Hypoglycemia
Pathophysiology
Medications
Interventions
Pertinent Information
Patient Education
Hypoglycemia can be a result from other causes besides the pharmacologic treatment of diabetes
abnormalities with the regulation of blood glucose, levels of insulin, availability to glucagon, catecholamines secretion, growth hormone, and cortisol
Other known causes of hypoglycemia include: pancreatic tumors, adrenal insufficiency, liver disease, and pituitary disorders
Some cases: cause of hypoglycemia is unknown
syndrome that is developed when blood glucose levels fall to less than 70 mg/dL
Three categories for the causes of hypoglycemia are: 1) exogenous, 2) endogenous, and 3) functional
Exogenous causes: outside factors that act on the body to produce a low blood glucose. Include: insulin, oral hypoglycemics, alcohol, and exercise
Endogenous causes include: organic hypoglycemia and extrapancreatic neoplasms
Functional causes of hypoglycemia include: alimentary hypoglycemia, drug -related (ethanol, haloperidol, pentamidine, salicylates) reactive hypoglycemia, drinking alcohol on an empty stomach, rapid discontinuation of total parenteral alimentation, glucocorticoid deficiency, severe liver deficiency, lack of body stores for protein/fat/carbohydrates, and prolonged muscular exercise
Hypoglycemia is indicated when a patient's blood glucose levels are below 70 mg/dL
Signs and symptoms depend on how quickly blood glucose levels are failing
Rapid fall in blood glucose levels: secretion of epinephrine, cortisol, glucagon, and growth hormone in order to increase glucose levels
Adrenergic symptoms that are the result of the physiologic response include: weakness, hunger, diaphoresis, tremors, anxiety, irritability, headache, pallor, and tachycardia
Neuroglycopenic symptoms include: confusion, weakness, dizziness, blurred/double vision, seizure, and comas (severe cases)
To diagnose a person with hypoglycemia: health care providers would have to obtain the person’s fasting blood glucose, OGTT, administration of a intravenous glucose tolerance test, and 72-hour inpatient fasting
Diagnosis of hypoglycemia is based on Whipple’s triad: 1) presence of symptoms, 2) documentation of low blood glucose when symptoms occur, and 3) improvement of these symptoms when blood glucose rises (must occur in absence of sulfonylurea treatment/abnormal plasma insulin/C peptide)
15/15 Rule
15 grams of carbohydrates, wait 15 minutes, and retest. If there is no improvement in the patient's condition, another 15 grams of carbohydrates should be administered (be cautious of rebound hypoglycemia
15 grams of carbohydrates can be made made up of the following: 3-4 glucose tablets, 4-5 hard candies, ½ cup of fruit juice, one cup of milk, or 4-6 ounces of non diet soda
proper food intake
restriction of carbohydrates to no more than 100 grams a day
avoiding simple sugars
encouraging intake of complex carbohydrates
encouraging a high-protein diet
having smaller and frequent meals
avoiding alcohol
how to monitor blood glucose levels (how to use a glucose blood meter)
how to bring up blood glucose levels
administer glucagon
give patient a fast-acting sugar (ex. cup of orange juice)
give patient a high-protein snack
How to check blood glucose, Step 1: Wash hands/proper hand hygiene. Obtain blood glucose meter.
How to check blood glucose, Step 2: Assure device is on and insert test strips into the blood glucose meter.
How to check blood glucose, Step 3: Use the lancing device on the side of the fingertip to get a drop of blood (poke finger using lancing device).
How to check blood glucose, Step 4: Touch and hold edge of the test strip to drop the drop of blood and wait for result
How to check blood glucose, Step 5: Blood glucose level should appear on the meter’s display. Patients should compare blood glucose levels with normal levels of blood glucose. Patients may have to retake blood glucose if not enough blood was provided or there was an error with the blood glucose meter.
Monitoring blood glucose serum levels to be sure they are between 70-100 mg/dL before a meal, and no higher than 180 mg/dL after meals.
administering glucagon
giving the patient a food or beverage item has fast-acting sugar
to increase blood sugar: giving the patient a high-protein diet snack
symptoms/signs of hypoglycemia
shakiness, dizziness, sweating, hunger, increased heart rate, inability to concentrate, confusion, irritability, moodiness, anxiety, nervousness, and headache
Signs of a hypoglycemic episode at night time (occurs while sleeping) include: damp sheets or night clothes due to diaphoresis, nightmares, tiredness, irritability, or confusion upon waking
what events may occur if hypoglycemia is untreated
clumsiness or jerky movements, inability to eat or drink, weakness in muscles, have difficulty speaking, slurred speech, blurry or double vision, drowsiness, confusion, convulsions, seizures, unconsciousness, comas, and death.
contact doctor
need changes in medication/dosage/timing/adjustments to diabetes treatment regimen
experiencing serious problems or symptoms, which also may require emergency care
glucose supplements
glucose-elevating agents
inhibitors of insulin secretion
glucagon
glucagon intranasal
dextose
diazoxide
octreotide