-
All patients on sulfonylureas and/or insulin therapy should be able to self-monitor their blood glucose levels and be educated on the symptoms and signs and how to treat hypoglycaemia
-
Symptoms and signs of hypoglycaemia (confirmed by BGL < 4 mmol/L)
-
Sweating and fatigue
-
Palpitations, tremors and anxiety
-
Hunger
-
Dizziness and weakness
-
Confusion/cognitive impairment
-
Seizure and coma in severe hypoglcaemia
-
Older age
-
Previous episodes of severe hypoglycaemia
-
Loss of hypoglycaemic awareness
-
Long duration of diabetes
-
Erratic carbohydrate intake e.g. irregular meals, low carbohydrate diet
-
Renal impairment
-
Tight glycaemic control e.g. HbA1c < 48 mmol/mol
-
Beta blockade
-
Significant alcohol intake
-
Autonomic neuropathy
-
Severe hypoglycaemia or frequent episodes of mild hypoglycaemia requires urgent medical review to consider the cause(s) of hypoglycaemia and reduction in insulin and/or sulfonylureas as required
-
Missed meals
-
Exercise/physical activity
-
Alcohol
-
Too rapid an increase in insulin and/or sulfonylureas
-
Accidental overdose – NB the majority of insulin overdoses are intentional so screen for depression
-
Deterioration in renal function
-
Administering insulin into new injection sites if previous sites had lipohypertrophy
-
The law states that patients must not drive for 1 hour after an episode of mild hypoglycaemia and not for 24 hours after an episode of severe hypoglycaemia.
-
Appropriate treatment of hypoglycaemia will likely prevent severe rebound hyperglycaemia
-
Treatment of hypoglycaemia (blood glucose levels < 4 mmol/L)
-
Weight-based management of hypoglycaemia is more effective
-
Eat 0.3 grams/kg of body weight OR 30 grams of rapid acting carbohydrate
-
How to get 30 grams of rapid acting carbohydrate
-
10 Dextro or vita glucose tablets or 6 BD glucose tablets
-
30 grams of glucose powder
-
6 teaspoons of sugar dissolved in water
-
350 mL of fruit juice or non-diet/zero soft drink
-
18 jellybeans
-
2 tablespoons of honey
-
3 tablespoons of jam
-
2 Hypofit gels
-
Wait 15 minutes and re-check blood glucose level
-
If glucose level < 4 mmol/L repeat steps above until glucose > 4 mmol/L
-
Once glucose is > 4 mmol/L have a carbohydrate snack e.g. a slice of toast, 2 biscuits or crackers with cheese and recheck glucose levels in 30 minutes to ensure safe
-
If the patient becomes unresponsive and is unable to take carbohydrate replacement an ambulance should be phoned for. Glucagon 1 mg may be administered intravenously or intramuscularly, but has reduced efficacy in type 2 diabetes and should not delay treatment with IV or buccal glucose.