Treat and Refer - Hypoglycaemia

Question 1

Who is the Hypoglycaemia treat and refer guideline targeted at?

Answer 1

Adult patients with diagnosed diabetes who have fully recovered from an episode of hypoglycaemia and have consumed oral carbohydrates.

Question 2

Why is there an increased risk if leaving a pt at home who takes oral diabetic medications?

Answer 2

Long duration of action, increased risk of recurrent hypo.

Question 3

What reasons might cause a pt without diabetes to have a hypoglycaemic episode?

Answer 3

1. Drug/alcohol overdose
2. Liver/endocrine disease
3. Tumour
4. Sepsis
5. Malnourishment

Question 4

What are some appropriate glucose options for the pt to take in future hypo’s?

Answer 4

6-7 jelly beans, 1 tbsp of honey, a cup of fruit juice.

Question 5

Within what timeframe should the pt contact their diabetes provider about their hypo?

Answer 5

24hrs

Question 6

What are the contraindications for Treat and Referring a hypo?

Answer 6

1. Incomplete recovery to normal conscious state
2. Risk of prolonged or recurrent hypoglycaemia
   - Unwitnessed onset/prolonged episode
   - Oral hypoglycaemic meds
   - Overdose on medication (intentional/accidental)
   - Unable/unwilling to eat carbohydrates
   - Unable to be monitored by adult for >4hrs
3. No diagnosis of diabetes
4. Suspected causes requires further investigation
5. Injury or seizure sustained
6. Pregnancy

Question 7

If a hypoglycaemic pt is being treat and referred, what is the management?

Answer 7

1. Provide pt with health info sheet
2. Refer pt to usual diabetes PCP within 24hrs
3. Confirm BGL >4, and pt remains GCS15 at least 10 minutes after last treatment.
4. Remove IV if cannula required
5. Confirm pt understands advice given