Hypoglycaemia

Questionnaire/history: Blood glucose less than 3.5 mmol/L? Past medical history? Family history? Current medication? Management: 10–20 g of a fast-acting form of carbohydrate, preferably in liquid form as this is easier to take, eg - 3–6 glucose tablets - 90–180 mL of fizzy drink or squash - 50–100 mL of Lucozade Energy® (contains 26% glucose syrup per 100 mL) - 2–4 spoonfuls of sugar added to a cup of drink (for example water) - sweets (eg 4 large jelly babies or 7 large jelly beans) - 1–2 tubes of Dextrogel®) (for children and young people, approximately 0.3 g/kg of fast-acting carbohydrate) Recheck blood glucose levels after 10–15 minutes (Note: Hypoglycaemia should be reversed in about 10 minutes, improvements in signs and symptoms may lag behind improvement in blood glucose level.) No response or an inadequate response: - Repeat oral intake as above and re-test blood glucose levels after another 15 minutes Symptoms improve or normal blood glucose is restored: - If the next meal is due, the carbohydrate intake of that meal should be increased (for example with bread, potatoes, or pasta) - If the next meal is not due soon, the person should immediately eat some long-acting starchy carbohydrate (such as a sandwich or some biscuits) to maintain blood glucose Unconscious and unable to swallow (severe hypoglycaemia): - 1 mg of intramuscular (IM) glucagon (children younger than 8 years of age (or body weight less than 25 kg) 500 micrograms) Emergency transfer to hospital if: - IM glucagon is not available - Family/carers not trained to administer glucagon - Alcohol cause of or has contributed to the development of hypoglycaemia (intravenous [IV] glucose required) - No response to glucagon treatment within 10 minutes for treatment with IV glucose Person responds to glucagon treatment within 10 minutes and is sufficiently awake and able to swallow safely: - To eat some oral carbohydrate (to replace the body's supply and to prevent relapse of hypoglycaemia) Note: Vomiting common in the recovery phase, and recurrent hypoglycaemia may recur Consequently, close monitoring with regular checking of blood glucose If hypoglycaemia recurs, the person may require additional oral carbohydrate or urgent hospital admission for treatment with IV glucose (if symptoms are severe) Nocturnal hypoglycaemia: - To eat a snack before bedtime and to keep a source of fast-acting carbohydrate next to the bed -> To check blood glucose between 2 am and 3 am - To review insulin regimens, evening eating habits and recent physical activity (or changes in physical activity) Reference(s): NICE CKS: When should I suspect hypoglycaemia in a person with type 1 diabetes? NICE CKS: When should I suspect hypoglycaemia in a person with type 2 diabetes?