Hypoglycaemia
‘Hypoglycaemia’ refers to a plasma glucose <4.0mmol/L, although the threshold for developing symptoms varies, and will almost certainly be present before a capillary glucose test reaches 4.0.
Causes: It is most likely that hypoglycaemia will occur in known diabetics who have either not eaten enough after taking their insulin, or who have taken too much insulin. Hypoglycaemia from oral diabetes tablets (sulphonylureas) is very unlikely, outside the setting of an overdose.
Other relevant causes include one of or a combination of:
- Excessive exercise
- Poor nutritional intake
- Alcohol consumption
Rare causes:
- Pancreatic disease
- Pituitary disease
- Liver disease & failure
- Drug interactions
Symptoms of hypoglycaemia
Symptoms usually develop quite rapidly over minutes. Symptoms and signs of low brain sugar levels (neuroglycopenia) are:
- Confusion
- Lethargy
- Hunger
- Aggression
- Seizures
- Coma
Symptoms and signs of autonomic dysfunction are:
- Sweating
- Pallor
- Tachycardia
- Vomiting
Hypoglycaemia assessment and management
Your assessment is the same as always: safe approach, ABCDE & O2. In this setting, think of ‘ABC DEFG’ (Don’t Ever Forget Glucose!)
Ideally, it is desirable to confirm hypoglycaemia with a BM reading, however, this should not cause any delay in the immediate management:
If conscious:
- Give oral, or buccal, glucose in any available form. This could include energy or soft (sugary) drinks, sweets, jam, honey, sugar. 10-20 g glucose orally in solution
If unconscious:
If unconscious:
- Remember oxygen
- Recovery position
- IV 5 mls/kg 10% dextrose
- IM glucagon 1 mg
- Hypostop®
- Use the buccal mucosa as above with any sugary substance available
Re-evaluate. There should be a response and improvement with the correct treatment within a few minutes. Refer to an Emergency Department if in any doubt.