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Agakhan Hospital Dar es Salaam
Emergency management of Hypoglycemia (Low Blood Sugar)
Whipple’s TRIAD
1. Signs and symptoms of
hypoglycemia
2. Glucose level less
then 4mMol/L
3. Resolution of hypoglycemia
signs and symptoms with
glucose administration
1st
Step: Check ABC for the emergency Primary evaluation and management
2nd
Step: History of :-
Missed, small or delayed meals
Excessive insulin dose, or oral diabetic medications
Vomiting, gastroparesis
Kidney disease
Alcohol
& Check for following symptoms and signs
Autonomic symptoms CNS Symptoms
Palpitation Anxiety, Headache
Shaking, tremors, Difficulty speaking
Sweating forgetfulness Irritability Confusion
Generalized weakness, tiredness Drowsiness
Hunger Coma, Seizures
CHECK BLOOD SUGAR by finger prick method, establish IV line and send Blood sample for laboratory
tests ( CBC, RBSL, MP, S Creatinine as minimum or more detailed if having co-morbids)
2nd
Step : Evaluation of Preferred route of Glucose administration and dose:-
Patient is alert 150ml of soft drink like Coke, or fruit juice
Patient is able to sit and hold cup Sugar 3-4 teaspoons
Patient is able to swallow or cough 15 gm Glucose orally
Patient cannot cough, or drowsy
with history of recurrent hypos.
Insert IV line, draw sample for and administer I/V Dextrose 50% -
30ml bolus (DOSE – 0.25 gram Glucose per Kg Body weight)
3rd
step of Management: Evaluation of recovery
Check for resolution of symptoms and signs in 15 minutes
Check blood sugar – If less than 4.1 then repeat second bolus of I/V Dextrose 50% 30ml.
4th
Step: - Disposition of patient:
If patient’s GC improves with resolution of initial
complaints
Discharge home and Refer to O.P.D. for further
evaluation
If patient had severe hypoglycemia or coma Admit to ward / HDU / CCU according to general
condition of patient.Co-morbids, or elderly
If cause of hypoglycemia cannot be explained
Suspect heavy doses of oral hypoglycemic
medications or Long acting Insulin doses.

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Protocol of hypoglycemia management

  • 1. Agakhan Hospital Dar es Salaam Emergency management of Hypoglycemia (Low Blood Sugar) Whipple’s TRIAD 1. Signs and symptoms of hypoglycemia 2. Glucose level less then 4mMol/L 3. Resolution of hypoglycemia signs and symptoms with glucose administration 1st Step: Check ABC for the emergency Primary evaluation and management 2nd Step: History of :- Missed, small or delayed meals Excessive insulin dose, or oral diabetic medications Vomiting, gastroparesis Kidney disease Alcohol & Check for following symptoms and signs Autonomic symptoms CNS Symptoms Palpitation Anxiety, Headache Shaking, tremors, Difficulty speaking Sweating forgetfulness Irritability Confusion Generalized weakness, tiredness Drowsiness Hunger Coma, Seizures CHECK BLOOD SUGAR by finger prick method, establish IV line and send Blood sample for laboratory tests ( CBC, RBSL, MP, S Creatinine as minimum or more detailed if having co-morbids) 2nd Step : Evaluation of Preferred route of Glucose administration and dose:- Patient is alert 150ml of soft drink like Coke, or fruit juice Patient is able to sit and hold cup Sugar 3-4 teaspoons Patient is able to swallow or cough 15 gm Glucose orally Patient cannot cough, or drowsy with history of recurrent hypos. Insert IV line, draw sample for and administer I/V Dextrose 50% - 30ml bolus (DOSE – 0.25 gram Glucose per Kg Body weight) 3rd step of Management: Evaluation of recovery Check for resolution of symptoms and signs in 15 minutes Check blood sugar – If less than 4.1 then repeat second bolus of I/V Dextrose 50% 30ml. 4th Step: - Disposition of patient: If patient’s GC improves with resolution of initial complaints Discharge home and Refer to O.P.D. for further evaluation If patient had severe hypoglycemia or coma Admit to ward / HDU / CCU according to general condition of patient.Co-morbids, or elderly If cause of hypoglycemia cannot be explained Suspect heavy doses of oral hypoglycemic medications or Long acting Insulin doses.