Hypoglycemia Treatment Protocol
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DOCUMENTATION OF HYPOGLYCEMIA TREATMENT PROTOCOL (file this form within the Progress Note Section of the Chart) IMPRINT PATIENT IDENTIFICATION HERE General Information: Check fingerstick BG if patient experiences any symptoms of hypoglycemia including Pallor, Clammy Skin, Hunger, Restless Sleep, Fatigue, Headache, Confusion, Sweatiness and Irritability If bedside BG < 70, confirm by repeating bedside test immediately as per policy, and Do Not Delay Hypoglycemia Treatment If the patient is/was taking oral medication for diabetes in the sulfonylurea class (glipizide [Glucotrol ® ], glyburide [Glynase® , Micronase® , DiaBeta® ]; glimepiride [Amaryl ® ], chlorpropramide [Diabinese® ], tolazamide [Tolinase® ]) then hold the sulfonylurea, follow this algorithm, check BG every 4 hours X 24 hours and consider immediate Diabetes Consult Document low Blood Glucose (BG): Date: Time: RN: BG < 70 in a patient with BG 50-69 in an ALERT patient ? LEVEL OF CONSCIOUSNESS g n i w o l l o f e h t f o e n o e v i G . 1 g n i w o l l o f e h t f o e n o e v i G . 1 g n i w o l l o f e h t f o e n o e v i G . 1 : ) n e v i g e n o e h t k c e h c ( : ) n e v i g e n o e h t k c e h c ( : ) n e v i g e n o e h t k c e h c ( 4 oz Orange/Apple Juice 8 oz milk (or Orange/Apple juice) 50 ml D50 IV (1 amp) and start IV r u o h / L m 0 0 1 t a W 5 D s r e k c a r C m a h a r G 3 d n a s r e k c a r C m a h a r G 3 1 tube Glucose Gel (if able to 2 tubes Glucose Gel (if able to if no IV access : glucagon 1mg IM* ) s d i u q i l d e n e k c i h t w o l l a w s ) s d i u q i l d e n e k c i h t w o l l a w s Time given: if NPO or unable to swallow: if NPO or unable to swallow: V I t r a t s d n a ) p m a 1 ( V I 0 5 D l m 0 5 V I t r a t s d n a V I 0 5 D l m 0 2 2. If there is a change in level of r u o h / L m 0 0 1 t a W 5 D r u o h / L m 0 0 1 t a W 5 D consciousness from baseline, if unable to swallow AND no if unable to swallow AND no IV then call Condition C IV access: glucagon 1mg IM* access: glucagon 1mg IM* Time called: : n e v i g e m i T : n e v i g e m i T 2. Notify MD (verify IV solution, volume, 2. Notify MD (verify IV solution, 3. Notify MD (verify IV solution, f i , n o i t a r u d d n a , e t a r , e m u l o v f i , n o i t a r u d d n a , e t a r , e m u l o v ) e l b a c i l p p a f i , n o i t a r u d d n a , e t a r Time: applicable) Time: applicable) Time: : d e i f i t o n D M : d e i f i t o n D M : d e i f i t o n D M : G B n i m 5 1 n i G B k c e h c e R . 4 : G B n i m 5 1 n i G B k c e h c e R . 3 : G B n i m 5 1 n i G B k c e h c e R . 3 1. If BG <70 at 15 minutes, then re-treat & notify MD per algorithm Document Treatment Given: 2. Document BG 15 minutes after second treatment BG:__________Time:_____________ RN:_____________________________ 1. If still < 70 after second treatment, then re-treat & notify MD per algorithm Document Treatment Given: 2. Consider Diabetes Consult (Pager #1082) 3. Document BG 15 minutes after third treatment BG: Time: RN: 4. If still < 70 after third treatment, individual management is needed. Call Diabetes Consult Service (Pager #1082) * If glucagon is used, it should be followed as soon as possible by EITHER oral carbohydrates (if patient can subsequently eat) or by obtaining IV access and starting D5W as indicated in the box. Glucagon should not be repeated. BG < 50 in an ALERT patient
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Transcript of Hypoglycemia Treatment Protocol
DOCUMENTATION OF HYPOGLYCEMIA
TREATMENT PROTOCOL
(file this form within the Progress Note Section of the Chart)
IMPRINT PATIENT IDENTIFICATION HERE
General Information:
Check fingerstick BG if patient experiences any symptoms of hypoglycemia including Pallor, Clammy Skin, Hunger, Restless Sleep, Fatigue,
Headache, Confusion, Sweatiness and IrritabilityIf bedside BG < 70, confirm by repeating bedside test immediately as per policy, and Do Not Delay Hypoglycemia Treatment
If the patient is/was taking oral medication for diabetes in the sulfonylurea class (glipizide [Glucotrol® ], glyburide [Glynase® , Micronase® ,
DiaBeta® ]; glimepiride [Amaryl® ], chlorpropramide [Diabinese® ], tolazamide [Tolinase® ]) then hold the sulfonylurea, follow this algorithm,
check BG every 4 hours X 24 hours and consider immediate Diabetes Consult
Document low Blood Glucose (BG): Date: Time: RN:
BG < 70 in a patient with BG 50-69 in an ALERT patient ? LEVEL OF CONSCIOUSNESS
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4 oz Orange/Apple Juice 8 oz milk (or Orange/Apple juice) 50 ml D50 IV (1 amp) and start IV
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1. If BG <70 at 15 minutes, then re-treat & notify MD per algorithm Document Treatment Given:
2. Document BG 15 minutes after second treatment BG:__________Time:_____________ RN:_____________________________
1. If still < 70 after second treatment, then re-treat & notify MD per algorithm Document Treatment Given:
2. Consider Diabetes Consult (Pager #1082)
3. Document BG 15 minutes after third treatment BG: Time: RN:
4. If still < 70 after third treatment, individual management is needed. Call Diabetes Consult Service (Pager #1082)
* If glucagon is used, it should be followed as soon as possible by EITHER oral carbohydrates (if patient can subsequently eat) or by obtaining IV
access and starting D5W as indicated in the box. Glucagon should not be repeated.
BG < 50 in an ALERT patient
