Presentation title
Emergency Care
Part 2: Treating and Preventing
Hypoglycaemia
Slide no 2
Emergency care
1
Managing DKA
2
Treating and preventing hypoglycaemia
3
Surgery in children with diabetes
Slide no 3
Hypoglycaemia
• One of the most common acute complications of
diabetes
• Low blood glucose
• May causes severe symptoms
• Coma or seizures
• Limitation in the management of diabetes
• Effective treatment and prevention are key
Slide no 4
Criteria
• Symptoms of hypoglycaemia occur around <3.5
mmol/l (but not always!)
• Awareness of symptoms depend on background
values
• Confusion may occur with rapidly dropping BGs but
also with only modest hypoglycaemic values
• Counter regulation in individuals without diabetes
begins at <4 mmol/l
• “Hypo” or “low sugar” symptoms due to bodies’ selfcorrecting hormonal responses (adrenalin)
Slide no 5
Symptoms
• Trembling
• Rapid heart rate
• Pounding heart (palpitations)
• Sweating
• Pallor
• Hunger and/or nausea
• Irritability
Neuroglycopenia
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Difficulty concentrating
Irritability
Blurred or double vision
Disturbed colour vision
Difficulty hearing
Slurred speech
Poor judgement and
confusion
• Dizziness and unsteady
gait
• Tiredness
• Nightmares
• Inconsolable crying
• Loss of consciousness
• Seizures
Slide no 7
DCCT and now standard
Classification of severity
• Mild Hypoglycemia
• Recognition and self treatment
• Usually <3.9 mmol/l
• Moderate Hypoglycemia
• Aware of symptoms
• Needs assistance to take care of themselves
• Severe Hypoglycemia
• Loss of consciousness (coma), convulsion, marked
confusion
• Usually <2.5 mmol/l
Slide no 8
Management
• Identify hypoglycaemia
• Symptoms
• Blood glucose values
• Teach how to recognize and manage hypoglycaemia
• Learn symptoms
• Learn responses to symptoms
• Re-enforcement by family and heath care workers
• Treat the hypoglycaemia
• Determine cause (when possible)
Slide no 10
Treatment (1)
• Feed the child simple sugar
• Rapid acting carbohydrate e.g. sweetened drinks, fruit
juices, glucose in water, sweets, packet of sugar
• Enough to make symptoms go away… don’t overtreat
• Give 0.3 g/kg of glucose if available
• Follow up with regular meal or snack – controversial but
certainly reasonable if less than optimal monitoring
possible
Treatment (2)
• If the child has severe symptoms
• Not able to eat
• Glucagon (0.5 mg for age <12 yr, 1.0 mg for ages >12
yr)
• IV glucose (3 ml/kg of 10% dextrose, 1 ml/kg of 30%
dextrose)
• Oral rapid acting foods - glucose, sugar or honey
Slide no 12
Determine cause
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Too much insulin – dose error or timing
Too little/late food
Increased activity, sometimes hours later
Illness, esp. gastrointestinal viruses
Alcohol
• Does not cause hypo but makes it nearly impossible for
body to self-correct since “liver is busy”
• Knowing cause helps to avoid future hypoglycaemia
Slide no 13
Prevention
• Reminders about the symptoms of hypoglycaemia
• Reminders about the causes
• Help to identify risk factors e.g. age, longer duration of
diabetes, higher doses, etc.
• Repeated episodes of hypoglycaemia should result in
specific advise to prevent recurrences
• Re-involve adults and caregivers/direct supervision
• Often some psychological issues
Questions
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