Hypoglycemia Flashcards
What is the official definition of hypoglycemia?
blood glucose < 70
Which diabetic patients are at risk of hypoglycemia?
impacts about 90% of type 1
Symptoms of Hypoglycemia
- may be asymptomatic
- sympathetic: sweating, tremor, N, irritability, tachycardia, hunger, pallor
- neuroglycopenia: HA, lethargy, poor judgment, confusion, dizziness,paralysis, seizures, coma, death
Hypoglycemia Precipitating Factors
- intentional or accidental insulin overdose (inadequate food intake, increased exercise, decreased insulin needs, noncompliance)
- rapidly fluctuating blood glucose
- type 2s taking insulin or sulfonylureas
- alcohol
- exercise
Risks for Hypoglycemia in DM2
use of insulin therapy with:
- missed or irregular meals
- advanced age
- longer duration of diabetes
- exercise
- taking greater than prescribed dose
- excessive EtOH intake
Tx of Hypoglycemia
- glucose 15-20 g (any form of CHO with glucose) and recheck glucose in 15 mins
- glucagon: prescription; for repeated episodes of low BG or hypoglycemia unawareness
- severe hypoglycemia requires assistance and can’t be treated with oral CHO
Whipple’s Triad
- observation of sxs of hypoglycemia
- documentation of hypoglycemia (blood glucose)
- resolution of sxs with treatment (glucose)
Postprandial Hypoglycemia Characteristics
- usually within 4 hours of meal
- sudden drop in blood glucose
- glucagon and epinephrine kick in
- recovery as BG rises
- often response to high carb, high sugar meal
Sxs of Postprandial Hypoglycemia
- sweating
- weakness
- tachycardia
- irritability
- tremor
Treatment of Postprandial Hypoglycemia
medical nutrition therapy:
- reduce simple sugars, use complex CHO
- higher protein, moderate to high fat
- smaller, more frequent meals
- avoid excess fluids with meals
- avoid caffeine
What might cause fasting hypoglycemia?
- exogenous insulin or oral agents
- alcohol binge
- Addisons or hypopituitary
- glycogen storage dz
- sepsis
- liver failure
- beta adrenergic antagonists
Symptoms of Fasting Hypoglycemia
- diplopia, blurred vision
- HA, confusion, unconsciousness
- abnormal behavior
- amnesia
- tonic clonic seizures
DM Sick Days: Should insulin still be used?
yes
DM Sick Days: How often should pt test blood sugar?
every 1-4 hours
DM Sick Days: Besides BG, what else should patient test and when?
test ketones if blood sugar > 240, vomiting or sxs of hyperglycemia or ketoacidosis
