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Hypoglycaemia

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

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Hypoglycaemia

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  1. Hypoglycaemia Diabetes Outreach(June 2011)

  2. 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.

  3. 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.

  4. 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).

  5. Signs blood glucose level < 4.0mmol/L Symptomatic (sometimes) unconscious Symptoms: hunger / sweating faintness / dizziness trembling palpitations headache irritability / confusion unconsciousness Signs and symptoms

  6. Causes of hypoglycaemia • missing or delaying a meal or snack • inadequate carbohydrate intake • over-administration of insulin/OHA • prolonged exercise • excessive alcohol • vomiting.

  7. 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.

  8. Treatment of conscious person Step 1 BGL <4.0mmol/L give 15g fast acting carbohydrate (CHO) eg 90ml Lucozade, or15g glucose tablets or equivalent. Step 2 Test BGL at 10 mins. If over 4 proceed to step 3, if under repeat step 1.

  9. 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.

  10. 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.

  11. 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.

  12. Diabetes Manual 2010

  13. 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.

  14. ‘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.

  15. ‘Hypo’ kit for health services

  16. 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.

  17. 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.

  18. 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 ___________________________________________________

  19. Question • 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.

  20. 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.

  21. 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/default.asp

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