Endocrine System >
Diabetic Hypoglycaemia
“Lower than normal blood glucose levels (< 4 mmol/L), particularly in diabetic patients on insulin”
Risk Factors
- Modifiable:
- Drugs with a higher risk of hypos e.g. gliclazide, glibenclamide, repaglinide, nateglinide
- Insulin
- Inadequate BG monitoring
- Irregular lifestyle, increased activity/exercise
- Non-Modifiable:
- Family history
- Increasing age
- Renal or hepatic impairment
- Sepsis, terminal illness, dementia/cognitive dysfunction
Aetiology
- Insulin errors
- Overdose of oral antidiabetic medication e.g. sulphonylureas, repaglinide
- Unplanned or intense physical exercise
- Fasting, skipping or delaying meals, eating fewer carbohydrates than usual
- Binge drinking or drinking alcohol on an empty stomach
Pathophysiology
- Results from an imbalance between glucose supply, glucose utilisation and current insulin levels
- Overly high insulin dose administration causing the excessive glucose-lowering effect
- Lack of sufficient glucose intake to maintain normoglycaemia
Investigations
- Finger-prick BG monitoring
Management
- Self-management
- Quick-acting sugary drink or snack e.g. 4-5 dextrose tablets, small glass fruit juice or fizzy drink, a handful of sweets
- Test blood sugar after 10-15 mins
- If < 4mmol → repeat step 1
- If > 4mmol → eat main meal or snack containing carbohydrate e.g. biscuits, toast with spread
- Management of unconscious patient
- Place the patient in the recovery position
- IM glucagon or 150-200ml 10% glucose infusion over 15 minutes (if on the ward)
- Give them a sugary drink/snack followed by carbohydrate-containing snack when they wake up
- Reducing the risk of hypos
- Check BGs regularly and be aware of hypo symptoms
- Carry sugary snack/drink on yourself
- Avoid skipping meals
- Avoid bingeing on alcohol or drinking on an empty stomach
- Eat carb-containing snack before exercise
- Inject a lower dose of insulin before or after strenuous exercise
- Have carb-containing snack before bed to avoid night-time hypos
- NB: Be aware of risks of driving and hypoglycaemia
Complications
- Seizures
- Coma
- Death (if untreated)