Blood glucose below 4.0mmol/L is generally considered hypoglycaemia. In a non-diabetic patient, symptoms are often not present until closer to 2.5mmol/L. In somebody unwell (or in diabetics or the frail), treatment is reasonable for levels that are truly at or below 4.0mmol/L; those with normal physiology can tolerate mild hypoglycaemia (provided the aetiology is benign and the situation is not going to get worse).
Symptoms
Neuroglycopenia is generally the cause of the hypoglycaemic symptoms. In order of severity:
- Coma
- Seizure
- Weakness
- Confusion
Adrenergic symptoms such as diaphoresis, tremor, pale skin, nausea, dizziness or light-headedness also manifest.
Acute management
For those with working mouths
15-30g of oral sugars:
- HypoFit, 1 sachet
- about 5 jellybeans
- 1 tablespoon of glucose, sugar, or jam
- 150mL of fruit juice or normal soft-drink
Intravenous glucose
Reason would have you give 15-30g as well. The guidelines suggest 25g.
- 250mL D10 (10% dextrose in water)
- 50mL D50 (50% dextrose in water)
Both of these solutions are hypertonic, and D50 is an irritant solution.
Central access is best for D50 but you probably don’t have that. Be protective over your peripheral line if there is only one of them… Think about whether it really needs to go in faster than 2-3mL/min.
Other measures
If you can’t squirt sugar in the mouth and IV access is unavailable, 1mg of intramuscular glucagon is an alternative. Then make it so that IV access in available.
If you give D50 peripherally, keep an eye on the IV line. Maybe put in another.
If three doses of glucose (oral or IV) don’t push the blood glucose into an acceptable range, start and infusion (D10 at 100mL/hr) and ask for somebody with a bigger paycheck (perhaps the medical registrar).
Once you have fixed the problem…
Think about giving the patient a snack or some complex carbohydrate (banana, bread, fruit).
Further reading:
- Hospital Health Pathways Waitaha | Canterbury.