All patients on sulfonylureas and/or insulin therapy should be able to self-monitor their glucose levels and be educated on the symptoms and signs and how to treat hypoglycaemia
Symptoms and signs of hypoglycaemia (confirmed by blood glucose level < 4 mmol/L)
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
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
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 level < 4 mmol/L) is weight-based. If the patient weighs > 70 kg they should eat 30 grams of rapid acting carbohydrate and if the patient weighs < 70 kg they should eat 15 grams of rapid acting carbohydrate
How to get 30 grams of rapid acting carbohydrate (halve for 15 grams)
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 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.
