‫‪HYPOGLYCEMIA‬‬
‫‪IN DIABETIC‬‬
‫‪PATIENT‬‬
‫‪PRESENTED BY :‬‬
‫االء عبدهللا محمد علي‬
‫فاطمة محمد يوسف الساقزلي‬
‫مبروكة نصر الوقاع‬
‫رتاج احسين اوحيدة‬
‫ايناس‬
OUR GOALS :
➢ Presenting the Case Scenario
➢ ​Answer the possible questions
➢ Introduction of hypoglycemia
➢ management
➢ ​prevention
THE CASE
Dania. 7yrs old, known case of type I DM
for 3yrs,
she is on Novo rapid pre meal and 14 fU Lantus
once at morning she presented to the casualty
last night because of abnormal movement.
At afternoon Dania visited her grandma,
when she came back to home she started to complain from
headache, she became pale, sweaty then developed tonic
convulsion involved LT upper limb associated with rolling up of
her eyes and bluish discoloration of lips, mam gave her
some honey and convulsion stopped, mam did not record
blood sugar at that time, this event lasted for about
2 min followed by lethargy and sleep.
No history of fever, no vomiting or diarrhea,
No palpitation or blurred vision, no previous history
of head trauma.
Mam explained this attack by heavy
exercise.
.
QUESTION :
Q.1
Q.2
Q.3
Q.4
What are the
information’s should be
taken in the history ?
What could be D/D her
condition ?
How to manage
hypoglycemic attacks in
diabetic patients ?
Mention one of
emergency treatment
could be used in this
situation ?
.
Q.1 WHAT ARE THE INFORMATION’S SHOULD BE TAKEN IN
THE HISTORY ?
● last time eat or take insulin before
the attack ?
● blood sugar measurements before
and after attack?
● When she went to her grand mother
• take extra dose insulin
• who gave the routine dose ?
•Adjustment of the does to exercise
and playing
• change diet or missed meal ?
• Matching with food?
• measure the blood suger after attack
in afternoon?
● change in diet or medication regimen
recently?
● change in exercise routine recently?
● experience any symptoms before
and attack such as .. Sweating
,shaking, dizziness, pallor?
( to exclude Hypoglycemia symptoms )
● other symptoms such as Polyuria
Polydipsia, Vomiting ,Abdominal pain
,Cozumel breathing ( to exclude DkA
symptoms)
● other symptoms such as
Generalized or localized abnormal
movement, unrolling eye, forty
secretion from mouth
• headache ,photophobia , projectile
Vomiting ( to exclude cns symptoms)
.
Q.1 WHAT ARE THE INFORMATION’S SHOULD BE TAKEN IN
THE HISTORY ?
PAST MEDICAL :
●Dm (H\o Admitions \ ICU )
• Drug names
• doses
• Route
• change site of administration
• given by who?
• eating after
• regular meals and snaks, healty diet
● S\E
• Episodes of low blood sugar in the
past ?
if yes what’s the trigger?
• H\o DKA
● Adjustment of the insulin to heavy
exercises and illness
● Educated on how to recognize and
treat hypoglycmia
● Regular monitering of blood
sugar
● How to use glucometer
● Regular follow up
● Psychological impact of DM in
patient and parents
● school preference
● outcome of parents
● other medical conditions
● family history of chronic disease
Q.2 WHAT COULD BE D/D
OF HER CONDITION?
❑ Hypoglycemia (most likely)
❑ epilepsy
❑ meningitis
❑ stroke
❑ Brain tumor
❑ cerebral edema
Q.3
Q.3 ?
How to manage hypoglycemic attacks in diabetic patients
How to
manage
hypoglycemic
attacks in
diabetic
Lorem ipsum dolor sit amet, adipiscing elit
patients ?
➢ WHAT'S HYPOGLYCEMIA ?
Hypoglycemia is a condition that occurs when the blood
glucose level in a diabetic patient drops below normal
levels (CHILD less than 70 mg/dL) , neonate according to age and
sex (less than 40mg/dl)
This can happen due to various reasons such as
1-taking too much insulin or other diabetes medications,
skipping meals, exercising excessively.
2- Growth hormone deficiency
3-hypothyroidism
4-insulimoma
5-addison disease
Symptoms of hypoglycemia include
sweating, shaking, dizziness, confusion, irritability,
pallor, abnormal behavior and weakness.
If left untreated, severe hypoglycemia can lead to seizures, loss of
consciousness or even death
Note: Diabetic patients are advised to monitor their blood
glucose levels regularly and take appropriate measures to prevent hypoglycemia
.
●Diagnosis:
✓ Clinically( presence of symptoms )
✓ Investigation :
1-blood glucose montring (Gluometer,laboratory)
2-hormone: insulin, growth hormone ,sex hormones
(androgen,estrogen,progesterone), TFT,cortisol
3- c-peptides level
4-urine anylsis
5-serum for ketone body and
FFA
6- Imaging tests: In some cases, MRI or CT scans may be used to investigate if
there is an underlying condition such as a tumor or pancreatic disease causing
hypoglycemia.
MANAGEMENT
DEPEND ON :
Conscious level
severity
Q.3 How to manage hypoglycemic attacks
in diabetic patients ?
❑ IN CONSCIOUS PATIENT (MILD TO MODERATE )
➢ ROLE OF 15
WE NEED APPROXIMATELY 15 GRAMS OF GLUCOSE TO
CORRECT HYPOGLYCEMIA
➢ TAKE AT LEAST ½ CUP FRUIT JUICE , 3 SPOONS OF
SUGAR IN GLASS OF WATER OR SPOON OF HONEY.
➢ 3 GLUCOSE TABLETS
➢ AFTER 15 MINUTES, CHECK YOUR BLOOD SUGAR AGAIN
AND REPEAT A DOSE OF FAST-ACTING CARBOHYDRATES
2 OR 3 UNTIL BLOOD GLUCOSE INCRESASE TO >70MG/DL
➢ ONCE BLOOD GLUCOSE IS NORMALIZED ,CONSUME SNAK
AND MEAL CONTANING COMPLEX CARBOHYDRATES AND
PROTEIN IN ORDER TO AVOID RECURRENCE OF
HYPOGLYCEMIA
Q.3 How to manage hypoglycemic attacks
in diabetic patients ?
❑ IN UNCONSCIOUS PATIENT (SEVER) (EMERGNCY)
●ADMISSION
●CALL FOR HELP
●AIRWAY
●BREATHING
●CIRCULATION
➢ IF INTRAVENOUS ROUTE IS OPEN
▪ *ADMINISTER OF 10% DEXTROSE IV OVER 1-3 MINUTES IN INFANT , 25% DEXTROSE
IV IN CHILD *REPEAT THE BLOOD GLUCOSE TEST AFTER 5MINUTES
▪ *IF BLOOD GLUCOSE IS STILL 70 MG/DL, RE- ADMINISTER THE DOSE AND CHECK
SUGAR USING FINGERTIP WITHIN 5 MINUTES *REPEAT THE PROCEDURE UNTIL
THE GLUCOSE LEVEL >70 •MG/DL
➢ NO INTRAVENOUS ACCESS
▪ ADMINISTER 1 MG OF GLUCAGON SUBCUTANEOUSLY OR INTRAMUSCULARLY
▪ REPEAT THE BLOOD GLUCOSE TEST AFTER 15MINUTES
❖ IF BLOOD GLUCOSE IS STILL 70 MG/D, RE-ADMINISTER THE DOSE, AND CHECK
GLUCOSE USING FINGERTIP WITHIN 15 MINUTES, REPEAT PROCESS UNTIL
GLUCOSE LEVEL >70 MG/DL.
❖ PREVENTION
➢ monitor blood sugar levels
regularly and keep them within
the target range
➢ inform family and friends about
hypoglycemia and what
symptoms to look for so they
can alert you to early symptoms
➢ Great effort must be invested in
patient education on
hypoglycemia prevention and
management
➢ Education about adjustment of
the insulin doses before heavy
exercise
THANK YOU