Hypoglycaemia
Hypoglycaemia occurs when the blood glucose level falls to values low enough to cause symptoms and signs. Significant hypoglycaemic symptoms tend not to occur until blood glucose levels below 3 mmol/l, though features such as minor cognitive disturbances may be seen at levels between 3 and 4 mmol/l. The clinical suspicion of hypoglycaemia should be confirmed using blood or appropriate reagent sticks with, in certain circumstances, a confirmatory blood sample sent to the laboratory for subsequent assay. If the patient is not a known diabetic on insulin or on oral hypoglycaemic agent, a blood sample should be removed and sent to the laboratory in appropriate tubes (yellow top) for later analysis of blood glucose and plasma insulin (speckled top).
Treatment
- Oral glucose should be given (20-30 grams) if the patient is still conscious.
- If the patient is unconscious or unable to swallow, the initial treatment (with exceptions notes below) should be with 1mg Glucagon, subcutaneous or intramuscular.
- If Glucagon does not correct the low blood glucose within 10 - 15 minutes (and this includes prior administration by ambulance staff), 250 ml of 10% glucose i.v. should be given stat
- If the patient does not recover consciousness, check BM and give further 250ml of 10% glucose.
Notes
- Intravenous glucose, rather than Glucagon injections, should be used in sulphonylurea-induced hypoglycaemia and with hepatic disease. Sulphonylurea-induced hypoglycaemia may be very prolonged (several days).
- If Addison's disease or hypopituitarism is suspected, blood should be taken for later assay or cortisol and ACTH, and Hydrocortisone 200 mg i.v. as a bolus should be given prior to intravenous glucose.
- In alcoholics parenteral thiamine (pabrinex) should be given with the glucose (? Wernicke's).
