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Hypoglycemia Hypoglycemia Prevention & Treatment Gary Scheiner MS, CDE Owner, Integrated Diabetes Services 333 E. Lancaster Ave., Suite 204 Wynnewood,

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Presentation on theme: "Hypoglycemia Hypoglycemia Prevention & Treatment Gary Scheiner MS, CDE Owner, Integrated Diabetes Services 333 E. Lancaster Ave., Suite 204 Wynnewood,"— Presentation transcript:

1 Hypoglycemia Hypoglycemia Prevention & Treatment Gary Scheiner MS, CDE Owner, Integrated Diabetes Services 333 E. Lancaster Ave., Suite 204 Wynnewood, PA SELF-MGT ( ) (610)

2 Hypoglycemia: Definitions Mild: Adrenergic (BG<70) Moderate: Cognitive (BG<50) Severe: Unconscious (BG ???)

3 Hypoglycemia: Cause Imbalance between factors raising and lowering blood glucose levels Blood Glucose FoodInsulin/Oral Meds Counterregulatory Hormones Physical Activity

4 Hypoglycemia The Greatest Limiting Factor In Diabetes Management

5 The Great Limiting Factor Performance Impairment

6 The Great Limiting Factor Accident Risk

7 The Great Limiting Factor Anxiety / Embarrassment

8 The Great Limiting Factor Lasting Damage?

9 The Great Limiting Factor Diminished Symptoms (Hypoglycemic Unawareness)

10 The Great Limiting Factor Rebound

11 The Great Limiting Factor Weight Gain

12 Hypoglycemia: Targets/Goals Unable to recognize & verbalize lows: >80 Able to recognize & verbalize lows: >70 Pregnancy: >60 <10% of readings below target at each time of day No severe lows

13 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)

14 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)

15 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)

16 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)

17 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)

18 Hypoglycemia Prevention Strategies 1b. Insulin Program Setup (Meal/Bolus)

19 Hypoglycemia Prevention Strategies 2. Meal/Snack Timing Major issue w/a.m. NPH/Lente Minor issue w/Lantus or Ultralente Not usually an issue with pump use

20 Hypoglycemia Prevention Strategies 1500-Rule (aggressive) 1800-Rule (conservative) (Total Daily Ins.)/1500 or 1800 May vary day vs. night (nighttime often 50% more than day) 3. Proper Correction Doses

21 Hypoglycemia Prevention Strategies I:C Ratio that matches pre-meal BG 3-4 hours (not 2!) after eating I:C Ratio often varies from meal to meal (bkfst dose > lunch & dinner) 4. Proper Meal/Bolus Doses

22 Hypoglycemia Prevention Strategies 5. Account For Unused Insulin* Time since meal insulin 1 Hr2 Hrs3 Hrs4 Hrs Conservative Approach 70% left40% left10% left0% left Aggressive Approach 67% left33% left0% left * Newer pumps figure this automatically based on the insulin duration you set.

23 Hypoglycemia Prevention Strategies 5. Account For Unused Insulin Example: Gave 6.0 units at 7pm, BG 200 at 9pm. Conservative approach: 40% remaining (6 x.4) = 2.4 units left Aggressive approach: 33% remaining (6 x.33) = 2 units left Subtract the unused insulin from your usual correction dose!

24 Hypoglycemia Prevention Strategies 6. Carb Counting Accuracy Proper Portion Measurement Look Up Unknown / Restaurant Foods Use Carb Factors Subtract 100% of Fiber Subtract 50% of Sugar Alcohols

25 Hypoglycemia Prevention Strategies 7. Extend Meal Insulin When Necessary Use When: Portions are very large Meal is prolonged Food is low-glycemic index (pasta, legumes, dairy…) Apply Via: Square/Dual/Extended/Combo bolus on pump Delayed or Split bolus on injections

26 Hypoglycemia Prevention Strategies 8. Adjustment for Physical Activity Exercise, recreation, chores: all count! Reduce meal insulin (25%, 33%, 50%) for after-meal activity Snack prior to after/between meal activity Lower long-acting/basal insulin prior to and during prolonged activity

27 Hypoglycemia Prevention Strategies 8. Watch Out for DOH! (Delayed Onset Hypoglycemia) Following High-Intensity Exercise Following Extended Duration Activity May Occur Up to 24 Hours After Adjustments to food and insulin may be necessary

28 Hypoglycemia Prevention Strategies 9. Adjustment for Alcohol Alcohol reduces the livers output of glucose and masks hypoglycemic symptoms Delayed BG drops can occur Decrease basal insulin (or overnight long-acting insulin) after drinking

29 Hypoglycemia Prevention Strategies 10. Consistent Monitoring Before All Meals & Snacks Pre/Post Exercise Bedtime 3 a.m. (occasionally)

30 Hypoglycemia Prevention Strategies 11. Recording & Analysis Record all pertinent data BGs Carb Activity Insulin Use an organized form (multiple days on single page, if possible)

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32 Hypoglycemia Prevention Strategies 11. Recording & Analysis Review every 7-10 days Look for patterns > 10% below target given time Lows during/post-activity Lows on School/Work vs. off-day Lows Post-Menstrual

33 Hypoglycemia Prevention Strategies 12. Caffeine Helps reduce risk of nighttime hypoglycemia, but not daytime Benefit seen with 4 cups of coffee per day (250 mg caffeine twice daily) WILL YOU SLEEP???

34 Hypoglycemia Treatment Mild/Moderate Low –Check BG First –Treat w/High-Glycemic Index Food –Treat w/Proper Amount –Re-Check in 15 Minutes High-GI Foods Glucose Tablets Dry Cereal Pretzels Graham Crackers Vanilla Wafers Jelly Beans

35 Hypoglycemia Treatment Use of Glycemic Index – Lower GI foods digest & convert to glucose more slowly – High-fiber slower than low – Hi-fat slower than low – Solids slower than liquids – Cold foods slower than hot – Type of sugar/starch affects GI

36 Use of Glycemic Index (contd) Hypoglycemia Treatment

37 Always Carry Rapid-Acting Carbs!

38 Hypoglycemia Treatment Wt-lbs (BG rise/g) BG 70sBG 60sBG 50sBG 40sBG <40 <40 ( 9-10) 6g7g8g9g10g ( 7-8) 7g8g10g11g13g ( 5-6) 8g10g12g14g16g ( 4) 11g13g16g19g21g ( 3) 14g17g21g24g27g >220 ( 2) 20g25g30g35g40g Once BG has risen, give rapid-acting insulin to cover any overtreatment!

39 Hypoglycemia Treatment Severe Low –Unconscious / Unresponsive –Seizure –Uncooperative

40 Take-Home Messages Quantify Your Lows Strategize to Minimize Plan for Proper Treatment

41 The Source of My Highs and Lows


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