Hypoglycaemia

Question 1

What to do first?

Answer 1

Dynamic risk assessment (SMART).
Patient assessment triangle.

Question 2

Signs and symptoms ?

Answer 2

Confusion
Sweating
Aggressive
Trembling / shaking
Hunger / thirst
Headaches
Speech difficulty
Lack of coordination.

If patient is unconscious (GCS below 8 ) convulsing or aggressive treat as severe hypoglycemia.

Question 3

Primary survey ( ABCDE) ?

Answer 3

Airways > talking
Breathing > resp rate, sp02.
Circulation > pulse rate, BP.
Disability > GCS, Temp, BM (ketones)
Examine > make sure patient is as comfortable as possible.

Question 4

History taking ?

Answer 4

Consent from patient
Presenting complaint
Socrates
Past medical
Family > diabetic
Social > diet, alcohol
Lifestyle > diet
Risk factors > irregular lifestyle, drug ingestion, inadequate carb intake

Question 5

Observations ?

Answer 5

BP
Sats (02)
BM
Ketones
Temperature
Pulse rate

Question 6

Management for mild ?

Answer 6

Quick carbs (15-20g) such as pure fruit juice or 1-2 tubes of 40% glucose.
Retest blood glucose after 15 mins.
If remains <4mmol repeat treatment twice at 15 mins intervals until BM is obtained.
If fails to rise above consider IV 10% or IM glucagon.

Question 7

Management for Moderate ?

Answer 7

If capable :
Give 15-20g acting carbs eg 1-2 tubes of 40% glucose gel.
If no capable (unable to swallow):
1-2 tubes 40% glucose to buccal mucosa or give 1mg glucose IM.
Retest after 15 mins.
If BM stay low repeat 40% glucose. IM glucose cannot be repeated.
If 40% glucose can’t be admin consider IV 10% glucose.
If BM remains low repeat twice until blood glucose is remained.

Question 8

Management for severe: (unconscious)

Answer 8

Admin IV glucose 10%.
If IV cannot be done admin IM glucose.
Retest BM levels after 10 mins.
If BM remains low admin further dose 10% glucose.
Repeat until BM is obtained.
If no improvement consider hospital ED.

Question 10

Management medications ( glucose 40% oral gel) ?

Answer 10

Admin > squeezed into the mouth between teeth and gums.
Dose > 10 - 20 grams.
Retake BM after 15 mins to see a change in reading .
If no improvement consider IM glucagon or IV glucose 10%.

Question 11

Management medications (10% glucose IV) ?

Answer 11

Admin > IV infusion
(concentration 50g glucose in 500ml fluid. )
Dose > 10g (100ml) repeat after 5 mins if no improvement.
Max dose 30g (300ml)

Question 12

Management medications (glucagon IM) ?

Answer 12

Admin > intramuscular , antero lateral aspects of high or upper arm.
Dose > 1 milligram (no repeat).
Only administer if oral glucose is not possible or IV access isn’t possible.

Question 13

Management ?

Answer 13

Once blood glucose is above 4mmol give patient a starch snack.
If glucagon had been administered the patient needs a larger portion of carbs.
If patient had insulin pump they may need a long acting carb.

Question 14

Management non conveyance?

Answer 14

To discharge Patient on scene they must have a sustained glucose level of 5/4 mmol.
A referral will be made to a primary care team or the patients diabetic nurse.
Documentation must be Completed in full including after care advice.

Question 15

Further management ?

Answer 15

Reassurance.
Position patient for their comfort.
Explain what is happening to the patient.