Hypoglycemia

 

• Background

  Definition and causes

  • Defined as glucose <3 mmol/L (<2.6 in kids, <4 in hospital), with or without symptoms.
  • A side effect of diabetes treatment – insulin and sulfonylureas – not the disease itself.
  • Considered 'severe' if patient requires assistance to replace glucose.
  • Other causes in adults: alcohol, Addison's, insulinomas, autoimmune hypoglycaemia (insulin receptor antibodies).

  Triggers

  • ↑Insulin
  • ↑Activity
  • ↓Food
  • Alcohol, including up to 24h after drinking.
  • Infection

• Signs and symptoms

  Onset is usually rapid i.e. a few minutes.

  Autonomic response:

  • Shakes
  • Palpitations
  • Nervous
  • Hunger

  Neuroglycopenia:

  • Tingling
  • Numbness
  • Fatigue, drowsiness, confusion.
  • Coma, seizures.

  Can be asymptomatic.

• Management

  If oriented:

  • Eat/drink 10-20 g glucose quickly, then slower-release carbs once glucose >4.

  If confused but able to swallow:

  • 2 tubes GlucoGel squeezed into mouth.
  • If ineffective, treat as if unconscious.

  If unconscious:

  • Glucagon 1 mg IM/SC if at home.
  • Glucose IV if in hospital: 200 ml of 10% or 100 ml of 20%. Glucagon IM/SC if IV access difficult.
  • Switch to 10% IV or oral carbs if they regain consciousness.

  Also:

  • Thromboprophylaxis: LMWH + TED.
  • Take next insulin as scheduled.