Introduction
Hypoglycaemia refers to a blood glucose level below 3.6 mmol/L. Treatment induced hypoglycaemia on the other hand refers to an established hypoglycaemia as a result of treatment.
Hypoglycaemia is more common in elderly diabetics and those with kidney function impairment as well as those on long-acting oral anti-hyperglycaemic medications or insulin.
Severe hypoglycaemia (blood glucose < 2.2 mmol/L) may result in alteration of consciousness, fits, self-injury and various degrees of irreversible brain damage.
Following successful treatment of hypoglycaemia, its cause must be
determined and measures, including patient education and revision of anti-hyperglycaemic drug doses, should be taken to prevent its recurrence.
Causes of hypoglycaemia
- Overdose of any anti-hyperglycaemic medication i.e. insulin or oral agent
- Antihyperglycaemic medication use in renal impairment and the elderly
- Omitted or inadequate amount of food
- Unaccustomed physical overactivity
- Excessive alcohol intake
Symptoms of hypoglycaemia
The following are the symptoms of hypoglycaemia
- Dizziness
- Blurred vision
- Headaches.
- Palpitation
- Sweating
- Shaking of the hands and body
- Unconsciousness
- Convulsions
- Irritability and abnormal behaviour especially in children
Signs of hypoglycaemia
The signs of hypoglycaemia are:
- Sweating
- Tremors
- Tachycardia and bounding pulse
- Confusion
- Unconsciousness
- Convulsions
Investigations
- Random blood glucose (urgently done using a glucose meter)
- Blood urea and electrolytes
- Liver function tests
Treatment for treatment induced hypoglycaemia
Treatment objectives
The objectives of treating”treatment induced hypoglycaemia” include the following:
- To rapidly restore blood glucose levels to normal
- To maintain the level of blood glucose within the normal range until the patient can begin eating normally
- To identify and address the cause
Non-pharmacological treatment
Mild hypoglycaemia
- 2-3 teaspoons of granulated sugar or 3 cubes of sugar or ½ a bottle of soft drink (sugar containing, not ‘diet’ drinks) to individuals who are conscious.
- A glass of milk or fruit drink and a tablespoonful of honey are useful alternatives
- The above measures should be followed immediately by a meal or snack
Moderate hypoglycaemia
- Same as for mild hypoglycaemia, but repeat after 10 minutes.
- If no improvement is observed, treat as for severe hypoglycaemia
Pharmacological treatment
A. Severe hypoglycaemia
1st Line Treatment
Evidence Rating: [A]
Dextrose, IV,
Adults:
- 50% solution, 25-50ml 1-3 minutes through a large vein,
Then
- 5-10% solution, 500 ml 4 hourly until the patient is able to eat normally
Children
- 10% solution 4 ml/kg body weight over 1-3 minutes through a large vein
Then
- 5% solution: According to total daily fluid requirement until blood glucose levels normalise
2nd Line Treatment
Evidence Rating: [A]
Glucagon, IV, IM or subcutaneous,
Adults: 1 mg stat.
Children:
- 8-18 years (bodyweight > 25 kg); 1 mg stat.
- 8-18 years (bodyweight < 25 kg); 500 micrograms stat.
- 1 month-8 years; 500 micrograms stat.
- Neonate; 20 microgram/kg stat.
Referral Criteria
If the patient does not respond to recommendations, refer to a specialist.