Hypoglycemia is a condition in which your blood sugar (glucose) level is lower than the standard range. Glucose is your body's main energy source. Hypoglycemia is often related to diabetes treatment. But other drugs and a variety of conditions — many rare — can cause low blood sugar in people who don't have diabetes.

1. HYPOGLYCEMIA
Mr. Abhijit Bhoyar
Assistant Professor
Department of
Child Health Nursing

2. Specific Learning Objectives
At the end of the lecture, the students will be
able to
• Define Hypoglycemia.
• Describe the causes of Hypoglycemia.
• Explain the signs and symptoms of Hypoglycemia.
• Determine the management of Hypoglycemia.

3. Introduction
Hypoglycemia, also called low
blood sugar or low blood glucose, can be dangerous
if not treated. Caused by too much insulin in the blood,
it’s common in diabetes. Simple tests can help to monitor
blood glucose so catch hypoglycemia early and bring
blood sugar back to a healthy range.

4. Definition
• Hypoglycemia is when the level of sugar in the blood
drops below a healthy range i.e. below 70 mg/dL
(milligrams per deciliter). It’s also called low blood
sugar or low blood glucose.

5. Types
1. Post-prandial hypoglycemia -
• This is also called reactive hypoglycemia and is
observed in subjects with an elevated insulin secretion
following a meal.
• This causes transient hypoglycemia and is associated
with mild symptoms.
• The patient is advised to eat frequently rather than the
3 usual meals.

6. Cont….
2. Fasting hypoglycemia :
• Low blood glucose concentration in fasting is not
very common.
• However, fasting hypoglycemia is observed in patients
with pancreatic beta -cell tumor and hepatocellular
damage.

7. Cont….
3. Hypoglycemia due to alcohol intake :
• In some individuals who are starved or engaged in
prolonged exercise, alcohol consumption may cause
hypoglycemia.

8. Cont….
• This is due to the accumulation of NADH (Nicotinamide
adenine dinucleotide)(during the course of alcohol
metabolism by alcohol dehydrogenase) which diverts the
pyruvate and oxaloacetate (substrates of gluconeogenesis)
to form, respectively, lactate and malate.
• The net effect is that gluconeogenesis is reduced due to
alcohol consumption.

9. Cont….
4. Hypoglycemia due to insulin overdose :
• The most common complication of insulin therapy in
diabetic patients is hypoglycemia.
• This is particularly observed in patients who are
on intensive treatment regime.
5. Hypoglycemia in premature infants :
• Premature and underweight infants have smaller stores of
liver glycogen, and are susceptible to hypoglycemia.

10. Causes
It most commonly
happens when a
person with
diabetes has taken
too much insulin.
Strenuous
exercises and
Exercise without
proper food
intake.
Skipping meals
Excessive alcohol
consumption:
drinking heavily
can block liver
from releasing
stored glucose

11. Cont.….
• Taking someone else's oral diabetes medication
accidentally- It is a possible cause of hypoglycemia.
Other medications may cause hypoglycemia, especially in
children or in people with kidney failure. One example is
quinine which is used to treat malaria.

12. Cont.….
• Some critical illnesses.
 Severe illnesses of the liver, such as severe hepatitis,
can cause hypoglycemia.
 Disorders of the kidney, which can keep body from
properly excreting medications, can affect glucose
levels due to a buildup of those medications.

13. Cont.….
• Long-term starvation, as may occur in the eating
disorder anorexia nervosa, can result in the depletion of
substances your body needs to generate glucose
(gluconeogenesis), causing hypoglycemia.
• Insulin overproduction. A rare tumor of the pancreas
(insulinoma) may cause overproduction of insulin,
resulting in hypoglycemia.

14. Cont.….
• Hormone deficiencies.
Certain disorders of the adrenal glands and the pituitary
gland can result in a deficiency of key hormones that
regulate glucose production.
Children may experience hypoglycemia if they have a
deficiency of growth hormone.
Lack of glucagon (hormone that is secreted from the
pancreas that raises blood glucose levels)

17. Signs and Symptoms
Trembling/shakiness
Sweating
Anxiety
Irritability
Pallor
Heart palpitations.
Headache.
Mild Symptoms

18. Cont….
Concentration
problems
Confusion
Irrational and
disorderly
behaviour (similar
to somebody who
is drunk)
Seizures
(uncommon)
Loss of
consciousness
(uncommon)
Severe Symptoms

19. Management
• Check blood sugar often, if below 70mg/dl (milligrams per
deciliter) stabilize it by eating.
• Full conscious patient: 1- oral glucose , sucrose or any
sugar containing fluid.

20. Immediate hypoglycemia treatment
• If you have hypoglycemia symptoms, do the
following:
• Eat or drink 15 to 20 grams of fast-acting
carbohydrates. These are sugary foods or drinks
without protein or fat that are easily converted to
sugar in the body. Try glucose tablets or gel, fruit
juice, regular (not diet) soda, honey, or sugary
candy.

21. •Recheck blood sugar levels 15 minutes after treatment. If blood
sugar levels are still under 70 mg/dL (3.9 mmol/L), eat or drink
another 15 to 20 grams of fast-acting carbohydrate, and recheck
your blood sugar level again in 15 minutes. Repeat these steps until
the blood sugar is above 70 mg/dL (3.9 mmol/L).
•Have a snack or meal. Once your blood sugar is back in the standard
range, eating a healthy snack or meal can help prevent another drop in
blood sugar and replenish your body's glycogen stores.

22. Immediate treatment of severe hypoglycemia
• Hypoglycemia is considered severe if Patient need help from
someone to recover. For example, if patient can't eat, you
might need a glucagon injection or intravenous glucose.
• In general, people with diabetes who are treated with
insulin should have a glucagon kit for emergencies. Family
and friends need to know where to find the kit and how to
use it in case of emergency.
• If you're helping someone who is unconscious, don't try to
give the person food or drink. If there's no glucagon kit
available or you don't know how to use it, call for
emergency medical help.

23. Cont.…
• Patient mental function:
1- IV 50% dextrose 25 – 50 ml or as much as possible until
patient mental state recover.
2- If hypoglycemia is caused by long acting insulin
continue 10% dextrose drip for 24 hr. – 48 hr.
3- Glucagon 1 mg IM , SC can be given to treat severe
hypoglycemia if IV accesses difficult.

24. Complications
Untreated hypoglycemia can
lead to:
• Seizure
• Coma
• Death
Hypoglycemia can also cause:
• Dizziness and weakness
• Falls
• Injuries
• Motor vehicle accidents
• Greater risk of dementia in
older adults

25. Prevention
• Checking blood glucose levels - keep a regular
check on blood sugar levels and identify the onset of
symptoms.
• Eat regularly - keep to your eating routine.
• Exercise - make sure you have eaten some
carbohydrate-rich food before you do any exercise.

26. Cont.…
• Be ready - children with diabetes type 1 should
always carry a container of sugary fruit juice or a
candy bar so that they are ready if symptoms are felt.
• Let people know - if you are susceptible to attacks
of hypoglycemia, let your friends, colleagues and
family members know. Explain what the signs are
and what should be done.

27. Summary
So far today we have discussed
about Hypoglycemia. It is a condition characterized by
abnormally low level of blood sugar. More serious to be
treated fast. Continues monitoring of the hypoglycemia
patient. Diabetic patient should informed to take food in
the time.

28. Expected Questions
Short
1. Explain the causes of Hypoglycaemia.
Very Short
1. Enumerate any four Causes of Hypoglycaemia.
2. Define Hypoglycaemia.

29. THANK YOU