Presentation title

Emergency Care

Part 2: Treating and Preventing Hypoglycaemia

Emergency care

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Managing DKA

Surgery in children with diabetes

Treating and preventing hypoglycaemia

Hypoglycaemia

• One of the most common acute complications of diabetes

• Low blood glucose

• May causes severe symptoms• Coma or seizures

• Limitation in the management of diabetes

• Effective treatment and prevention are key

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Criteria

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• Symptoms of hypoglycaemia occur around <3.5 mmol/l (but not always!)

• Awareness of symptoms depend on background values

• Confusion may occur with rapidly dropping BGs but also with only modest hypoglycaemic values

• Counter regulation in individuals without diabetes begins at <4 mmol/l

• “Hypo” or “low sugar” symptoms due to bodies’ self-correcting hormonal responses (adrenalin)

Symptoms

• Trembling

• Rapid heart rate

• Pounding heart (palpitations)

• Sweating

• Pallor

• Hunger and/or nausea

• Irritability

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Neuroglycopenia

• Difficulty concentrating • Irritability • Blurred or double vision • Disturbed colour vision • Difficulty hearing • Slurred speech• Poor judgement and

confusion

• Dizziness and unsteady gait

• Tiredness • Nightmares • Inconsolable crying • Loss of consciousness • Seizures

DCCT and now standard Classification of severity

• Mild Hypoglycemia• Recognition and self treatment• Usually <3.9 mmol/l

• Moderate Hypoglycemia• Aware of symptoms• Needs assistance to take care of themselves

• Severe Hypoglycemia• Loss of consciousness (coma), convulsion, marked

confusion• Usually <2.5 mmol/l

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Management

• Identify hypoglycaemia• Symptoms

• Blood glucose values

• Teach how to recognize and manage hypoglycaemia• Learn symptoms

• Learn responses to symptoms

• Re-enforcement by family and heath care workers

• Treat the hypoglycaemia

• Determine cause (when possible)

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Treatment (1)

• Feed the child simple sugar• Rapid acting carbohydrate e.g. sweetened drinks, fruit

juices, glucose in water, sweets, packet of sugar

• Enough to make symptoms go away… don’t overtreat

• Give 0.3 g/kg of glucose if available

• Follow up with regular meal or snack – controversial but certainly reasonable if less than optimal monitoring possible

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Treatment (2)

• If the child has severe symptoms• Not able to eat• Glucagon (0.5 mg for age <12 yr, 1.0 mg for ages >12

yr)• IV glucose (3 ml/kg of 10% dextrose, 1 ml/kg of 30%

dextrose)• Oral rapid acting foods - glucose, sugar or honey

Determine cause

• Too much insulin – dose error or timing• Too little/late food• Increased activity, sometimes hours later• Illness, esp. gastrointestinal viruses• Alcohol

• Does not cause hypo but makes it nearly impossible for body to self-correct since “liver is busy”

• Knowing cause helps to avoid future hypoglycaemia

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Prevention

• Reminders about the symptoms of hypoglycaemia

• Reminders about the causes

• Help to identify risk factors e.g. age, longer duration of diabetes, higher doses, etc.

• Repeated episodes of hypoglycaemia should result in specific advise to prevent recurrences

• Re-involve adults and caregivers/direct supervision

• Often some psychological issues

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Questions

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