Very good presentation

1. HYPOGLYCEMIA
HYPOGLYCEMIA
BY: OSCAR LAGENIO
BY: OSCAR LAGENIO

2. OBJECTIVES
OBJECTIVES
At the end of this topic, the participants
At the end of this topic, the participants
will be able to:
will be able to:
To understand what term hypoglycemia
To understand what term hypoglycemia
means
means
To list the common symptoms of
To list the common symptoms of
hypoglycemia
hypoglycemia
To describe the common causes of
To describe the common causes of
hypoglycemia
hypoglycemia
To understand how to prevent &
To understand how to prevent &
effectively self manage hypoglycemia
effectively self manage hypoglycemia
reaction.
reaction.

3. HYPOGLYCEMIA
HYPOGLYCEMIA
DEFINITION
DEFINITION
defined as the development of autonomic
defined as the development of autonomic
and neuroglycopenic symptoms, a low
and neuroglycopenic symptoms, a low
blood glucose level (<4.0 mmol/L for
blood glucose level (<4.0 mmol/L for
people treated with insulin or insulin
people treated with insulin or insulin
secretagogue), and symptoms
secretagogue), and symptoms
responding to the administration of
responding to the administration of
carbohydrates.
carbohydrates.
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

4. HYPOGLYCEMIA
HYPOGLYCEMIA
UNAWARENESS
UNAWARENESS
Is the term given when people do not
Is the term given when people do not
experience the first stage symptoms and
experience the first stage symptoms and
are unaware that their blood glucose are
are unaware that their blood glucose are
low. Possible reasons for this include
low. Possible reasons for this include
frequent low or untreated blood sugar
frequent low or untreated blood sugar
levels, long standing diabetes and nerve
levels, long standing diabetes and nerve
damage.
damage.
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

5. CAUSES OF
CAUSES OF
HYPOGLYCEMIA
HYPOGLYCEMIA
Side effects of diabetes medications
Side effects of diabetes medications 1,2
1,2
Less intake of food
Less intake of food
Increased in physical activity
Increased in physical activity
Excessive alcohol intake
Excessive alcohol intake
Food malabsorption (celiac disease)
Food malabsorption (celiac disease)
1. O’Shaughnessey C, H. Hypoglycemia. Primary Care Reports Available from: CINAHL Plus with Full Text.
2. Sutton L, Chapman-Novakofski K. Hypoglycemia education needsAvailable from: MEDLINE.
3. Holt P. Effective management of hypoglycaemia in diabetes. Available from: CINAHL Plus with Full Text.

6. CAUSES OF
CAUSES OF
HYPOGLYCEMIA
HYPOGLYCEMIA
Poor injection technique
Poor injection technique
Insulin prescription & administration
Insulin prescription & administration
errors
errors
Mistiming of prescribed medication in
Mistiming of prescribed medication in
relation to food consumption.
relation to food consumption.
Holt P. Effective management of hypoglycaemia in diabetes. Available from: CINAHL Plus with Full Text.

7. SEVERITY OF
SEVERITY OF
HYPOGLYCEMIA
HYPOGLYCEMIA
MILD – autonomic symptoms are present.
MILD – autonomic symptoms are present.
The individual is able to self-treat.
The individual is able to self-treat.
MODERATE – autonomic &
MODERATE – autonomic &
neuroglycopenic symptoms are present.
neuroglycopenic symptoms are present.
The individual is able to self-treat.
The individual is able to self-treat.
SEVERE – individual requires assistance
SEVERE – individual requires assistance
of another person. Unconsciousness may
of another person. Unconsciousness may
occur.
occur.
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

8. SYMPTOMS OF
SYMPTOMS OF
HYPOGLYCEMIA
HYPOGLYCEMIA
AUTONOMIC
AUTONOMIC
Trembling
Trembling
Palpitations
Palpitations
Sweating
Sweating
Anxiety
Anxiety
Hunger
Hunger
Nausea
Nausea
Tingling
Tingling
NEUROGLYCOPENIC
NEUROGLYCOPENIC
 Difficulty concentrating
Difficulty concentrating
 Confusion
Confusion
 Weakness
Weakness
 Drowsiness
Drowsiness
 Vision changes
Vision changes
 Difficulty speaking
Difficulty speaking
 Headache
Headache
 Dizziness
Dizziness
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

9. TREATMENT OF
TREATMENT OF
HYPOGLYCEMIA
HYPOGLYCEMIA
 GOALS:
GOALS: To detect and treat a low blood
To detect and treat a low blood
glucose level promptly by using an intervention
glucose level promptly by using an intervention
that provide a rapid rise in blood glucose to a
that provide a rapid rise in blood glucose to a
safe level, eliminating the risk for injury, and
safe level, eliminating the risk for injury, and
relieving symptoms quickly.
relieving symptoms quickly.
 15 g of glucose will usually increase blood
15 g of glucose will usually increase blood
glucose by 2.1 mmol/L within 20 minutes with
glucose by 2.1 mmol/L within 20 minutes with
adequate symptom relief for most people.
adequate symptom relief for most people.
 20 g of glucose will usually increase blood
20 g of glucose will usually increase blood
glucose by 3.6 mmol/L within 45 minutes.
glucose by 3.6 mmol/L within 45 minutes.
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

10. TREATMENT OF
TREATMENT OF
HYPOGLYCEMIA
HYPOGLYCEMIA
MILD TO MODERATE HYPOGLYCEMIA
MILD TO MODERATE HYPOGLYCEMIA
 15 g of oral carbohydrates, preferably as glucose or
15 g of oral carbohydrates, preferably as glucose or
sucrose tablets or solution. Retest blood glucose in 15
sucrose tablets or solution. Retest blood glucose in 15
minutes; repeat treatment if BG still <4.0 mmol/L.
minutes; repeat treatment if BG still <4.0 mmol/L.
SEVERE HYPOGLYCEMIA (CONSCIOUS)
SEVERE HYPOGLYCEMIA (CONSCIOUS)
 20 g of oral carbohydrates (glucose tablets or
20 g of oral carbohydrates (glucose tablets or
equivalent); retest in 15 minutes & repeat treatment if
equivalent); retest in 15 minutes & repeat treatment if
BG still <4.0 mmol/L
BG still <4.0 mmol/L
SEVERE HYPOGLYCEMIA (UNCONSCIOUS)
SEVERE HYPOGLYCEMIA (UNCONSCIOUS)
 1 mg of GLUCAGON subcutaneously or
1 mg of GLUCAGON subcutaneously or
intramascularly or 10 to 25 g of glucose
intramascularly or 10 to 25 g of glucose
intraveneously (20 – 50 cc of D50W)
intraveneously (20 – 50 cc of D50W)
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

11. TREATMENT OF
TREATMENT OF
HYPOGLYCEMIA
HYPOGLYCEMIA
Examples of 15 g of carbohydrates:
Examples of 15 g of carbohydrates:
 4 glucose tablets
4 glucose tablets
 15 mL (3 teaspoons) or 3 packets of table sugar
15 mL (3 teaspoons) or 3 packets of table sugar
dissolved in water
dissolved in water
 175 mL (3/4 cup) of juice or regular drink
175 mL (3/4 cup) of juice or regular drink
 15 mL (1 teaspoon) of honey
15 mL (1 teaspoon) of honey
• To prevent repeated hypoglycemia, once the
To prevent repeated hypoglycemia, once the
hypoglycemia has been reversed, the person should
hypoglycemia has been reversed, the person should
have the usual meal or snack that is due at that time
have the usual meal or snack that is due at that time
of the day. If a meal is >1 hour away, a snack
of the day. If a meal is >1 hour away, a snack
(including 15 g CHO & a protein source) should be
(including 15 g CHO & a protein source) should be
consumed.
consumed.
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

12. PREVENTION OF
PREVENTION OF
HYPOGLYCEMIA
HYPOGLYCEMIA
Eat regular meals, have enough at each
Eat regular meals, have enough at each
meal, and try not to skip meals or
meal, and try not to skip meals or
snacks.
snacks.
Check blood sugar before sports,
Check blood sugar before sports,
exercise, or other physical activity and
exercise, or other physical activity and
have a snack if the level is lower than
have a snack if the level is lower than
expected.
expected.
Lowth M. Hypoglycaemia Prevention and management. 2012. Available from: Consumer Health Complete -
EBSCOhost.

13. PREVENTION OF
PREVENTION OF
HYPOGLYCEMIA
HYPOGLYCEMIA
Adjusting medication before physical
Adjusting medication before physical
activity.
activity.
Check blood glucose periodically after
Check blood glucose periodically after
physical activity.
physical activity.
Alcoholic beverages should always be
Alcoholic beverages should always be
consumed with a snack or meal at the
consumed with a snack or meal at the
same time.
same time.
Lowth M. Hypoglycaemia Prevention and management. 2012. Available from: Consumer Health Complete -
EBSCOhost.

14. PREVENTION OF
PREVENTION OF
HYPOGLYCEMIA
HYPOGLYCEMIA
Check blood sugar level before driving and
Check blood sugar level before driving and
at least every 4 hours (more often in cases
at least every 4 hours (more often in cases
of hypoglycemia unawareness) during long
of hypoglycemia unawareness) during long
drives.
drives.
Drivers should not drive when blood sugar
Drivers should not drive when blood sugar
level is below 4.0 mmol/L, and should not
level is below 4.0 mmol/L, and should not
begin to drive without prophylactic
begin to drive without prophylactic
carbohydrate treatment.
carbohydrate treatment.
Drivers should stop and treat themselves as
Drivers should stop and treat themselves as
soon as hypoglycemia is suspected.
soon as hypoglycemia is suspected.
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

15. PREVENTION OF
PREVENTION OF
HYPOGLYCEMIA
HYPOGLYCEMIA
Drivers should not drive until 45 to 60
Drivers should not drive until 45 to 60
minutes after the effective treatment of
minutes after the effective treatment of
mild to moderate hypoglycemia.
mild to moderate hypoglycemia.
Always carry blood glucose monitoring
Always carry blood glucose monitoring
equipment and supplies of rapidly
equipment and supplies of rapidly
absorbable carbohydrates within easy
absorbable carbohydrates within easy
reach when driving.
reach when driving.
2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

16. RECOMMENDATION
RECOMMENDATION
An immediate source of glucose or
An immediate source of glucose or
sucrose must be always available.
sucrose must be always available.
Equipment for blood glucose monitoring
Equipment for blood glucose monitoring
must be available for immediate
must be available for immediate
confirmation and safe management of
confirmation and safe management of
hypoglycemia.
hypoglycemia.
Lowth M. Hypoglycaemia Prevention and management. 2012. Available from: Consumer Health Complete -
EBSCOhost.

17. RECOMMENDATION
RECOMMENDATION
Glucagon should readily be accessible,
Glucagon should readily be accessible,
especially when there is a high risk of
especially when there is a high risk of
severe hypoglycemia. Education on
severe hypoglycemia. Education on
administration is essential.
administration is essential.
Wear some form of identification or
Wear some form of identification or
warning of their diabetes.
warning of their diabetes.
Lowth M. Hypoglycaemia Prevention and management. Available from: Consumer Health Complete -
EBSCOhost.