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19.6 Hypoglycaemia

Table of Contents

Hypoglycaemia is defined as blood glucose <4 mmol/L.

Diagnostic Criteria

  • Hunger
  • Sweating
  • Trembling or shaking
  • Anxiety
  • Dizziness
  • Lightheadedness
  • Palpitation
  • Numbness around the lips and fingers
  • Headache
  • Confusion
  • Lack of concentration
  • Weakness
  • Changes in behaviour (eg irritability, tearfulness, crying), paraesthesiae.

Patients may also present with convulsions, seizures or coma due to delayed corrective action or impaired hypoglycaemia awareness where the patient loses the ability to detect the early symptoms of hypoglycaemia due to repeated episodes of mild hypoglycaemia or long duration of diabetes leading to loss of adrenergic and glucagon response, with eventual loss of adrenergic and neuroglycopaenic symptoms.

Non-Pharmacological Treatment For conscious Patients:

Quickly take a glass of a sugar-rich drink

OR

Eat one table spoon of sugar or honey

AND

Have a meal.

If symptoms persist after 5 minutes repeat the above.

For unconscious Patients give:

C: IV 50% dextrose (40–50ml)

OR

C: 10% dextrose (200–300ml). Repeat if patient is not responsive or if after 15 minutes, the blood glucose is still below 4mmol/l. Follow by 8–10 % glucose infusion. Use 5% dextrose if the higher concentrations are not available.

OR

C: Glucagon injection 1mg IM or SC

Note: If IV access is impossible, consider nasogastric tube or rectal glucose

On Recovery:

  • Give long-acting carbohydrate snack eg a piece of bread
  • Identify the cause of hypoglycaemia and correct it
  • If hypoglyceamia is a result of long acting suphonylureas, long- or intermediateacting insulin or alcohol frequently monitor blood glucose (2hourly) and give IV dextrose infusion (5–10%) for 12–24 hours

If patient is not responding look for another cause or refer.

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