Hypoglycemia Flashcards
Define Hypoglycemia
Abnormally low plasma glucose that exposes the patient to potential hard
Common Precipitating Factors Found
Meal-related problems (not eating enough or skipping meals)
Wrong insulin product administered (long vs rapid)
Wrong dose or confuse dosing units
Pathophysiology
o Decreased glucose acting on the pancreas and the CNS
o Pancreas is going to sense the glucose and decrease insulin secretion and increase glucagon
o CNS is going to release acetylcholine and epinephrine
o Adrenal medulla is going to increase epinephrine
o All working together to increase glucose
Neurogenic Symptoms
Through the autonomic nervous system
Patient tends to recognize
Catecholamine and cholinergic symptoms
Catecholamine Symptoms
AKA sympathetic
Shakiness/tremor
Palpitations
Anxiety/arousal
Cholinergic Symptoms
AKA parasympathetic
Sweating
Hunger
Parasthesia
Neuroglycopenic Symptoms
Via brain glucose deprivation Family tends to recognized • Warmth • Weakness/fatigue • Difficulty thinking/confusion • Behavioral changes • Mood swings • Seizures/loss of consciousness • Coma • Brain damage and death with severe prolonged hypoglycemia
Causes of Hypoglycemia
o Too much insulin
o Exogenous glucose decrease (meal size, missed meal, overnight fasting)
o Endogenous glucose decrease (alcohol)
o Increased use of glucose (exercise)
o Increased insulin sensitivity (weight loss, exercise)
o Decreased insulin clearance (renal disease)
Define Relative Hypoglycemia
Patient’s weight higher A1c may perceive hypoglycemia at higher plasma glucose levels
- Takes 2-4 weeks to readjust
Define Hypoglycemia Unawareness
Reduce sympathoadrenal response caused by recent hypoglycemia or diet and exercise
Hypoglycemia Unawareness Occurs more frequently in those who:
Have hypoglycemia often
Have long-term diabetes
Tightly controlled diabetes
Strategies for Preventing Hypoglycemia
Patient education (signs/symptoms, proper administration, appropriate SMBG)
Dietary Interventions
Medication adjustments
Exercise Management
Patient instructions regarding administration times
Exercise Management
Test before and after
If BG less than 100 → pre-treat with 1 carb serving
Avoid exercise if BG > 250 + ketones
Use caution if BG > 300 without ketones
Questions to Ask
Do they recognize the symptoms of hypoglycemia
Frequency, timing and treatment
What level prompts low symptoms
Physical activity
Meal timing (how often and how long between meals)
Medication timing
Recent Illness
Insulin Counseling Point
o Take medications at the appropriate time
o Always eat when taking bolus insulin
o Take before eating!
o Avoid alcohol on an empty stomach
o Always inform your health care provider of any new medications
o Always inform your health care provider before starting a new exercise regimen
o Anytime a BG level is low or symptoms occur, record BG level, timing/quantity of food, activity changes, symptoms
Rule of 15
- Consume 15-20 grams of glucose or simple carbohydrates
- Recheck your blood glucose after 15 minutes
- If hypoglycemia continues, repeat
- Once blood glucose returns to normal, eat a small snack if your next planned meals or snack is more than an hour or two away
Good Options for 15 grams of Carbs
3-4 glucose tablets Glucose gel tube 1/2 cub of juice or regular soda 8 ounces of nonfat or 1% milk 1 tablespoon sugar, honey or corn syrup 4-5 hard candies 2 tablespoons of raisins
Things NOT to use for Carbs
Diabetic or sugar-free bars/drinks
High fat food (candy bars, cookies, cake)
Alcohol (causes hypoglycemia or mask symptoms)
What do you do after the Rule of 15?
• Patient should have a snack after hypoglycemia is resolved consisting of carbohydrate + protein o ½ peanut butter sandwich o 4 peanut butter crackers o 4 crackers with cheese or o 8 ounces of milk
How do you treat SEVERE hypoglycemia?
- Use glucagon when the patient is unconscious or in a state of stupor
- 1 mg given IM via an emergency kit
- Inject into the patient’s buttock, arm, or thigh
- When the patient regains consciousness (5-15minutes), they may experience N/V
- If patient does not respond within 15 minutes, call 911
- DO NOT GIVE ORAL GLUCOSE TO AN UNCONCIOUS PATIETN DUE TO RISK OF ASPIRATION!!
Hypoglycemia Counseling Points
Always carry a source of sugar
Treat all glucose levels less than 70 mg/dL regardless of presence of symptoms
If more than 1-2 episodes occur within a week, patients should contact their provider
In the long-term symptoms can change
Patients should always be aware of all types of symptoms
Microvascular Complications
Retinopathy
Neuropathy
Nephropathy
Diabetic Retinopathy
Most common
Initially asymptomatic
Causes blindness
Diabetic Retinopathy Screening
- Dilated and comprehensive eye exam should occur: within 5 years after onset of T1 and shortly after diagnosis of T2
- If normal, repeat in 2 years
- If abnormal, re-examine in 1 year
