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Type 2 Diabetes Management Guidelines

Management of hypoglycaemia

  • Symptoms and signs of hypoglycaemia (confirmed by blood glucose level < 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
  • Causes of hypoglycaemia
  • 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