hypoglycaemia Flashcards
most common SE of the following 2 drugs
insulin
SUs
5 drugs that are unlikely to result in hypo when prescribed without insulin or SUs
metformin
pioglitazone
DDP4 inhibitors (gliptins)
SGLT2i inhibitors (flozins)
GLP1 receptor agonists (-tide)
treatment of adults with symptoms of hypo who have BGC of >4mmol/L
small carb snack e.g. slice of bread or normal meal if due
treatment of adult with BGC <4mmol/l with or without symptoms who is conscious and able to swallow
treat with fast acting carbohydrate by mouth
- lift glucose liquid
- glucose tabs
- glucose 40% gel (e.g. glucogel, dextrose gel, rapilose)
- pure fruit juice
- sugar dissolved in appropriate volume of water
what type of forms are preferred in treatment of hypo and why
oral glucose forms because absorption occurs more quickly
Treatment of hypoglycaemia in pt with BGC <4 with or without symptoms who are conscious and able to swallow need to be treated with a fast acting carbohydrate by mouth. This can include pure fruit juice.
However, avoid orange juice in the following people…
people following low potassium diet due to CKD
Treatment of hypoglycaemia in pt with BGC <4 with or without symptoms who are conscious and able to swallow need to be treated with a fast acting carbohydrate by mouth. This can include sugar dissolved in appropriate volume of water.
However avoid sugar dissolved in water in the following pt
pt taking acarbose because this prevents the breakdown of sucrose to glucose
Why should you avoid choc and biscuits if possible in pt who are being treated for hypo
they have lower sugar content and their high fat content can delay stomach emptying
How many times can you repeat treatment for hypo
If necessary repeat treatment after 15 minutes up to a maximum of three treatments in total
Once BGC is above 4 and the patient has recovered, will they need further treatment
Yes
Give a snack providing long acting carbohydrate to prevent blood glucose from falling again
Once BGC is above 4 and the patient has recovered, give a snack providing long acting carbohydrate to prevent blood glucose from falling again.
What can this include
2 biscuits
1 slice of bread
200-300ml of milk (NOT soya or other forms of alt milk e.g. almond, cocunut)
Normal carb containing meal if due
do not omit insulin dose but dose regimen may need review
define hypoglycaemia which does not respond
BGC that remains below 4 after 30 to 45 minutes or after three treatment cycles
treatment of hypoglycaemia which does not respond (2)
IM Glucagon
Glucose 10% IV infusion
treatment of hypoglycaemia which does not respond in alcoholic pt
Thiamine supplementation should be given with, or following, the administration of IV glucose to minimise the risk of Wernicke’s encephalopathy.
what is glucagon and how does it work
polypeptide hormone produced by the alpha cells of the islets of Langerhans, which increases blood-glucose concentration by mobilising glycogen stored in the liver
Glucagon is ineffective in the following pt, therefore DO NOT GIVE
ineffective in patients whose liver glycogen is depleted, therefore should not be used in anyone who has fasted for a prolonged period or has adrenal insufficiency, chronic hypoglycaemia, or alcohol-induced hypoglycaemia
Treatment of hypoglycaemia that does not respond in patient who takes a SU and why
Glucagon IM may also be less effective in patients taking a sulfonylurea; in these cases, intravenous 10% glucose will be required.
In an emergency, if the patient has a decreased level of consciousness caused by hypoglycaemia, what can be given by a family member or friend
IM glucagon can be given by a family member or friend who has been shown how to use it.
If glucagon is not effective after 10 minutes, glucose 10% intravenous infusion should be given.
when is hypoglycaemia an emergency
when it causes unconsciousness
Hypoglycaemia which causes unconsciousness is an emergency. Patients who are unconscious, having seizures, or who are very aggressive, should have the following treatment
STOP any IV insulin
Treat initially with glucagon
If glucagon IM unsuitable (e.g. adrenal insufficiency, taking SU, alcohol induced hypo, fasted for long period of time, chronic hypoglycaemia) or if no response after 10mins, give glucose 10% IV infusion or alt glucose 20% IV infusion
why is glucose 50% IV infusion not recommended
it is hypertonic, thus increases the risk of extravasation injury, and is viscous, making administration difficult.
Once the patient has recovered, a long acting carb should be given ASAP and their BGC is above 4. (e.g. 2 biscuits, 1 slice of bread, 200-300ml milk that is not soya or alt forms of milk, or normal carb containing meal if due)
However, what is treatment in people who have received glucagon?
They need larger portion of LA carb to replenish glycogen stores
4 biscuits
2 slices bread
400-600ml milk
normal carb containing meal if due
What must be given to pt who are nil by mouth
glucose 10% IV infusion
after hypo, what should patients do who self manage their insulin pump
may need to adjust their pump infusion rate
