HYPOGLYCAEMIA AND TREATMENTS Community Diabetes Specialist Nurses Nottingham CityCare Partnership

WHAT IS A HYPOGLYCAEMIA

WHEN GLUCOSE LEVELS DROP HYPOGLYCAEMIA (HYPO) WHEN GLUCOSE LEVELS DROP USUALLY BELOW 4MMOLS

WHY DOES HYPOGLYCAEMIA OCCUR?

Missed or late meals Eating less carbs than usual Too much insulin Too much sulphonylurea More activity than usual e.g gardening, shopping, golf, walking, dancing

Injecting muscle instead of the fatty layer under the skin Excessive alcohol consumption Extremes in temperature Stress and illness

Consider If Hba1c is less than 48 mmol/mol Overtreatment of medication Increase risk of Hypoglycaemia

Common Symptoms of Hypo Sweating Dizziness Trembling Tingling hands, feet, lips and tongue Hunger Anxiety Irritability Palpitations

If not treated quickly the symptoms of hypo become more severe Coordination may suffer Vision can become blurred Behaviour can become irrational and erratic, even aggressive If the hypo sufferer refuses help this needs to be ignored as the effects of the hypo are causing them to react in an irrational way

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Treatment of a Hypo MILD to MODERATE 7 Dextrosol energy tablet or 5 Glucotabs Sweet drink (200mls)– pure fruit juice, fizzy pop (not diet), lucozade (amount can vary depending on type) 3-4 Jelly Babies 1 tube of Glucogel Each has approximately 15-20g of carbohydrate CHECK GLUCOSE AFTER 10 MINUTES AND REPEAT IF STILL LOW DO NOT USE THESE TREATMENTS FOR SOMEONE WHO IS UNABLE TO SWALLOW OR UNCONSCIOUS

SEVERE HYPO This is where the patient is unable to react ‘normally’ to a situation … they may not be completely still and silent GLUCAGON Glucagon is a hormone (like insulin) also made by the pancreas but has the opposite effect of insulin. It raises the glucose level in the blood Available in the UK on prescription: GlucaGen Hypo Kit Comes as a vial of powder and syringe of water which is mixed just before injecting IF GLUCOGEN IS NOT AVAILABLE IN THIS SITUATION A 999 AMBULANCE NEEDS TO BE CALLED.

After a Hypo Is Normal to feel Emotional Headachy Nauseous

Following a Hypo Once the patient has started to recover from the hypo If their meal is due they can have this. If it is a while until their next meal 1 slice of medium bread or toast or 2 digestive biscuits. These are approximately 15-20g of carbohydrate Patient will need reassuring as it can be a very frightening experience.

If next insulin injection is due following a severe hypo it would be wise to delay this until patient is fully recovered The Insulin or Sulphonylurea doses will need reviewing Consider why the hypo happened

HYPOGLYCAEMIA AND DRIVING

DVLA changes to driving and using insulin DVLA must be informed - 3yr driving licence New rules brought in end of 2012 + Group 2 drivers ( lorry and bus drivers) can now use insulin Testing before driving – 5 to drive – then every 2hrs. Carry testing kit and hypo treatment always Sulphonylureas If hypo while driving what do you advise? Informing DVLA of any severe hypos – 2 in 1yr licence will be revoked - 1 in 1yr for Group 2 drivers