Hypoglycemia How to Deal With Hypoglycemia: What

Hypoglycemia

How to deal with hypoglycemia:

What is hypoglycemia?

Hypoglycemia is a condition that occurs when a patient's blood sugar (glucose) is too low. Quite often, the patient will be aware of this condition through symptoms such as feeling faint, agitation or anxiety, sweating, weakness, or headache. Confusion and double vision may also manifest themselves. Technically, any blood sugar below 70 mg/dL is considered low (Topiwala 2012). Common causes of hypoglycemia include too much insulin is released into the bloodstream when the patient is an insulin-dependent diabetic.

People with diabetes often suffer hypoglycemia when their condition is not being treated properly, such as when they inject themselves with too much insulin. "Hypoglycemia may also result if, after taking your diabetes medication, you don't eat as much as usual (ingesting less glucose) or you exercise more (using up more glucose) than you normally would" (Hypoglycemia, 2012, Mayo Clinic). Other causes include drinking too much alcohol, pancreatic tumors, infections, and thyroid deficiencies. In severe cases, extreme hypoglycemia can cause seizures (Topiwala 2012). Anorexia nervosa can cause hypoglycemia, as can certain kinds of weight loss surgery, which commonly "occurs after meals because the body produces more insulin than is needed" (Hypoglycemia, 2012, Mayo Clinic). "Another potential risk for hypoglycemia is the use of ?-blocker medication in cardiac and hypertensive patients. Using medications for ?-blockade may shift the glycemic threshold" (Tomky 2005). It is important to remember that "Like fever, hypoglycemia isn't a disease itself -- it's an indicator of a health problem" (Hypoglycemia, 2012, Mayo Clinic).

Nutrition

Ideally, patients with diabetes should monitor their blood sugar to ensure that they take the correct amount of insulin with meals. "Home monitoring of blood sugar with a fingerstick sample" is strongly advised (Topiwala 2012). However, when hypoglycemia does result, treatments should be immediately administered to reduce the risk of complications. "Early symptoms can usually be treated by consuming sugar, such as eating candy, drinking fruit juice or taking glucose tablets to raise your blood sugar level. If your symptoms are more severe, impairing your ability to take sugar by mouth, you may need an injection of glucagon or intravenous glucose" (Hypoglycemia, 2012, Mayo Clinic). In most instances, the patient's blood sugar will return to normal within 10 to 15 minutes after ingesting a high-sugar, high-carbohydrate food (Diabetes, 2012, Ambulance Technician Study). Diabetics should be instructed to carry such foods at all time, to reduce the span of time between the drop of blood sugar and treatment and to reduce the risk of seizures.

In a hospital situation, when treating a NPO (nothing by mouth) patient, "viable alternatives for treating early hypoglycemia include giving an intravenous (IV) bolus of 50% dextrose, or, if absent an IV, giving intramuscular glucagon" (Tomky 2005). This may also be necessary if the patient is unconscious. "Glucagon is usually given by injection beneath the skin, in the muscle. It comes as a powder and liquid that will need to be mixed just before administering the dose. Glucagon should be administered as soon as possible after discovering that the patient is unconscious from low blood sugar" (Diabetes, 2012, Ambulance Technician Study). The needle should be inserted at an 80 to 90 degree angle with a quick, decisive thrust. If there is any blood which escapes, the needle should be reinserted into another area of the muscle. "After the injection, the patient should be turned onto the side to prevent choking if they vomit. When the patient comes round you'll need to encourage them to eat carbohydrates as they will be suffering a glucose deficiency" (Diabetes, 2012, Ambulance Technician Study).

Ultimately, to cure the problem requires the treatment of the underlying condition, whether that is poorly-managed diabetes, a tumor, or another hormonal imbalance. For non-diabetics who suffer from frequent bouts of hypoglycemia: "If you don't have diabetes but have recurring episodes of hypoglycemia, eating frequent small meals throughout the day is a stopgap measure to help prevent your blood sugar levels from getting too low" (Hypoglycemia, 2012, Mayo Clinic). For diabetics, "A consistent carbohydrate diet is important to appropriately match the insulin regimen or secretagogue activity to food for optimum glucose control and prevention of hypoglycemia" (Tomky 2005).

Hypostop

"Hypostop is a tube of concentrated glucose gel that can be given to someone who has known or suspected hypoglycemia in a conscious patient without any risk of choking or aspiration" (Diabetes, 2012, Ambulance Technician Study). In the absence of consciousness, an intramuscular injection should be used instead.

Ethics

Ethical considerations which may arise include the patient's willingness to consent to treatment if the patient is incapacitated. Ideally, a patient's relative or caregiver should be consulted if available. If unavailable, if the patient's life is at risk, the nurse many need to act decisively and engage in proactive treatment when the patient is unconscious. In most instances, diabetic patients are aware of their situation and will give consent, even if somewhat impaired by the 'brain fog' of hypoglycemia or they will have made provisions for persons to give consent if they are incapacitated. "Capacity means the ability to use and understand information to make a decision. Any evidence that a person does not have this capacity has to show both of the following: A person's mind or brain is impaired or disturbed. The impairment or disturbance means the person is unable to make a decision at the current time (Consent to treatment: Capacity, 2012, NHS).