Hypoglycemia

Pathophysiology

Metabolism depends primarily on glucose for fuel

The brain is dependent on continual supply of glucose diffusing from the blood into the interstitial tissue within the CNS system and into the neurons.

The brain is on the first organs affected if the amount of glucose supplied by the blood falls

Low blood sugar levels.

Common in type 1 diabetes

Causes: Drugs, critical illness, hormonal deficiency

Signs & Symptoms

shaking,
tachycardia,
sweating,
anxious,
dizziness,
hunger,
impaired vision,
weakness,
fatigue,
headache irritable

Medications

Sulfonylureas:
most widely used drugs for the treatment of type 2 diabetes and appear to function by stimulating insulin secretion.

Metformin:
most often used in patients with type 2 diabetes who are obese, because it promotes modest weight reduction or at least weight stabilization. This is in contrast to the increased appetite and weight gain often induced by insulin and sulfonylureas. Metformin typically lowers fasting blood glucose concentrations

THIAZOLIDINEDIONES:
Avandia (Rosiglitazone) and Actos (Pioglitazone) reverse insulin resistance by acting on muscle, fat, and to a lesser extent liver to increase glucose utilization and diminish glucose production.

ALPHA-GLUCOSIDASE INHIBITORS:
Acarbose (Precose) & Miglitol (Glycet) inhibit the upper gastrointestinal enzymes that convert dietary starch and other complex carbohydrates into simple sugars which can be absorbed. The result is to slow the absorption of glucose after meals.

Pertinent Assessment Findings

WHEN TO SEEK HELP: CALL 911


  • remain confused 15 minutes after being treated with glucagon.


  • unconscious (or nearly unconscious) and glucagon is not available.


  • continue to have low blood sugar despite eating adequate amounts of a fast-acting carbohydrate or receiving glucagon.



TAKE NOTE: will be given treatment intravenously (IV) to raise your blood sugar level immediately

Normal fasting blood glucose for an adult is 70 to 105 mg/dL. Critical values for hypoglycemia are less than 40 to 50 mg/dL.

Manifestations of hypoglycemia may depend on every individual but are consistent in the same individual.


The signs are the result of both increased adrenergic activity and decreased glucose delivery to the brain.

Patient Education

Teach patient on blood sugar management

Promote and encourage physical activity

Encourage patient to keep recordings of numbers in a notebook

Educate the patient on short term and long term effects of medication

Educate the patient of rule of 15

give 15 grams of carbs

recheck BG after 15 minutes

give 15 g of carbs again if BG not over 70

Interventions

Assess medications taken regularly.

Access for hypoglycemia

Assess blood glucose level before meals and at bedtime.

Assess for anxiety, tremors, and slurring of speech. Treat hypoglycemia with 50% dextrose.

Assist the patient in identifying eating patterns that need to be modified.

Administer insulin medications as directed.

Provide food or other sources of glucose as directed for hypoglycemia.

Educate the patient about the proper ways of taking prescribed medications.

Discuss the importance of balance exercise with food intake.