Help with Hypos

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Help with Hypos

• Vera Nagle
• Diabetes Nurse Specialist
• Practice Nurse Conference
• 1/10/16

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What is Hypoglycaemia ?

• Hypoglycaemia or a hypo occurs when your blood
  glucose falls too low (i.e. less than 4mmol/L).
• Almost everyone with Type 1 diabetes will have a
  hypo at some stage

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Hypoglycaemia

• Hypoglycaemia is the principle limiting factor in
  the management of diabetes and cause severe
  disruption to the lives of people with diabetes.

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Causes of Hypoglycaemia

• Excessive, inappropriate or ill-timed insulin
  dosage, or wrong type of insulin.
• People using oral glucose lowering drug therapies
  incorrectly (e.g. dose or timing).
• A reduction in exogenous glucose missed meals and
  snacks)
• A reduction in endogenous glucose production (
  alcohol)
• Exercise
• Tight glycaemic control

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Causes of Hypoglycaemia

• Renal disease
• Vomiting
• Breastfeeding
• Hot weather

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Classification of Hypoglycaemia

• Symptomatic hypoglycaemia-the episodes are
  interpreted by the patient.
• Asymptomatic hypoglycaemia- the person does not
  recognise the episode

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Classification of Hypoglycaemia

• Mild- Moderate Symptomatic
• The person is able to recognise and treat
  mild-moderate hypoglycaemia

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Classification of Hypoglycaemia

• Severe Hypoglycaemia
• Temporary disabling and therefore requires the
  assistance of another person

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Classification of Hypoglycaemia

• Asymptomatic Hypoglycaemia
• Detection of hypoglycaemia requires measurement
  of blood glucose

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Glucose Counter Regulation

• To maintain homeostasis and protect the brain
  from prolonged glucose deprivation, hypoglycaemia
  activates several autonomic and hormonal
  mechanisms , which reverse the metabolic effects
  of insulin

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Symptoms
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Consequences of Hypos

• Fear
• Being alone at night
• Anxiety while driving
• Limitations on social activities

• Upset to routine
• Loss of time
• Loss of concentration
• Cognitive Impairment
• Embarrassment( work, socially)
• Argumentative
• Injury (self other property, driving)

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How people describe their experiences of
hypoglycaemia.

• Reference NHS Recognition, treatment and
  prevention of hypoglycaemia n the community
• 
  December 2011

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Treatment of Hypoglycaemia

• 15 Rule
• 15grams of carbohydrate and repeat the blood
  sugar in 15 minutes
• If blood sugar remains less than 4.0mmol/l repeat
  the oral 15grams of carbohydrate

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What is 15g of Carbohydrate?

• 5 glucose (Dextro-Energy, Lucozade) tablets
  OR
• 100 ml Lucozade original  OR
• 200 ml fruit juice OR fun size cans of Coke
• 150 ml sugary drink (e.g. Coke, 7UP - not the
  diet version)
• Take a long acting carbohydrate snack (a slice of
  bread or fruit)

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• Check your blood glucose level after 10-15
  minutes
• If you still don't feel well and your blood
  glucose level remains less than 4.0 mmol/L,
  repeat the above
• Eat your next meal if due
• If your next meal is not due within an hour, have
  a small snack e.g. bread, fruit
• If your next meal is due, do not leave out fast
  acting insulin however the dose may need to be
  reduced.
• Remember always carry glucose tablets or some
  form of sugar with you !

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Treatment of Severe Hypo

• Call 999 / 112 immediately for an ambulance
• Do not give the person  anything by mouth (as you
  may choke)
• Place the person  in the recovery position
• Inject person with glucagon
• Insulin should never be given to an unconscious
  patient.

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What is Glucagon ?      

•                                
• Glucagon has the opposite effect to insulin. It
  works by raising blood glucose levels temporarily
  
• Glucagon may take up to 15mins to work and only
  lasts for a short time
• When you are conscious again, you must have a
  drink containing sugar to stop the hypo

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Hypoglycaemia Unawareness

• Hypoglycaemia unawareness is used to describe
• a situation where people with diabetes, are
  frequently unable to recognise a low blood sugar
  or a hypo.

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Diabetes and Driving         

• For people with diabetes who drive, extra
  precautions need to be taken to help maximise
  road safety.

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Education

• A fundamental element of to the avoidance of this
  potentially life threatening complication of
  insulin therapy is EDUCATION!
• Identification by the patient of the symptoms
  individual to then is crucial.

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EDUCATION Strategies

• Try to identify possible symptoms and or
  situations.
• Strict home glucose monitoring
• Adjust regime approrpratiely
• Carbohydrate counting
• Exercise planning
• Carry id and hypo treatment
• Instruct relatives how to administer glycogen
• Structured Education Programmes

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Conclusion

• Hypoglycaemia is a side effect of particular
• diabetes treatments that can have a wide reaching
• impact on a persons life.
• It is important to educate people with diabetes,
• their carers and other professionals in the early
• recognition, treatment and prevention of the
• condition in the community.
• Simple steps can be taken to prevent harm from
  hypoglycaemia through prompt and effective
  management of the condition.

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