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Hypoglycaemia and driving in India


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Management of Hypoglycaemia and dilemma of driving vehicles - Indian Scenario

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Hypoglycaemia and driving in India

  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.