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Hypoglycemia

Levels
–Mild: adrenergic (<70 mg/dL)
–Moderate: cognitive (<50 mg/dL)
–Severe: unconscious

A key message for patients: People with diabetes need to know their individual symptoms of hypoglycemia and be prepared to measure blood glucose and treat this complication.

Here are some supporting points:

• Hypoglycemia can cause a wide range of physical, mental, and emotional symptoms. Common symptoms include sweating, trembling or shaking, hunger, and slowed thinking or slurred speech. Changes in a person’s ability to do routine tasks, or difficulty concentrating or reading, can be signs that blood glucose levels are too low. Hypoglycemia can cause emotional changes, such as irritability and anxiety, or giddiness and euphoria. Emotional changes may cause the person with hypoglycemia to resist treatment or become uncooperative.
• Symptoms of hypoglycemia differ among individuals and may vary in the same person between episodes. For this reason, it is important for each person with diabetes to recognize his or her usual responses to hypoglycemia. Point out that people from different cultures may use other terms for hypoglycemia, such as “falling out.”
• Some people with diabetes experience few or no symptoms of hypoglycemia, which increases their risk of developing severe hypoglycemia. People with “hypoglycemia unawareness” need to test their blood glucose frequently, especially at times when levels are likely to be low or when hypoglycemia might be dangerous, such as driving a car.
Treatment
–Rapid-acting carbohydrate (10-20g).   
–Examples: glucose tablets, orange juice, regular soda, crackers, cereal.  
–Wait 15-20 minutes, recheck blood glucose. 
–If blood glucose has not risen, repeat treatment. 
–Glucagon for severe / unconscious hypoglycemia

It is important to monitor and treat symptoms of hypoglycemia as well as hyperglycemia. While the body begins reacting to blood glucose levels in the high to mid 70 mg/dL range, there may be few clinical symptoms. However, in the mid-60s when adrenergic hypoglycemia occurs, as stated on the previous slide, patients may experience sweating, hunger, trembling and nervousness, weakness, palpitations, and may even have trouble speaking. There is a sense of urgency to eat. Cognitive function is affected around 50 mg/dL because the brain does not get enough glucose and symptoms progress to drowsiness and confusion. Lower levels can lead to coma and seizure.

Immediate treatment includes the consumption of carbohydrate foods to return the blood glucose into a normal range. It will also be important to consume a full meal within about an hour to maintain a target range of blood glucose.

A key message for patients is to carry an emergency supply of carbohydrate and a blood glucose meter. By doing so, people with diabetes can be prepared to treat hypoglycemia in almost any situation.

Here are some supporting points:

• Emphasize the importance of taking prompt action at the first sign of suspected hypoglycemia. If possible, blood glucose should be measured first. However, a person with symptoms should not wait to treat hypoglycemia if it is not practical to test immediately.
• If hypoglycemia occurs, a person should eat or drink 15 grams of a carbohydrate-containing food or beverage. Various foods and drinks that supply this amount of carbohydrate may include a glass of milk, ½ cup of juice, sugar-containing soda, glucose tablets, or 5 sugar-containing lifesavers. Advise against eating high-fat foods, such as pie, ice cream, or chocolate, to raise blood glucose. Explain that fat slows stomach emptying and the absorption of carbohydrates, which can delay a rapid increase in blood glucose.
• After eating or drinking a carbohydrate-containing food, people should retest blood glucose within 15 to 20 minutes. If blood glucose remains low, the treatment should be repeated, even if symptoms have disappeared.
• People should remain alert for additional episodes of hypoglycemia. Advise them to eat a meal within the next hour. They also should continue to test blood glucose more frequently for the next few hours. People who experience repeated or frequent episodes of hypoglycemia need to contact their doctor or diabetes educator.
   
General Patient Monitoring  
Hemoglobin A1c: twice/year or more
•Blood pressure: at every HCP appointment
•Lipid levels: yearly
•Kidney function: yearly
•Retina screening: yearly
•Dental exam/cleaning:
at least twice/year

General monitoring is routine in diabetes to identify and prevent complications. Routine measurements will include blood pressure, glycemic control, and physical examination of skin, foot sensation, and an assessment of the eyes.

Hemoglobin A1c should be checked at least twice per year. This test gives an overview of the average plasma glucose over a period of 2-3 months.

If diabetes is well-controlled, yearly examination of blood pressure, blood lipid levels (includng cholesterol and triglycerides), kidney function (including microalbuminuria and serum creatinine), and an ophthalmoscope exam of the back of the eyes to evaluate for retinopathy.

Twice per year the patient should receive a thorough dental cleaning and examination.

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