Hypoglycaemia

Question 1

What is normal blood glucose range

Answer 1

4.0-8.0mmol/L

Question 2

What blood glucose range does hypoglycaemia occur in

Answer 2

When capillary blood glucose is below 4.0mmol/L

When hypoglycaemic, there is insufficient energy for cells to function normally

Question 3

Who is at risk of hypoglycaemia

Answer 3

Type 1 diabetic
Type 2 diabetic on insulin
Type 2 diabetic (tablet/diet controlled)
Non diabetic

If meals are delayed/missed, activity level is high or metabolic demand is increased, everyone has the potential to become hypoglycaemic

There is additional risk of hypoglycaemic episode associated with with use of insulin / other diabetic medication

Question 4

What is diabates

Answer 4

Body does not effectively regulate the uptake of glucose into the cells from the blood stream

Question 5

Type 1 diabetes

Answer 5

Body failed to produce insulin (so glucose cannot enter blood stream)

People with type 1 diabetes will always require insulin

Question 6

Type 2 diabetes

Answer 6

Body produces insufficient insulin causing insulin resistance

May be managed with insulin / medication / weight loss / diet

Question 7

Assessment of hypoglycaemia

Answer 7

Identified if blood capillary glucose is below 4.0mmol/L

Severity is categorised by observing neurological / behaviour status

AVPU (alert, verbal, pain, unresponsiveness) and behavioural indicators eg ability to self help - should be used to assess severity

1. Mild
   (A)No stimulus required, conscious, able to self help
2. Moderate
   (V)Responds to; loud voice/touch, conscious, drowsy, (P)disorientated, unable to self help
3. Severe
   (P)Shake and shout/earlobe pinch) very drowsy, aggressive, fitting
   (U)unresponsive, unconscious, nil by mouth

Question 8

Symptoms of hypoglycaemia

Answer 8

Shaking
Sweating
Palpitations
Headache
Confusion
Aggression
Hunger
Slurred speech
Loss of consciousness

Question 9

Management of hypoglycaemia

Answer 9

Treatment depends on severity

1. Deliver 15-20g fast acting carbohydrates + complex carb
2. Repeat up to 3x
3. If hypoglycaemia persists, call 999
4. Raise capillary blood glucose using the hormone glucagon before it is safe to give any oral products

Question 10

Mild hypoglycaemia

Answer 10

1st line treatment
15-20g fast acting carbohydrate + 18g complex carbohydrate
Eg bottle of gluco-juice + 2 biscuits

2nd line treatment (if unresolved)
Repeat up to 3x

Discharge/escalation
- plan for safe discharge if resolved
A minimum of 2 normal capillary blood glucose readings should be obtained before discharge
- consider and seek to manage conditions which may exacerbate hypoglycaemia (Eg pain/infection)