12. Hypoglycemia

what blood glucose level defines hypoglycemia?

less than 70 mg/dL

common causes of hypoglycemia

• too much insulin or oral hypoglycemic medication

• too little food

• excessive physical activity

when is hypoglycemia most likely to happen?

it can happen any time, but it is common before meals and during the peak of specific insulin

why are older adults at higher risk for hypoglycemia?

• they may live alone and not recognize symptoms

• decreased kidney function delays excretion of oral hypoglycemic medications

• decreased appetite or limited finances may lead to skipped meals

• decreased visual acuity may lead to insulin administration errors

what acute glucose problem becomes dangerous faster? hypoglycemia or hyperglycemia?

hypoglycemia will kill a patient first

what blood sugar level is considered mild hypoglycemia?

70mg/dL to 54 mg/dL

what are common mild hypoglycemia symptoms?

sweating; tremor; tachycardia; palpitations; nervousness; hunger

what blood sugar level is considered moderate hypoglycemia?

less than 54 mg/dL

what are common moderate hypoglycemia symptoms?

impaired CNS

• inability to concentrate

• headache

• lightheadedness

• confusion, memory lapses

• numbness of the lips and tongue

• slurred speech

• impaired coordination

• emotional changes, irrational or combative behavior

• double vision, drowsiness

what are severe hypoglycemia findings?

• disoriented behavior

• seizures

• difficulty arousing from sleep

• loss of consciousness

why do mild hypoglycemia symptoms happen?

a falling blood glucose level triggers release of epinephrine and norepinephrine

why do moderate and severe hypoglycemia symptoms happen?

the brain is not getting enough glucose to function normally

what is the first action when a patient has severe hypoglycemia symptoms?

check the blood glucose first to tell hypoglycemia from a neurologic emergency like a stroke or TIA

what should be given first for hypoglycemia if the patient is awake and able to swallow?

15g of a fast-acting concentrated carbohydrate

• ex: 4 oz of juice, 1 tablespoon of sugar, honey, or syrup; 8 to 10 hard candies, jellybeans, or gumdrops; 3 to 4 glucose tablets; 1 dose of glucose gel

what do you do after giving the 15g of carbs?

retest blood glucose in 15 mins

when should blood glucose be rechecked after giving fast-acting carbohydrate?

15 minutes later

what should be done if blood glucose is still below 70 mg/dL after the first 15 g of carbohydrate?

give another 15 g of a fast-acting concentrated carbohydrate

what emergency treatments are used for severe hypoglycemia when the patient cannot take carbohydrates by mouth?

• glucagon 1 mg subcutaneous or intramuscular (intranasal glucagon available too)

• 25-50mL dextrose 50% in water by IV in the hospital

what is given to severe hypoglycemic patients in the hospital?

25-50mL dextrose 50% in water by IV

• irritates the veins, patient might complain of headache and pain

• can override no orders in emergencies per policy

hypoglycemia prevention teaching

keep a consistent pattern of eating, insulin administration, and exercise

safety education for hypoglycemic patient

• wear a medical alert band

• recognize symptoms of hypoglycemia

• check blood glucose frequently

• carry a form of simple sugar at all times

• report hypoglycemic episodes to the provider

• do not use high-calorie, high-fat desserts to treat hypoglycemia (doesn’t work fast enough)