Treating a Hypoglycemic Patient

Kate DeRondeLindsay GigonLauren Deming

Common Causes of Hypoglycemia

Conditions That Increase R/F Hypoglycemia

Eating late or consuming wrong type of carb

Recent or severe hypoglycemia

Missed meal Gastroparesis

Fasting or Malnourishment Liver disease or kidney failure

Too much insulin or insulin secretagogues

Pregnancy

Prolonged or unplanned activity

Injection-related, such as insulin administeredin the leg just before exercise

Over-correction of high blood glucoselevel with insulin (rapid or regular),sliding scale, or an extra sulfonylurea

Adrenergic Symptoms• Anxiety• Diaphoresis• Headache• Hunger• Hypotension• Nervousness• Pallor• Shakiness• Tachycardia• Tachypnea• Tingling in extremities

Neuroglycopenic Symptoms• Abnormal behavior• Blunted mental activity• Blurred vision• Confusion• Difficulty concentrating• Dizziness• Fatigue/sleepiness• Irritability• Loss of consciousness• Loss of fine motor skills• Numbness• Personality changes• Recall difficulty• Slurred speech• Seizures• Weakness

Blood Glucose Level <70for a Conscious Patient

-immediately have patient ingest 15g of simple carbohydrate (ie: 4oz of juice or regular soda)

-recheck glucose level in 15 mins

-if glucose level is still <70 give another 15 grams of simple carbohydrate

-recheck glucose level in 15 mins

-if glucose levels remain <70 call MD

-when relieved have patient ingest a long acting carbohydrate, such as a snack (ie: crackers with cheese or peanut butter), or meal if it is time

-recheck glucose in 45 minutes

For Worsening, Unconscious or Patients with Impaired Swallowing

-if patient has IV access administer 20-50ml of D50 IV at 3ml/min

-if no IV access administer 1mg of glucagon IM and turn patient on side

-call MD

-when the patient is alert ingest snack (ie: crackers with cheese or peanut butter) or scheduled meal if it’s time

-recheck glucose in 45 mins

Proper PO Choices

Evidence Based Practice

According to the American Diabetes Association, glucose (15 to 20 g) is the preferred treatment for the conscious individual with hypoglycemia, although any form of carbohydrate that contains glucose may be used. If testing 15 minutes after treatment shows continued hypoglycemia, the treatment should be repeated. After glucose level returns to normal, the individual should consume a meal or snack to prevent recurrence of hypoglycemia.

Documenting• All assessment findings and VS

• Notification of MD: date & time of calls made and times of MD response

• All MD orders taken and interventions made; ALL patient responses to care

• If MD overrules lab draw document this as well, physicians choosing to not have a laboratory draw for their patients take full responsibility.

• All patient/family teaching done and their level of understanding

Important to remember:

• Make sure your using an accurately calibrated glucometer

• A prompt but moderate approach is best. Overtreatment may cause rebound hyperglycemia.

• Document, Document, Document!

Test Your Knowledge

1. Name 3 objective symptoms of hypoglycemia. How might the patient report feeling?

2. What is the normal range for a blood glucose level?

3. Name 3 nursing interventions for a hypoglycemic patient.

4. List important aspects for comprehensive documentation.

BibliographyDeglin, J. H., Vallerand, A. H., & Sanoski, C. A. (2011). Davis's drug guide for nurses (12th ed.). Philadelphia: F.A. Davis.

Diabetic Hypoglycemia. (n.d.). NetCE Continuing Education Online. Retrieved February 13, 2013, from http://www.netce.com/coursecontent.php?courseid=714#chap.6

Kelly, R. C., & Owens, B. B. (2010). Hypoglycemia treatment in the ambulatory care setting. AAACN Viewpoint, 32(6), 1.

Lewis, S. M. (2011). Medical-surgical nursing: assessment and management of clinical problems (8th ed.). St. Louis, Mo.: Elsevier/Mosby.

Lowth, M. (2012). Hypoglycaemia Prevention and management. Practice Nurse,42(18), 12-16.