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Hypoglycemia Prevention & Treatment. Gary Scheiner MS, CDE Owner, Integrated Diabetes Services 333 E. Lancaster Ave., Suite 204 Wynnewood, PA 19096 877-SELF-MGT (735-3648) (610) 642-6055 www.integrateddiabetes.com garyscheiner@prodigy.net. Hypoglycemia: Definitions.

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hypoglycemia prevention treatment
HypoglycemiaPrevention & Treatment

Gary Scheiner MS, CDE

Owner, Integrated Diabetes Services

333 E. Lancaster Ave., Suite 204

Wynnewood, PA 19096

877-SELF-MGT (735-3648)

(610) 642-6055

www.integrateddiabetes.com

garyscheiner@prodigy.net

hypoglycemia definitions
Hypoglycemia:Definitions
  • “Mild”: Adrenergic (BG<70)
  • “Moderate”: Cognitive (BG<50)
  • “Severe”: Unconscious (BG ???)
hypoglycemia cause
Hypoglycemia:Cause
  • Imbalancebetween factors raising and lowering blood glucose levels
hypoglycemia
Hypoglycemia

“The Greatest Limiting Factor In Diabetes Management”

the great limiting factor
The Great Limiting Factor
  • Performance Impairment
the great limiting factor7
The Great Limiting Factor
  • Anxiety / Embarrassment
the great limiting factor9
The Great Limiting Factor
  • Diminished Symptoms

(Hypoglycemic Unawareness)

hypoglycemia targets goals
Hypoglycemia:Targets/Goals
  • Unable to recognize & verbalize lows: >80
  • Able to recognize & verbalize lows: >70
  • Pregnancy: >60
  • <10% of readings below target at each time of day
  • No severe lows
hypoglycemia prevention strategies
Hypoglycemia Prevention Strategies

1. Insulin Program Setup (background/basal)

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Hypoglycemia Prevention Strategies

1. Insulin Program Setup (background/basal)

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Hypoglycemia Prevention Strategies

1. Insulin Program Setup (background/basal)

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Hypoglycemia Prevention Strategies

1. Insulin Program Setup (background/basal)

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Hypoglycemia Prevention Strategies

1. Insulin Program Setup (background/basal)

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Hypoglycemia Prevention Strategies

1b. Insulin Program Setup (Meal/Bolus)

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Hypoglycemia Prevention Strategies

2. Meal/Snack Timing

  • Major issue w/a.m. NPH/Lente
  • Minor issue w/Lantus or Ultralente
  • Not usually an issue with pump use
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Hypoglycemia Prevention Strategies
  • 1500-Rule (aggressive)
  • 1800-Rule (conservative)

(Total Daily Ins.)/1500 or 1800

  • May vary day vs. night

(nighttime often 50% more than day)

3. Proper Correction Doses

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Hypoglycemia Prevention Strategies
  • I:C Ratio that matches pre-meal BG 3-4 hours (not 2!) after eating
  • I:C Ratio often varies from meal to meal

(bkfst dose > lunch & dinner)

4. Proper Meal/Bolus Doses

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Hypoglycemia Prevention Strategies

5. Account For “Unused” Insulin*

* Newer pumps figure this automatically

based on the insulin duration you set.

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Hypoglycemia Prevention Strategies

5. Account For “Unused” Insulin

Example:

Gave 6.0 units at 7pm, BG 200 at 9pm.

Conservative approach: 40% remaining (6 x .4) = 2.4 units left

Aggressive approach: 33% remaining (6 x .33) = 2 units left

Subtract the unused insulin from your usual correction dose!

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Hypoglycemia Prevention Strategies

6. Carb Counting Accuracy

  • Proper Portion Measurement
  • Look Up Unknown / Restaurant Foods
  • Use Carb Factors
  • Subtract 100% of Fiber
  • Subtract 50% of Sugar Alcohols
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Hypoglycemia Prevention Strategies

7. Extend Meal Insulin When Necessary

  • Use When:
  • Portions are very large
  • Meal is prolonged
  • Food is low-glycemic index (pasta, legumes, dairy…)
  • Apply Via:
  • Square/Dual/Extended/Combo bolus on pump
  • Delayed or Split bolus on injections
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Hypoglycemia Prevention Strategies

8. Adjustment for Physical Activity

  • Exercise, recreation, chores: all count!
  • Reduce meal insulin (25%, 33%, 50%) for after-meal activity
  • Snack prior to after/between meal activity
  • Lower long-acting/basal insulin prior to and during prolonged activity
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Hypoglycemia Prevention Strategies

8. Watch Out for D’OH!

(Delayed Onset Hypoglycemia)

  • Following High-Intensity Exercise
  • Following Extended Duration Activity
  • May Occur Up to 24 Hours After
  • Adjustments to food and insulin may be necessary
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Hypoglycemia Prevention Strategies

9. Adjustment for Alcohol

  • Alcohol reduces the liver’s output of glucose and masks hypoglycemic symptoms
  • Delayed BG drops can occur
  • Decrease basal insulin (or overnight long-acting insulin) after drinking
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Hypoglycemia Prevention Strategies

10. Consistent Monitoring

  • Before All Meals & Snacks
  • Pre/Post Exercise
  • Bedtime
  • 3 a.m. (occasionally)
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Hypoglycemia Prevention Strategies

11. Recording & Analysis

  • Record all pertinent data
    • BGs
    • Carb
    • Activity
    • Insulin
  • Use an organized form (multiple days on single page, if possible)
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Hypoglycemia Prevention Strategies

11. Recording & Analysis

  • Review every 7-10 days
  • Look for patterns
    • > 10% below target range @ given time
    • Lows during/post-activity
    • Lows on School/Work vs. off-day
    • Lows Post-Menstrual
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Hypoglycemia Prevention Strategies

12. Caffeine

  • Helps reduce risk of nighttime hypoglycemia, but not daytime
  • Benefit seen with 4 cups of coffee per day (250 mg caffeine twice daily)
  • WILL YOU SLEEP???
hypoglycemia treatment
Hypoglycemia Treatment
  • Mild/Moderate Low
    • Check BG First
    • Treat w/High-Glycemic Index Food
    • Treat w/Proper Amount
    • Re-Check in 15 Minutes
  • High-GI Foods
    • Glucose Tablets
    • Dry Cereal
    • Pretzels
    • Graham Crackers
    • Vanilla Wafers
    • Jelly Beans
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Hypoglycemia Treatment
  • Use of Glycemic Index
    • Lower GI foods digest & convert to glucose more slowly
    • High-fiber slower than low
    • Hi-fat slower than low
    • Solids slower than liquids
    • Cold foods slower than hot
    • Type of sugar/starch affects GI
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Hypoglycemia Treatment

Use of Glycemic Index (contd)

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Hypoglycemia Treatment
  • Always Carry Rapid-Acting Carbs!
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Hypoglycemia Treatment

Once BG has risen, give rapid-acting insulin to cover any overtreatment!

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Hypoglycemia Treatment
  • Severe Low
    • Unconscious / Unresponsive
    • Seizure
    • Uncooperative
take home messages
Take-Home Messages
  • Quantify Your Lows
  • Strategize to Minimize
  • Plan for Proper Treatment