer 10

Many pts w/ hypo or hyperglycemia have previously diagnosed diabetes but many diabetics go undiagnosed so history is not always reliable

**Beware the otherwise healthy pt w/ history of recent illness who is unconscious, hyperglycemic and hypotensive. Theses pts may have new diabetes w/ first time DKA or undiagnosed diabetes and have developed HHNS coma
These pts are at risk of dying and need careful management in the ER

Question 11

Intervention Guidelines

Answer 11

Position the pt
Supplemental O2
Correct suspected or confirmed hypoglycemia
- Glucogel 1 package

PCP
correct hypoglycema
Glucagon 1mg IM
Dextrose 10-25g D10W IV