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Hypoglycaemia

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An insightful presentation on issue of Hypoglycaemia in patients of Diabetes Mellitus with focus on causes, symptoms and management. Also find included experience based inputs on issue of vehicle driving and hypoglycaemia

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Hypoglycaemia

  1. 1. Hypoglycaemia
  2. 2. Causes of Hypoglycaemia
  3. 3. Hypoglycemia: Possible Causes  Diet changes  Insufficient carbohydrate intake  Lack of food  Delayed food intake  Skipping a meal  Changes in physical activity/Extra/unanticipated physical activity  Excess walk, gym, exercise  Exercise without food intake, on empty stomach  Medication changes  Sulphonylureas, meglitinides: intiation, dose changes  Insulin: initiation, intensification  Illness  Stress 6
  4. 4. Low blood glucose Presence of symptoms Reversal of these symptoms when blood glucose levels are restored Whipple’s triad - Hypoglycaemia
  5. 5. 14 Hypoglycemia: Possible Signs & Symptoms Mild Symptoms Hunger Sleepiness Shakiness Changed behavior Weakness Sweating Paleness Anxiety Blurry vision Dilated pupils Increase heart rate or palpitations Moderate to Severe Symptoms Yawning Confusion Irritability/frustration Restlessness Extreme tiredness/fatigue Dazed appearance Inability to swallow Unconsciousness/coma Sudden crying Seizures
  6. 6. Management of Hypoglycaemia
  7. 7. HYPOglycemia = LOW Glucose (sugar) Onset: • sudden, must be treated immediately • may progress to unconsciousness if not treated • can result in brain damage or death DMMP should specify signs and action steps at each level of severity: • mild • moderate • Severe DMMP – Diabetes Medical Management Plan 22
  8. 8. Hypoglycemia: Risks & Complications  Early recognition and intervention can prevent an emergency  Greatest immediate danger  Not always preventable  Impairs cognitive and motor functioning 23
  9. 9. Mild/Moderate Hypoglycemia: What to do Intervene promptly: • Check blood glucose if meter is available. • If no meter is available, treat immediately, on the spot. • NEVER send the patient with suspected low blood glucose anywhere alone • When in doubt, always treat. If untreated may progress to more serious events. • Consider “Rule of 15” 24
  10. 10. “Rule of 15” General guidelines: • Have the patient to eat or drink fast acting carbs (15g) • Check blood glucose 10-15 minutes after treatment • Repeat treatment if blood glucose level remains low or if symptoms persist • If symptoms continue, call physician 25
  11. 11. Quick Acting Glucose for Mild/Moderate Hypoglycemia Treatment for Lows: 15 g Carbohydrate • 4 oz. fruit juice • 15 g. glucose tablets (3-4 tablets) • 1 tube of glucose gel • 4-6 small hard candies • 1-2 tablespoons of honey • 6 oz. regular (not diet) soda (about half a can) • 3 tsp. table sugar • One-half tube of cake mate 26
  12. 12. Severe Hypoglycemia: What To Do 29
  13. 13. Hypoglycaemia and driving  Safe driving requires constant integration of mental integration of mental functions, includes:  Visual and auditory processing,  Motor skills;  Reasoning, logic or problem solving  1st symptoms of hypoglycaemia appears when blood glucose < 70 mg/dl  Varies from person to person  Hypoglycaemia causes nervousness, tremors, tiredness, confusion and retarded mental functions  Functions, mainly affected by hypoglycemia include:  Rapid decision making,  Sustained attention,  Analysis of complex visual stimuli  Hand-eye coordination
  14. 14. Precautions to be taken:  Avoid driving if possible  Do not drive alone  Measure blood glucose level before driving and no drive if it is below 5 mmol/L (90 mg/dL)  Frequently recheck blood glucose levels when on long journey (2 hourly)  Always carry rapid acting carbohydrate eg. Glucose sachets  If BG < 90 mg/dL or symptoms of hypoglycaemia, discontinue driving and consume rapid acting carbohydrate  Not to drive till 30 to 45 min after restoration of blood glucose  To carry “I am a diabetic” card and emergency contact no. and stick “I am a diabetic” stickers on car with emergency contact no.

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