1. Hypo Awareness Week 2013 This resource offers an example of: Hypo Box Contents list A Hypo Box Algorithm for treatment of Hypoglycaemia in patients with Diabetes (Adults) The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus

2. Hypoglycaemia is a blood glucose of 4 mmol/l or less (if not less but symptomatic give small carbohydrate snack for symptom relief and monitor glucose levels) HYPO BOX : For Treatment of Hypoglycaemia in Patients with Diabetes (Adult inpatient care) Repeat at 5-15 min intervals as necessary depending on patient symptoms and glucose concentrations. Once conscious, follow yellow step one and two To prevent glucose levels falling again ensure long-acting carbohydrates such as adequate amounts of bread/potato/rice is eaten with a meal or a snack such as 2-3 biscuits, fruit, current bun is eaten if it is not a meal time. Continue regular monitoring for 24 – 48 hours and reflect on cause of hypo event. Refer to diabetes specialist team if no obvious cause of hypo event MILD Alert, conscious and able to swallow MODERATE Drowsy or uncooperative and/or risk of choking SEVERE - Call Enter your own details Unconscious and potential for no gag reflex, and/or fitting, and/or NBM STEP 1 STEP 2 Give 100mls of Lucozade Original or 200ml orange juice or 5-6 Dextrose sweets if available, if not administer 1x25g Glucose 40% oral gel from the hypoglycaemia kit inside the cheek. Massage outside of cheek allowing it to be absorbed or swallowed. Initially administer ONE or TWO tube(s) of glucose 40% oral gel from the hypoglycaemia kit, inside the cheek. Massage outside of cheek allowing it to be absorbed 1) Check ABC. Place in recovery position if required 2) Administer IM injection of Glucagon 1mg using GlucaGen Kit stored in locked ward fridge. 3) If no response from Glucagon within 5-10 minutes Give 10-15g IV glucose using either: 75- 80ml 20% glucose given over 15-20 minutes OR 150- 16mls 10% glucose given over 10-15minutes. The use of 50%glucose is not recommended unless there is “no other option” as it can lead to thrombophlebitis STEP 3 INSULIN SHOULD NOT BE OMITTED FOLLOWING AN EPISODE OF HYPOGLYCAEMIA. If you are concerned, patients should be assessed for a smaller insulin dose rather than an omission Adapted with kind permission of Portsmouth Hospital Trust

3. Please replenish each item from Ward Stock every time the HYPO-BOX is used Each item is ward stock and can be replenished through the normal process: Glucose 40% oral gel (3x25g pack) and GlucaGen kits via pharmacy stock requisition Biscuits via SBS (shared business services) – NHS supply catalogue Expiry dates will be checked by the ward nurses as part of a routine weekly check The Diabetes Nurse Specialists will replenish patient record books on request HYPO-BOX Contents: 3 x Triple Packs glucose 40% oral gel 25g 2 x packs two biscuits Sticker indicating that 1 x GlucaGen HypoKit 1mg is stored in locked ward fridge Treatment guidance flowchart Patient treatment Record Book Diabetes Specialist Nurses (DSN):  Refer to DSN if hypos are occurring without known cause via insert own details here  or inform DSN on routine visits  Diabetes Centre ext insert own details here If you have any questions regarding the products contained within the Hypo Box please call insert your own details here Item No: SH/DIAB/428/AUG13 Date of prep: Aug 13