Presentation title

Emergency Care
Part 2: Treating and Preventing
Hypoglycaemia
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Emergency care

1 Managing DKA

2 Treating and preventing hypoglycaemia

3 Surgery in children with diabetes

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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
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)
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Symptoms

Trembling
Rapid heart rate
Pounding heart (palpitations)
Sweating
Pallor
Hunger and/or nausea
Irritability
Neuroglycopenia

Difficulty concentrating Dizziness and unsteady

gait
Irritability
Tiredness
Blurred or double vision
Nightmares
Disturbed colour vision
Inconsolable crying
Difficulty hearing
Loss of consciousness
Slurred speech
Seizures
Poor judgement and
confusion
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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 dont 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
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
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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
Questions
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