Question

Review treatment protocols for hypoglycemia?

Answer 1

Hypoglycemia (abnormally low blood glucose levels) occurs when the blood glucose falls below 50 to 60 mg/dL.

Hypoglycemia may result from too much insulin or oral hypoglycemic agents, poor oral intake ( eg : fasting, starvation) , or excessive physical activity.

[1] MEDICAL MANAGEMENT

Immediate treatment should be given when hypoglycemia occurs

The usual recommendation is 15 g of a fast-acting concentrated source of carbohydrate orally (eg, three or four commercially prepared glucose tablets; 6 to 10 hard candies or  2 to 3 tsp of sugar or honey).
• Patient should avoid adding table sugar to juice, even “unsweetened” juice, because this may cause a sharp increase in glucose, resulting in a ' reactive' hyperglycemia hours later.
• Treatment is repeated if the symptoms persist more than 10 to 15 minutes after initial treatment; patient is retested in 15 minutes and retreated if blood glucose level is less than 70 to 75 mg/dL.
• Patient should eat a snack containing protein and starch (milk, or cheese and crackers) after the symptoms resolve or should eat a meal or snack within 30 to 60 minutes.

Management of Hypoglycemia in the Unconscious Patient

25 to 50 mL of 50% dextrose in water is administered intravenously to patients who are unconscious or unable to swallow (in a hospital setting).

Glucagon, 1 mg subcutaneously or intramuscularly for patients who cannot swallow, or who refuse treatment; patient may take up to 20 minutes to regain consciousness.

[Injectable glucagon is usually available as a powder in 1-mg vials, and is to be mixed with a diluent before being injected ].

Glucagon is a hormone that has actions that are counter-regulatory to that of Insulin.

Give a concentrated source of carbohydrate followed by snack when the patient regains consciousness, in order to prevent recurrence of Hypoglycemia.

[2] NURSING MANAGEMENT

• Teach patient that hypoglycemia can be prevented by following a consistent, regular pattern for food intake ,insulin administration, and exercising.

Advise patient to consume between-meal and bed-time snacks to counteract the maximum insulin effect.

• Reinforce that routine blood glucose estimations are done so that changing insulin requirements may be anticipated and the dosage adjusted accordingly.

• Encourage patients taking insulin to wear an identification bracelet or tag indicating they have diabetes. This may help the emergency care provider to initiate management in emergency situations.

• Instruct patient to notify physician after severe hypoglycemia has occurred.

• Educate the patients and family about symptoms of hypoglycemia and use of glucagon.

• Teach family that hypoglycemia can cause irrational and unintentional behavior.

• Teach patient the importance of performing self-monitoring of blood glucose on a frequent and regular basis.

• Teach patients with type 2 diabetes who take oral sulfonylurea agents that symptoms of hypoglycemia may also develop.

• Patients with diabetes should carry a form of simple sugar with them at all times.

• Patient is discouraged from eating high-calorie, high-fat foods to treat hypoglycemia, because high-fat snacks may slow absorption of the glucose.