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• Pathophysiology
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Hypoglycemia is a condition in which your blood sugar (glucose) level is lower than normal. Glucose is your body's main energy source.
Hypoglycemia is often related to diabetes treatment. But other drugs and a variety of conditions — many rare — can cause low blood sugar in people who don't have diabetes
Hypoglycemia needs immediate treatment when blood sugar levels are low. For many people, a fasting blood sugar of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L), or below should serve as an alert for hypoglycemia. But your numbers might be different. Ask your doctor.
Treatment involves quickly getting your blood sugar back to normal either with high-sugar foods or drinks or with medications. Long-term treatment requires identifying and treating the cause of hypoglycemia.
Medication
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Glipizide is a 2.5 mg to 10 mg tablet, taken as a single dose or in two divided doses, 30 minutes before breakfast. Glimepiride is available as a 1 mg, 2 mg, or 4 mg tablets, taken once a day with breakfast or twice a day with meals. For patients at increased risk for hypoglycemia, such as older patients or those with chronic kidney disease, the initial dose could be as low as 0.5 mg daily. Glyburide is available as a 1.25 mg, 2.5 mg, or 5 mg tablets, taken as a single dose or in two divided doses.
Repaglinide is available as a 0.5 mg, 1 mg, or 2 mg tablets, taken orally in two to three divided doses per day.
[Glucacon Tablets, Glucose, Sweetners, Candies, Orange Juice]
Alpha-glucosidase inhibitors are available as 25 mg, 50 mg, or 100 mg tablets, given three times a day just before meals.
Pioglitazone is given as 15 mg, 30 mg, or 45 mg tablets daily. Rosiglitazone, while rarely used, is given as 2 mg, 4 mg, or 8 mg daily.
Among the DPP- 4 inhibitors, linagliptin is available as 5 mg daily. Vildagliptin is given as 50 mg once or twice weekly, Sitagliptin as 25 mg, 50 mg, or 100 mg once daily, and Saxagliptin as 2.5 mg or 5 mg once daily.
Among the SGLT2 inhibitors, canagliflozin is initially given as 100 mg daily, which is gradually increased to 300 mg daily, dapagliflozin as 5 mg or 10 mg daily, and empagliflozin as 10 mg or 25 mg daily.
Cycloset has an initial dose of 0.8 mg once daily, which is gradually increased to the usual dose of 1.6 mg to 4.8 mg once daily.
Pertinent Assessment
Assess blood glucose levels before meals and at bedtime.
Monitor the patient’s HbA1c-glycosylated hemoglobin.
Weight daily.
To help assess the adequacy of nutritional intake.
Assess for anxiety, tremors, and slurring of speech.
Assess feet for temperature, pulses, color, and sensation.
To monitor peripheral perfusion and neuropathy.
Assess bowel sounds by auscultation and note any reports of abdominal pain, bloating, nausea or vomiting.
Monitor urine albumin to serum creatinine for renal failure.
Assess the pattern of physical activity.
Possible wounds
Explore patient’s health beliefs about physical exercise and review exercise program recommendations with the patient.
Assess the patient’s adeptness in self-monitoring of blood glucose.
Assess the patient’s current knowledge and understanding about the prescribed diet.
Patient Education
Teach patient how to perform home glucose monitoring.
Report BP of more than 160 mm Hg (systolic). Administer hypertensive as prescribed.
Instruct patient to avoid heating pads and always to wear shoes when walking.
Instruct patient to take oral hypoglycemic medications as directed
Reducing hypoglycemia: The patient must be cautioned to consume food along with alcohol, however, carbohydrate consumed with alcohol may raise blood glucose.
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Intervention
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Normalize insulin activity. This is the main goal of diabetes treatment — normalization of blood glucose levels to reduce the development of vascular and neuropathic complications.
Intensive treatment. Intensive treatment is three to four insulin injections per day or continuous subcutaneous insulin infusion, insulin pump therapy plus frequent blood glucose monitoring and weekly contacts with diabetes educators.
Exercise caution with intensive treatment. Intensive therapy must be done with caution and must be accompanied by thorough education of the patient and family and by responsible behavior of patient.
Diabetes management has five components and involves constant assessment and modification of the treatment plan by healthcare professionals and daily adjustments in therapy by the patient.
Nutritional Management:. Nutrition, meal planning, and weight control are the foundations of diabetes management.
Treatment—The "15-15 Rule": have 15 grams of carbohydrate to raise your blood sugar and check it after 15 minutes. If it’s still below 70 mg/dL, have another serving.
Avoid smoking, say goodbye to alcohol.
Say a (daily) hello to sufficient sleep (avoid late nights) and regular exercise.
Remember to carry some high protein snacks, for any emergency to deal with a dip in blood sugar.