Hypoglycemia is defined as a glucose level of below 3.9mmol/L.
Hypoglycaemic events can be dangerous and present in unexpected ways, so watch your high-risk patients carefully and avoid diabetes regimens that increase the risk of hypos.
Risk factors for hypoglycemia:
Nocturnal hypoglycemia is more dangerous than those that occur in the day because the usual sympathetic response is delayed at night. Therefore, nocturnal hypoglycemia events are likely to be:
Hypoglycaemic episodes typically present with symptoms of sympathoadrenal stimulation, but often they present atypically in elderly patients. Usually, patients don’t volunteer that they’re having hypoglycaemic events, so you need to have a high index of suspicion and look for clues that suggest they are having hypoglycemic events:
Causes of hypoglycemia
Immediate management involves
Treatment is different to other causes of hypoglycemia. Giving dextrose or glucose can prolong the hypoglycaemia. Sulfonylureas stimulate insulin secretion by ß-cells in the presence of glucose, so the glucose treatment increases the action of sulphonylureas.
If hypoglycemia is severe or prolonged,
Avoid sulphonylurea treatment in high-risk individuals:
Follow-up after a hypoglycemic event
After a significant hypoglycemic event, close follow-up is required to:
If the cause for the hypoglycaemia is unclear, the following investigations are recommended:
Hypoglycemic unawareness describes the situation where patients do not get the usual warning signs of hypoglycemia until the glucose levels are very low. Glucose levels can be as low as 2 mmol/L before patients sense the hypoglycaemia and treat it. This is very dangerous and occurs in patients:
It takes 6 weeks of normal glucose levels to recover hypoglycaemic awareness, so it is important to understand the causes and rationalize diabetes treatment to improve glucose control for that period. During that recovery period, aim for glucose levels between 5 and 10 mmol/L. Glucose targets can return to normal once hypoglycaemic events are avoided and hypo awareness has recovered.
Rules for driving
Preventing the hypoglycaemia will depend on the cause of the hypoglycaemic events and the time that they typically occur.
Stress and sickness
You might have noticed that your glucose levels can get very high when you are feeling very stressed or when you are sick. This is due to the high levels of stress hormones that occur at these times. Hormones like cortisol and adrenaline make your liver release more glucose into the bloodstream and stop your insulin from doing its job.
Examples of stressful times that cause high glucose levels:
Stress and sickness
What to do: