Hypoglycaemia

Causes of Hypoglycaemia

Hypoglycemia: Possible Causes

Diet changes Insufficient carbohydrate intake

Lack of food

Delayed food intake

Skipping a meal

Changes in physical activity/Extra/unanticipated physical activity Excess walk, gym, exercise

Exercise without food intake, on empty stomach

Medication changes Sulphonylureas, meglitinides: intiation, dose changes

Insulin: initiation, intensification

Illness

Stress6

Low blood glucose

Presence of symptoms Reversal of these symptoms when

blood glucose levels are restored

Whipple’s triad - Hypoglycaemia

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Hypoglycemia: Possible Signs & Symptoms

Mild Symptoms

Hunger Sleepiness

Shakiness Changed behavior

Weakness Sweating

Paleness Anxiety

Blurry vision Dilated pupils

Increase heart rate or palpitations

Moderate to Severe Symptoms

Yawning Confusion

Irritability/frustration Restlessness

Extreme tiredness/fatigue Dazed appearance

Inability to swallow Unconsciousness/coma

Sudden crying Seizures

Management of Hypoglycaemia

HYPOglycemia = LOW Glucose (sugar)

Onset: • sudden, must be treated immediately• may progress to unconsciousness if not treated• can result in brain damage or death

DMMP should specify signs and action steps at each level of severity:

• mild• moderate • SevereDMMP – Diabetes Medical Management Plan

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Hypoglycemia: Risks &

Complications

Early recognition and intervention can prevent an emergency

Greatest immediate danger

Not always preventable

Impairs cognitive and motor functioning

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Mild/Moderate Hypoglycemia: What to do

Intervene promptly:

• Check blood glucose if meter is available.

• If no meter is available, treat immediately, on the spot.

• NEVER send the patient with suspected low blood glucose anywhere alone

• When in doubt, always treat. If untreated may progress to more serious events.

• Consider “Rule of 15”

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“Rule of 15”

General guidelines:

• Have the patient to eat or drink fast acting carbs (15g)

• Check blood glucose 10-15 minutes after treatment

• Repeat treatment if blood glucose level remains low or if symptoms persist

• If symptoms continue, call physician

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Quick Acting Glucose for Mild/Moderate Hypoglycemia

Treatment for Lows: 15 g Carbohydrate• 4 oz. fruit juice

• 15 g. glucose tablets (3-4 tablets)

• 1 tube of glucose gel

• 4-6 small hard candies

• 1-2 tablespoons of honey

• 6 oz. regular (not diet) soda (about half a can)

• 3 tsp. table sugar

• One-half tube of cake mate

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Severe Hypoglycemia: What To Do

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Hypoglycaemia and driving

Safe driving requires constant integration of mental integration of mental functions, includes:

Visual and auditory processing,

Motor skills;

Reasoning, logic or problem solving

1st symptoms of hypoglycaemia appears when blood glucose < 70 mg/dl

Varies from person to person

Hypoglycaemia causes nervousness, tremors, tiredness, confusion and retarded mental functions

Functions, mainly affected by hypoglycemia include:

Rapid decision making,

Sustained attention,

Analysis of complex visual stimuli

Hand-eye coordination

Precautions to be taken: Avoid driving if possible

Do not drive alone

Measure blood glucose level before driving and no drive if it is below

5 mmol/L (90 mg/dL)

Frequently recheck blood glucose levels when on long journey (2 hourly)

Always carry rapid acting carbohydrate eg. Glucose sachets

If BG < 90 mg/dL or symptoms of hypoglycaemia, discontinue driving

and consume rapid acting carbohydrate

Not to drive till 30 to 45 min after restoration of blood glucose

To carry “I am a diabetic” card and emergency contact no. and stick “I

am a diabetic” stickers on car with emergency contact no.