Hypoglycaemia Guidelines for patients with Diabetes Mellitus

What is hypoglycaemia (hypo)?

Hypoglycaemia is when a patients blood glucose level falls too low [CAPILLARY BLOOD GLUCOSE < 4.0 mmol/L]. If the patient is taking certain tablets (Sulphonylurea, ie Gliclazide), or insulin, there is a risk of hypoglycaemia.

What are the symptoms?

The most common symptoms include: Shaking, sweating, intense hunger, lack of concentration, pallor, tremor (neurogenic symptoms)

Or
Headaches, mood changes, aggressiveness, slurred speech, drowsiness or coma (neuroglycopenic symptoms)

Or
Diabetes patients (particularly those on insulin) may have a low CBG < 4.0 mmol/L with no symptoms (hypoglycaemia unawareness). If no symptoms, repeat CBG, if < 4.0 mmol/L, take venous glucose sample and then treat hypoglycaemia (as per Beaumont Hospital policy document).

Treatment of Hypoglycaemia
Is the patient conscious and able to swallow safely?
No
Acute hypoglycaemia If unconscious:
Give 25-50ml 50% Dextrose IV via minijet into a large patent vein. Follow with a saline flush. * 50% dextrose must be administered into a large patent vein to avoid extravasation Step 1 Give some 'quick-acting' sugar immediately 120 mls or of a small bottle of Lucozade (half a tea-cup) or 200 mls of fruit juice (one tea-cup/small carton) or 200 mls or of a small bottle of fizzy drink (ordinary Coke or Orange - not DIET) or 5 to 6 Lucozade sweets

Yes

If drowsy/semi-conscious/nil orally:
1. Give 10-20ml 50% Dextrose IV via minijet into a large patent vein. Follow with a saline flush. Repeat after 5 minutes if no effect * 50% dextrose must be administered into a large patent vein to avoid extravasation 2. Give 1mg Glucagon IM if there is no intravenous access. Repeat after 15 minutes if no effect. Glucagon is ineffective in hepatic dysfunction and / or glycogen depletion eg. Alcohol- related hypoglycaemia. As soon as the patient is alert and conscious follow steps 1 & 2 (This is not a prescription; prescribe on patients Drug Kardex)

Repeat capillary blood glucose in 10 minutes

Capillary Blood glucose < 4.0 mmol/L Repeat Step 1

Capillary Blood glucose 4.0 mmol/L

Step 2 If next meal is due within 1 hour, no further treatment is required and next meal is taken as normal. Otherwise give a 'slow-acting carbohydrate snack, e.g. 1 slice of bread / 2 biscuits If patient is on NG / PEG feeding:
Give 120 mls Lucozade via tube followed by 100 mls sterile water

If the capillary blood glucose is < 4.0 mmol/L and the patient is due insulin, treat hypoglycaemia first (As above) and give the insulin in the middle or towards the end of the meal. Why do patients have hypos?
Eating inadequate carbohydrate / Poor appetite Missing a meal or snack Timing of insulin or Sulphonylureas Too high a dose of Sulphonylureas / insulin

Refer to Diabetes Nurse Specialist / Endocrine Registrar as appropriate

Approved by Insulin Prescription Committee 2009