Hypoglycemia

Question 1

Hypoglycemia definition

Answer 1

BG level less than 4mmol

Question 2

When does hypoglycemia occur?

Answer 2

when your pt has too much insulin in proportion to glucose in the blood

Question 3

Hypoglycemia may occur relative to a:

Example:

Answer 3

sudden metabolic shift – such as vigorous or rapid administration of insulin

Question 4

4 common causes of hypoglycemia

Answer 4

Relative to mismatch in timing

1. Food intake and peak action of insulin or oral hypoglycemic agents
2. Too much insulin/OHA
3. Too much exercise
4. Pt fasting

Question 5

7 Common Manifestations of Hypoglycemia

Answer 5

• Confusion
• Irritability
• Diaphoresis
• Tremors
• Hunger
• Weakness
• Visual disturbances

Question 6

Untreated hypoglycemia can progress to:

Answer 6

• loss of consciousness,
• seizures,
• coma,
• and death (neuroglycopenic)

Question 7

What is hypoglycemia unawareness?

Answer 7

• Person does not experience warning signs/symptoms
• Increasing risk for decreased blood glucose levels

Question 8

What can cause hypoglycemic unawareness

Answer 8

Autonomic Neuropathy

Question 9

How does autonomic neuropathy cause hypoglycemic unawareness

Answer 9

Lack of production of hormones that produce symptoms of hypoglycemia; don’t feel symptoms associated with hypoglycemia

Question 10

What is autonomic neuropathy

Answer 10

damage to the nerves that control autonomic function

Question 11

Who is most at risk for hypoglycemic unawareness and why?

Answer 11

Patients with prolonged diabetes diagnosis due to damage to vasculature

Question 12

How does hypoglycemia unawareness alter BG control and management

Answer 12

• increases risk for decreasing BG levels
• therefore, loosened control of diabetes management. Patients allowed to go slightly high because they don’t recognize when they are going low

Question 13

Brief overview of nursing management of hypoglycemia at first sign or symptom

Answer 13

1. Check BG
2. if < 4 begin treatment
3. if > 4, investigate cause of symptom
4. if equipment unavailable, initiate treatment and obtain BG when available

Question 14

Adult hypoglycemia protocol for conscious/able to swallow/tube feed patient

Answer 14

15 grams of fast acting carbs
- 4 glucose 4 gram chewable tab
- 3 teaspoons of sugar in water

Question 15

Evaluation for oral adult hypoglycemia protocol

Answer 15

Observe patient consuming treatment

Repeat BGM & treatment
q15min until BGM is >4 mmol/L

Do oral twice through than move to NPO algorithm

Alert MD after 2x

Question 16

Adult hypoglycemia protocol for altered LOC, NPO with IV access

Answer 16

1. ABC
2. establish IV (glucagon if unable)
3. IV treatment (dextrose)
4. IM treatment (glucagon)

Question 17

With IV access, explain hypoglycemia protocol

Answer 17

1. ABC
2. Administer dextrose
3. Call MD if altered LOC
4. Check BGM in 15
5. repeat dextose < 4
6. Check BGM in 15
7. < 4 stat lab glucose and call MD for further treatment

Question 18

Without IV access hypoglycemia protocol

Answer 18

1. ABC
2. attempt to establish IV access in 1-2 min
3. glucagon IM
4. notify MD
5. reattempt IV
6. If < 4 dextrose
7. Check BGM in 15
8. repeat dextrose and call MD for stat lab and further treatment

Question 19

Describe diabetic neuropathy

Answer 19

• Changes in color and /or sensation can be a sign of diabetic neuropathy
• The pt cannot feel pressure or a sore on their feet – loss of protective sensation (LOPS)
• can be a large open wound by the time a HCP examines it

Question 20

In treatment of hypoglycemia when patient is NPO, would you administer glucagon or dextrose first and why?

Answer 20

Dextrose: most rapid

Glucagon: has to stimulate liver to create glucose so takes longer