Hypoglycaemia

• hypoglycaemia is a blood glucose concentration less than 4 mmol/L
• Symptoms:

  ·       Feeling hungry- first sign

  ·       Sweating

  ·       Dizziness

  ·       Fatigue

  ·       Burred vision

  ·       Palpitations

  ·       Trembling or shakiness

  ·       Escalation of symptoms if untreated- confusion and reduced GCS
• Any patient with a blood-glucose concentration less than 4 mmol/litre, with or without symptoms, and who is conscious and able to swallow, should be treated with a fast-acting carbohydrate by mouth
• Fast acting carbohydrates:

  • Glucojuice
  • Glucose tablets
  • Glucose gels
  • Pure fruit juice
  • Sugar dissolved in water
• If necessary, repeat treatment after 15 minutes, up to a maximum of 3 treatments in total. Once blood-glucose concentration is above 4 mmol/litre and the patient has recovered, a snack providing a long-acting carbohydrate should be given to prevent blood glucose from falling again (e.g. two biscuits, one slice of bread)
• Hypoglycaemia which does not respond (blood-glucose concentration remains below 4 mmol/litre after 30–45 minutes or after 3 treatment cycles), should be treated with intramuscular glucagon or glucose 10% intravenous infusion.
• In alcoholic patients, thiamine supplementation should be given with, or following, the administration of intravenous glucose to minimise the risk of Wernicke's encephalopathy.
• In an emergency, if the patient has a decreased level of consciousness caused by hypoglycaemia, intramuscular glucagon can be given by a family member or friend who has been shown how to use it. If glucagon is not effective after 10 minutes, glucose 10% intravenous infusion should be given.
• Hypoglycaemia with unconsciousness, seizures or aggression:

  • Stop any IV insulin
  • Treat initially with IM glucagon
  • If no response after 10 mins, give 10% glucose infusion
  • Give long acting carbohydrate as soon as able to eat
• If an insulin injection is due, it should not be omitted; however, a review of the usual insulin regimen may be required.
• Blood-glucose monitoring should be continued for at least 24–48 hours