Hypoglycaemia
Diabetes Outreach
(June 2011)
Hypoglycaemia
Learning outcomes
> Can state what hypoglycaemia is
> Be able to assess who is at risk of
hypoglycaemia
> Be able to recognise a hypo event
> Can state the treatment of a hypo in a health
service and in the community
> Is aware of the ways that hypo’s can be
prevented.
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What is hypoglycaemia?
> In people with diabetes who are at risk,
hypoglycaemia can cause signs and
symptoms.
> Hypoglycaemia is usually defined as a BGL
less than 4mmol/L.
> The BGL at which signs and symptoms occur
can vary from person to person.
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Features of hypoglycaemia
Symptoms of hypoglycaemia
occur as a response to adrenaline
(pale skin, sweating, shakiness,
palpitations, tingling especially
around the lips, feeling of anxiety).
Due to decreased glucose in the
brain (hunger, confusion,
behaviour changes &
psychological reactions, seizures
and coma).
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Signs and symptoms
Signs
blood glucose level
< 4.0mmol/L
Symptomatic (sometimes)
unconscious
Symptoms:
hunger / sweating
faintness / dizziness
trembling
palpitations
headache
irritability / confusion
unconsciousness
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Causes of hypoglycaemia
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missing or delaying a meal or snack
inadequate carbohydrate intake
over-administration of insulin/OHA
prolonged exercise
excessive alcohol
vomiting.
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Who’s at risk?
Consider
> types of diabetes
> age of the person
> duration of diabetes
> type of medication
> hypo awareness
> diabetes complications
> weight
> exercise
> excessive alcohol intake.
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Treatment of conscious person
Step 1
BGL <4.0mmol/L give 15g fast acting
carbohydrate (CHO) eg 90ml Lucozade, or
15g glucose tablets or equivalent.
Step 2
Test BGL at 10 mins. If over 4 proceed to step
3, if under repeat step 1.
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Treatment of conscious person
Step 3
Give slow acting CHO eg 2 biscuits or 1
piece of fruit or 1 cup (250ml) of milk or
equivalent or the person’s regular meal if
available.
Step 4
Ensure person receives and eats a normal
meal (adequate CHO serves) when next due.
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Unconscious hypoglycaemia
> If the person is unable to safely swallow then
glucagon needs to be administered either IM or
SC.
> People at significant risk of unconscious hypo
need to receive education about glucagon. A
caregiver or family member will require training.
> In a hospital or health service, nurses can
administer glucagon using a standing order.
> If no response to glucagon 50% IV glucose will
need to be ordered by MO.
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Administration of:
Glucagon (IM) is used when a person is
unconscious. Given intramuscular (but can be
given subcutaneous or intravenously).
Requires approx 6-10 minutes for peak onset of
action.
Glucose (IV) given as 10ml of 50% glucose
intravenously.
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Diabetes Manual 2010
Follow up
Follow-up post severe ‘hypo’:
> reassess person 15-30mins post hypo
> check BGL after 30mins from initial time
if level is <4mmol/L repeat step 1 & 2
> may need IVT (5% Dextrose)
> BGL 2-4 hourly for 12-24 hours (depending
on severity and duration)
> documentation of event.
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‘Hypo’ kit for health services
A ‘hypo’ emergency kit can be assembled and
placed in every ward or community health area
and should contain at least the following:
Quickly digested CHO: 1 bottle 50g Lucozade
(90ml = 15g CHO)
Slowly digested CHO: Biscuits.
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‘Hypo’ kit for health services
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Hypo action plans in the
community
> All people at risk of hypo should have an
action plan.
> A hypo kit is central to this action plan.
> Ask the person what foods they would like to
keep in their hypo kit.
> A hypo kit makes sure the person has
planned for a hypo in various situations.
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Case scenario
Lucy is 70yrs old.
She has had type 2 diabetes for 20yrs.
She is on a reduced dose of Metformin, Daonil
(sulphonylurea) and a basal insulin.
Over the past 4 years her weight has dropped
slightly from 63kgs to 57.
She lives alone.
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My ‘hypo’ plan
BG
___________________________
Step 1
at home ___________________________
out / car ___________________________
Step 2
monitor BG – 10-15 min and repeat step 1 until BG over 4
or
Step 3
____________________________
at home ____________________________
out / car ____________________________
Step 4
monitor BG – 1-2 hour increasing gap time until happy no repeat
hypo
or
____________________________
NB ________________________________________ ___________
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Question
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Is Lucy at risk of hypoglycaemia?
What makes her high risk?
How would you address the risk factors?
Use the hypo action plan on the next slide to
assist with the discussion.
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Summary
> Important that nurses assess the persons
knowledge and self care of hypoglycaemia.
> People should have an action plan in place
for hypoglycaemia.
> All health services and hospitals should have
a protocol in place for treatment of hypo and
a hypo kit that is easily accessible in all
patient care areas.
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References
> Cryer P E, Davis S N, and Shamoon H S
(2003) Hypoglycemia in diabetes. Diabetes
Care, 26(6): p1902-1912.
> Diabetes Outreach (2009) Diabetes Manual,
Section 4: Hospitalisation, Section 11:
Unstable diabetes.
> Diabetes Outreach (2011) Low blood glucose
in type 2 diabetes (hypoglycaemia) factsheet.
http://diabetesoutreach.org.au/consumer/defa
ult.asp
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