Hypoglycaemia

Question 1

Signs and symptoms of hypoglycaemia?

Answer 1

Blood glucose <4 for diabetic patients, <3 for non-diabetic patients. (MILLIMOLES PER LITRE.)
• One sided weakness
• Altered state of consciousness
• Convulsions
• Sweating, tremor, palpitations, hunger
• Headache, nausea
• Neurological- drowsy, speech difficulty, fitting
• Aggression
• Confusion
• Look for medical alert information such as bracelets/ cards.

Question 2

What classes as severe hypoglycaemia?

Answer 2

GCS 8 or below, unconscious / convulsing / aggressive

Question 3

What classes as mild- moderate hypoglycaemia?

Answer 3

Patient orientated, conscious, able to swallow

Question 4

How would you treat severe hypoglycaemia?

Answer 4

Administer IV glucose 10% over 15 minutes: 10g in 100ml.
(If IV not possible, IM glucagon 1mg vial in 1ml water for injection ONCE ONLY- CI pheochromocytoma).
Keep nil by mouth- risk of aspiration and choking. Glucose titrate to effect- reassess BM after 10 mins. If <4mmol/l, administer further dose of IV glucose. Reassess after 15 min. Consider rapid treatment if no improvement.
Monitor vital signs en-route, as well as GCS. Check glucose regularly. Provide pre-alert/ information call if necessary to A&E or diabetic nurse/ team if available.

Question 5

How would you treat moderate hypoglycaemia?

Answer 5

Pt conscious, orientated, able to swallow. Administer 1-2 tubes of 40% glucose gel (10g glucose in 25g gel). If not cooperative, IV glucose/ IM glucagon. Reassess after 10-15 minutes.
If no improvement, repeat oral treatment up to 3 times in total. If no improvement IV glucose 10%.
Once BM >4, give starchy snack such as a slice of toast or 200-300ml glass of milk.

Question 6

Further care for hypoglycaemia patients being left at home?

Answer 6

Advise to call for help if symptoms reoccur. Arrange for message to be sent to primary healthcare team / diabetes nurse / refer to specialist diabetes team. If not available, pts GP must be informed. Possibly give a leaflet.

Question 7

How would you assess for hypoglycaemia?

Answer 7

GOCAT
Consent
Airway
Breathing
Circulation- Measure BM- clean finger with sterile water not alcohol wipes
Disability
Examination
History- Presenting complaint, history of presenting complaint, family, medical, social history, medications, lifestyle, happened before? What has pt eaten/ drank. Any gastrointestinal surgery? Alcohol intake? Look for medical alerts such as bracelets or medical ID cards.

Question 8

Side effects of glucose IV?

Answer 8

None but make sure to flush with 0.9% sodium chloride to prevent vein irritation