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Hypoglycaemia
Causes of Hypoglycaemia
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
Low blood glucose
Presence of symptoms Reversal of these symptoms when
blood glucose levels are restored
Whipple’s triad - Hypoglycaemia
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
Management of Hypoglycaemia
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
Hypoglycemia: Risks &
Complications
 Early recognition and intervention can prevent an
emergency
 Greatest immediate danger
 Not always preventable
 Impairs cognitive and motor functioning
23
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
“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
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
Severe Hypoglycemia: What To Do
29
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
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.
Hypoglycaemia and driving in India
Hypoglycaemia and driving in India

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Hypoglycaemia and driving in India

  • 2.
  • 3.
  • 4.
  • 6. 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
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. Low blood glucose Presence of symptoms Reversal of these symptoms when blood glucose levels are restored Whipple’s triad - Hypoglycaemia
  • 13.
  • 14. 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
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 22. 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
  • 23. Hypoglycemia: Risks & Complications  Early recognition and intervention can prevent an emergency  Greatest immediate danger  Not always preventable  Impairs cognitive and motor functioning 23
  • 24. 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
  • 25. “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
  • 26. 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
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  • 46. 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
  • 47. 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.