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Presentation title Emergency Care Part 2: Treating and Preventing Hypoglycaemia.

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Presentation on theme: "Presentation title Emergency Care Part 2: Treating and Preventing Hypoglycaemia."— Presentation transcript:

1 Presentation title Emergency Care Part 2: Treating and Preventing Hypoglycaemia

2 Emergency care Slide no Managing DKA Surgery in children with diabetes Treating and preventing hypoglycaemia

3 Hypoglycaemia One of the most common acute complications of diabetes Low blood glucose May causes severe symptoms Coma or seizures Limitation in the management of diabetes Effective treatment and prevention are key Slide no 3

4 Criteria Slide no 4 Symptoms of hypoglycaemia occur around <3.5 mmol/l (but not always!) Awareness of symptoms depend on background values Confusion may occur with rapidly dropping BGs but also with only modest hypoglycaemic values Counter regulation in individuals without diabetes begins at <4 mmol/l Hypo or low sugar symptoms due to bodies self- correcting hormonal responses (adrenalin)

5 Symptoms Trembling Rapid heart rate Pounding heart (palpitations) Sweating Pallor Hunger and/or nausea Irritability Slide no 5

6 Neuroglycopenia Difficulty concentrating Irritability Blurred or double vision Disturbed colour vision Difficulty hearing Slurred speech Poor judgement and confusion Dizziness and unsteady gait Tiredness Nightmares Inconsolable crying Loss of consciousness Seizures

7 DCCT and now standard Classification of severity Mild Hypoglycemia Recognition and self treatment Usually <3.9 mmol/l Moderate Hypoglycemia Aware of symptoms Needs assistance to take care of themselves Severe Hypoglycemia Loss of consciousness (coma), convulsion, marked confusion Usually <2.5 mmol/l Slide no 7

8 Management Identify hypoglycaemia Symptoms Blood glucose values Teach how to recognize and manage hypoglycaemia Learn symptoms Learn responses to symptoms Re-enforcement by family and heath care workers Treat the hypoglycaemia Determine cause (when possible) Slide no 8


10 Treatment (1) Feed the child simple sugar Rapid acting carbohydrate e.g. sweetened drinks, fruit juices, glucose in water, sweets, packet of sugar Enough to make symptoms go away… dont overtreat Give 0.3 g/kg of glucose if available Follow up with regular meal or snack – controversial but certainly reasonable if less than optimal monitoring possible Slide no 10

11 Treatment (2) If the child has severe symptoms Not able to eat Glucagon (0.5 mg for age 12 yr) IV glucose (3 ml/kg of 10% dextrose, 1 ml/kg of 30% dextrose) Oral rapid acting foods - glucose, sugar or honey

12 Determine cause Too much insulin – dose error or timing Too little/late food Increased activity, sometimes hours later Illness, esp. gastrointestinal viruses Alcohol Does not cause hypo but makes it nearly impossible for body to self-correct since liver is busy Knowing cause helps to avoid future hypoglycaemia Slide no 12

13 Prevention Reminders about the symptoms of hypoglycaemia Reminders about the causes Help to identify risk factors e.g. age, longer duration of diabetes, higher doses, etc. Repeated episodes of hypoglycaemia should result in specific advise to prevent recurrences Re-involve adults and caregivers/direct supervision Often some psychological issues Slide no 13

14 Questions

15 Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S

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