Therapeutic Handbook - GGC Prescribing

Management of HypoglycaemiaIntroductionHypoglycaemia is a serious condition and should be treated as an emergency regardless of thepatient's level of consciousness. All documented blood glucose values < 4 mmol/L can be considereda hypoglycaemic event and should not be tolerated in any patient on a regular basis. The signs andsymptoms of hypoglycaemia can be variable and a high index of suspicion is often required. Somepatients experience hypoglycaemic symptoms where the blood glucose level is not < 4 mmol/L. If thishappens a small carbohydrate snack can be given for symptom relief.Table 1 – Symptoms of hypoglycaemiaAutonomicTremblingSweatingAnxietyHungerPalpitationsNauseaTinglingNeuroglycopaenicDifficulty concentratingConfusionWeaknessDrowsinessVisual changeDifficulty speakingHeadacheDizzinessTirednessBy far the commonest cause of hypoglycaemia is treatment with insulin or sulphonylurea drugs inpatients known to have diabetes. This may be accidental or deliberate. Patients taking sulphonylureadrugs who have a hypoglycaemic episode should be admitted for at least 24 hours for monitoring.Endocrine SystemAssessment / monitoring• Send blood glucose to the lab for a level. Glucostix ® can be inaccurate at low blood glucoseconcentrations. Waiting for the result should not delay giving appropriate treatment.• Assess whether hypoglycaemic episode is:Mild – autonomic symptoms may be a feature (see table above).Moderate / severe – autonomic and neuroglycopaenic symptoms may be a feature. Plasmaglucose is typically < 2.8 mmol/L and can result in coma if left untreated.• Once patient is stabilised (see general management and drug therapy section on the next pageon how to do this), investigate:- Likely cause of the episode (missed meal, dosage error, increased exercise, alcohol excess,deliberate overdose).- Establish the presence of hypoglycaemic ‘warning symptoms’ i.e. sweating, tremor, andtachycardia. These may be impaired in patients with longstanding diabetes.Continues on next pagePage 288