- When the Blood Glucose Level (BGL) falls below that required for optimal physiological function, (usually < 4mmol/L) with demonstrable signs or symptoms.
- Weakness, trembling, shaking.
- Diaphoresis.
- Headache.
- Abnormal behaviour.
- Altered conscious state.
- Tachycardia.
- Seizure
- 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.
- Encourage transport post treatment.
- Where intentional overdose is suspected the patient should be transferred to a healthcare facility, seek WAPOL support if required.
- Primary Survey
- Insert airway adjunct and assist ventilations as required
- Consider Oxygen as per CPG
- Reassurance (continuous)
- Vital Sign Survey (monitor regularly including pre-and-post intervention blood glucose levels)
- If conscious state allows (i.e. GCS 15/15):
- Give glucose drink or food (oral carbohydrates).
- Consider administering Glucose Oral Gel as per instructions on package
- Reassess GCS and BGL after 10 minutes
- Follow up as needed with complex carbohydrates (e.g. sandwich)
- 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
- Give Glucose Oral Gel if indicated; squeeze small amount of gel at a time into the cheek pouch.
- 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
- If GCS does not permit oral intake:
- Establish vascular access (if readily obtainable); administer intravenous glucose 10% as per CPG
- OR
- If IV access is delayed or not obtainable, administer intramuscular glucagon as per CPG
- 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
- Administer repeat dose of intravenous glucose 10% as per CPG
- OR
- Administer repeat dose of intramuscular glucagon as per CPG
- 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
- As per Advanced Care guidelines
- 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.
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