Case 1 - Hypoglycaemia Flashcards
Presentation of hypoglycaemia
- Autonomic - pallor, sweating, tremor, tachycardia, tingly lips, convulsions
- Neuro - decreased conc, behavioural change
- Sometimes none if hypoglycaemia unawareness
Managing hypoglycaemia
- A-E
- IV access
If mild - ie conscious and able to swallow:
* Glucojuice
* Lift juice shot
* 5-7 dextrose tablets
If able to swallow but bit disorientated:
* 2 tubes glucose gel
If no response in 40mins or after 3 treatment cycles:
* IM glucagon or 50ml of 20% glucose
If unconcious/aggressive/NBM or BG less than 2.6, start with severe management - 100ml 20% glucose over 10-15 minutes
After immediate treatment what further steps should be taken?
- Test CBG every 10 mins
- If remains less than 4mmol follow treatment plan
- Once above 4mmol/L and conscious and able to swallow give long acting carbohydrate eg cereal, biscuits, yoghurt
- Restart insulin once above 4mmol/L
Algorithm for treatment of hypoglycaemia
Reasons for recurrent hypoglycaemia
- Reduced oral intake
- Not eating enough
- Postponing or meal skipping
- Too much insulin given
- Drinking alcohol
- Increasing exercise without adjusting medication
What is meant by multiple daily injection basal bolus insulin regime with 1:10 QA to carb ratio?
- Multiple daily injections
- Basal - long acting insulin
- Bolus - fast acting insulin
- 1:10 - how much bolus insulin to give per gram of carb, eg 60g carbs give 6 units bolus insulin
Example of long acting insulin
- Lantus
- Tresiba
- Insulatard
- Humulin I
- Levemir
Examples of short acting insulin
- Novorapid
- Humalog
- Apidra
- Actrapid
- Humulin S