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Introduction
  • When the Blood Glucose Level (BGL) falls below that required for optimal physiological function, (usually < 4mmol/L) with demonstrable signs or symptoms.
Clinical Presentation
  • Weakness, trembling, shaking.
  • Diaphoresis.
  • Headache.
  • Abnormal behaviour.
  • Altered conscious state.
  • Tachycardia.
  • Seizure
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Always treat diabetics with altered conscious state as having hypoglycaemia, as well as any other problems (extra glucose won't worsen the hyperglycaemia, and saves the life of the unconscious hypoglycaemic).
  • Diabetic patients taking Glucobay (Acarbose) have a greater glucose requirement due to stimulation of pancreatic insulin release.
  • Consider the aetiology of hypoglycaemia when selecting the most appropriate treatment (eg: glucagon will be ineffective in the absence of adequate hepatic glycogen stores).
  • Chronic poorly controlled diabetes may be hypoglycaemic despite a BGL >4mmol/L.
  • Encourage transport post treatment.
  • Hypoglycaemia may present as a focal neurological deficit or coma.
  • All patients with an altered GCS (i.e. abnormal for the individual) should have a BGL test preformed and managed appropriately if symptomatic.
  • IV boluses of glucose may need to be repeated when the patient remains hypoglycaemic due to an Insulin overdose (accidental/intentional), the objective is to achieve normoglycaemia, GCS may not improve.
  • Hypoglycaemia may present as a focal neurological deficit or coma.
  • Encourage transport post treatment.
  • Where intentional overdose is suspected the patient should be transferred to a healthcare facility, seek WAPOL support if required.
Management
Primary Care
Intermediate Care (EMT / Level 2)
  • If altered level of consciousness: 
    • Give Glucose Oral Gel if indicated; squeeze small amount of gel at a time into the cheek pouch. 
    • If patient does not improve after 10 minutes or deteriorates, reassess GCS and  BGL
    • Administer 2nd dose of Glucose Oral Gel if indicated
  • Consider applying cardiac monitor if trained and authorised
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
  • If GCS does not permit oral intake:
  • Reassess GCS and BGL after 10 minutes
  • If the BGL is still low and the patient symptomatic:
    • Encourage oral intake of complex carbohydrates, patient condition permitting
    • OR
  • Consider cardiac monitoring
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Seizure
  • Coma
  • Brain Damage
  • Patients with insulin overdose will require frequent assessments, paying close attention to blood glucose levels and being aware of ECG changes.

References
References
Key Terms & Links
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