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Help with Hypos

Help with Hypos. Vera Nagle Diabetes Nurse Specialist Practice Nurse Conference 1/10/16. 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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Help with Hypos

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  1. Help with Hypos Vera Nagle Diabetes Nurse Specialist Practice Nurse Conference 1/10/16

  2. 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

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

  4. 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

  5. Causes of Hypoglycaemia • Renal disease • Vomiting • Breastfeeding • Hot weather

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

  7. Classification of Hypoglycaemia Mild- Moderate Symptomatic The person is able to recognise and treat mild-moderate hypoglycaemia

  8. Classification of Hypoglycaemia Severe Hypoglycaemia Temporary disabling and therefore requires the assistance of another person

  9. Classification of Hypoglycaemia Asymptomatic Hypoglycaemia Detection of hypoglycaemia requires measurement of blood glucose

  10. 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

  11. Symptoms

  12. 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)

  13. How people describe their experiences of hypoglycaemia. • Reference: NHS Recognition, treatment and prevention of hypoglycaemia n the community December 2011

  14. 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

  15. 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)

  16. 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 !

  17. 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.

  18. 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’

  19. 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.

  20. Diabetes and Driving          For people with diabetes who drive, extra precautions need to be taken to help maximise road safety.

  21. 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.

  22. 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

  23. Conclusion • Hypoglycaemia is a side effect of particular diabetes treatments that can have a wide reaching impact on a person’s 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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