Hypo Managment

Question 1

How does the body regulate blood glucose levels?

Answer 1

If levels rise: Beta cells in pancreas produce insulin. Forces cells to absorb more glucose. Causes liver to absorb glucose and stores it as glycogen.
If levels fall: Alpha cells in pancreas produce glucagon which travels to liver. Stimulates liver to break down glycogen and convert to glucose.

Question 2

What is type 1 diabetes?

Answer 2

An autoimmune response where T cells attack and destroy beta cells in pancreas, preventing insulin production.

Question 3

What is type 2 diabetes?

Answer 3

Cells become resistant to insulin making it harder for glucose to enter cells. Beta cells in pancreas compensate by growing to produce more insulin.

Question 4

Describe mild hypo?

Answer 4

The patient is conscious, orientated and able to swallow

Question 5

Describe moderate hypo?

Answer 5

The patient is conscious and able to swallow, but may be confused, disorientated and or combative

Question 6

Describe severe hypo?

Answer 6

The patient is unconscious or fitting or combative and there is an increased risk of choking.

Question 7

Describe algorithm for mild hypo?

Answer 7

Give 15-20g quick acting carbs such as 4-5 glucotabs, a bottle of glucojuice, 1-2 tubes of 40% glucogel, 3-4 heaped tablespoons of sugar in water.
Re test bm after 15mins
If bm remains less than 4 repeat above treatment Upto 2 more times until bm more than 4 is obtained.
If bm fails to raise above 4 consider IV 10% glucose or IM glucose

Question 8

Describe moderate hypo algorithm?

Answer 8

If capable and cooperative:
Repeat treatment for mild hypo
If not capable but able to swallow:
Administer 1-2 tubes of glucose gel 40% buccal or give 1mg glucagon IM
Re test bm after 15 mins
If 40% glucogel cannot be administered due to patient disposition, consider IV 10% glucose.
If bm remains less than 4 repeat above treatment up to 2 times.

Question 9

What to do once bm of 4 is achieved?

Answer 9

Give a starchy snack
Patients given glucagon require larger portions of carbs to replenish glycogen stores.
In most cases, patients who have fully recovered and maintain bm of 4 will not need ED.

Question 10

Describe severe hypo algorithm?

Answer 10

Check ABC and correct as necessary
Administer IV glucose 10%
If not possible administer IM glucagon (may take upto 15mins to work and can only be given once)
Re asses bm after 10mins
If lower than 4 administer further dose or IV10% glucose
Repeat until bm greater than 4 is achieved
If no improvement convey to ED
Check bm again if patient worsens
Pre alert if needed