Hypoglycemia (continued. Some In Type 1 Deck) Flashcards
Goals of treatment of hypo (3)
1- detect and treat quickly with fast rise of BG to safe level (do not over treat as weight gain and hyper can occur)
2-eliminate risk of injury
3- relieve symptoms quickly
15G of glucose raises BG by how much in how long?
2.1 mmol/l in 20 minutes.
20G of oral glucose will raise the BG level by what in how long?
3.6mmol/l at 45 minutes
How does glucose gel compare to 15 G CHO in its ability to raise BG?
It’s quite slow. Has to be swallowed. Only increases BG by 1mmol/l in 20 minutes.
If patient is taking an alpha glucosidase inhibitor, how do you treat hypo?
Must use glucose/dextrose tablets.
Milk or honey
Ie: has to be a monosaccharide as the mechanism of action prevents the breakdown of polysaccharides into glucose.
How should a diabetic patient be assessed for fitness to drive?
This must be done on an individual basis. Individuals should be encouraged to that an active Role in assessing their fitness to drive. In general they are fit to drive if they are medically fit, knowledgable about BG control and are able to avoid hypo episodes.
Example of 15G CHO to treat MILD to MODERATE hypo
Preferred treatment:
15G glucose tablets
15mls or 3 tsp/3 packets of sugar dissolves in water
5 cubes of sugar
Others:
6 lifesavers
150mls juice or pop
1 TBSP honey
Note: milk and juice are slower
Once recovered, have the usual meal or snack. If it’s > 1 hour away, have a snack with 15G CHO and protein source should be consumed.
After taking 15G of CHO for hypo symptoms, what should a patient do?
Re test BG in 15 minutes and re-treat with another 15 g carbohydrate if the BG level remains <4
How should severe hypo be treated in a conscious person?
20G CHO. Then retest in 15 minutes. If still below 4 then give another 15G
Once recovered, have the usual meal or snack. If it’s > 1 hour away, have a snack with 15G CHO and protein source should be consumed.
How do you treat severe hypo in unconscious person?
No IV access: 1mg glucagon sc or IM. Call emergency services.
IV access: 10-25G glucose IV (20-50cc D50W) over 1-3 minutes.
**individuals at risk of severe hypo should have support persons trained in glucagon admin
What are the 12 risk factors for severe hypoglycemia in a person on insulin or SU
1- prior episode of severe hypo 2- current low A1C <6 3- hypoglycemia unawareness 4- long duration of diabetes 5- adolescence and preschool age (unable to detect or treat on their own) 6-Autonomic neuropathy 7. CKD 8. Low economic status food insecurity 9. Low health literacy. 10. Pregnancy 11. Elderly. 12. Cognitive impairment.
Symptoms of nocturnal hypo
Tingling of lips and tongue Headache Difficulty getting up in am Nightmares Night sweats.
Describe the Dawn Phenomenon
Temporary rise in BG in am, thought to be due to wearing off of previous days insulin or natural timing of growth hormone production.
Note:Somogyi effect proposed that dawn phenomenon was a rebound hyper due to low night hypo. This has mostly been proven wrong with conditions blood glucose monitoring systems.
How much will
Glucagon increase BG and in how long?
3-12mmol/l in 60 minutes.
Patient usually will wake up within 15 minutes. If delayed there is no contraindication to another dose, but IV glucose must be considered by physician.
When patient wakes up give them 15G rapid CHO followed by CHO source food.
What is the dose of glucagon for adults and kids?
Adults and kids > 20kg or age 5 give 1mg either sc or IM.
Less than 20kg or younger than 5 give 0.5mg.
Admin in thigh or deltoid.
Glucagon is less effective in patients who have consumed alcohol.
If glucagon clear or cloudy when mixed?
Clear. Should not be used if cloudy!
For how many hours after exercise should BG be monitored to prevent hypo?
Up to 24 hours.
Ideal time to exercise is after a meal.
Is pre exercise testing is
Is dizziness a neurogenic or neuroglycopenic symptom?
Neuroglycopenic
