HYPOGLYCAEMIA AND TREATMENTS Community Diabetes Specialist Nurses Nottingham

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HYPOGLYCAEMIA AND TREATMENTS Community Diabetes Specialist Nurses Nottingham City. Care Partnership

HYPOGLYCAEMIA AND TREATMENTS Community Diabetes Specialist Nurses Nottingham City. Care Partnership

WHAT IS A HYPOGLYCAEMIA Slide 2

WHAT IS A HYPOGLYCAEMIA Slide 2

HYPOGLYCAEMIA (HYPO) WHEN GLUCOSE LEVELS DROP USUALLY BELOW 4 MMOLS Slide 3

HYPOGLYCAEMIA (HYPO) WHEN GLUCOSE LEVELS DROP USUALLY BELOW 4 MMOLS Slide 3

WHY DOES HYPOGLYCAEMIA OCCUR? Slide 4

WHY DOES HYPOGLYCAEMIA OCCUR? Slide 4

Missed or late meals Eating less carbs than usual Too much insulin Too much

Missed or late meals Eating less carbs than usual Too much insulin Too much sulphonylurea More activity than usual e. g gardening, shopping, golf, walking, dancing Slide 5

Injecting muscle instead of the fatty layer under the skin Excessive alcohol consumption Extremes

Injecting muscle instead of the fatty layer under the skin Excessive alcohol consumption Extremes in temperature Stress and illness Slide 6

Consider • If Hba 1 c is less than 48 mmol/mol • Overtreatment of

Consider • If Hba 1 c is less than 48 mmol/mol • Overtreatment of medication • Increase risk of Hypoglycaemia Slide 7

Common Symptoms of Hypo • Sweating • Dizziness • Trembling • Tingling hands, feet,

Common Symptoms of Hypo • Sweating • Dizziness • Trembling • Tingling hands, feet, lips and tongue • Hunger • Anxiety • Irritability • Palpitations Slide 9

If not treated quickly the symptoms of hypo become more severe • Coordination may

If not treated quickly the symptoms of hypo become more severe • Coordination may suffer • Vision can become blurred • Behaviour can become irrational and erratic, even aggressive • If the hypo sufferer refuses help this needs to be ignored as the effects of the hypo are causing them to react in an irrational way Slide 10

Game Slide 11

Game Slide 11

Treatment of a Hypo MILD to MODERATE 7 Dextrosol energy tablet or 5 Glucotabs

Treatment of a Hypo MILD to MODERATE 7 Dextrosol energy tablet or 5 Glucotabs Sweet drink (200 mls)– pure fruit juice, fizzy pop (not diet), lucozade (amount can vary depending on type) 3 -4 Jelly Babies 1 tube of Glucogel Each has approximately 15 -20 g of carbohydrate CHECK GLUCOSE AFTER 10 MINUTES AND REPEAT IF STILL LOW DO NOT USE THESE TREATMENTS FOR SOMEONE WHO IS UNABLE TO SWALLOW OR UNCONSCIOUS Slide 12

SEVERE HYPO This is where the patient is unable to react ‘normally’ to a

SEVERE HYPO This is where the patient is unable to react ‘normally’ to a situation … they may not be completely still and silent GLUCAGON Glucagon is a hormone (like insulin) also made by the pancreas but has the opposite effect of insulin. It raises the glucose level in the blood Available in the UK on prescription: Gluca. Gen Hypo Kit Comes as a vial of powder and syringe of water which is mixed just before injecting IF GLUCOGEN IS NOT AVAILABLE IN THIS SITUATION A 999 AMBULANCE NEEDS TO BE CALLED. Slide 13

After a Hypo Is Normal to feel • Emotional • Headachy • Nauseous Slide

After a Hypo Is Normal to feel • Emotional • Headachy • Nauseous Slide 14

Following a Hypo Once the patient has started to recover from the hypo If

Following a Hypo Once the patient has started to recover from the hypo If their meal is due they can have this. If it is a while until their next meal 1 slice of medium bread or toast or 2 digestive biscuits. These are approximately 15 -20 g of carbohydrate Patient will need reassuring as it can be a very frightening experience. Slide 15

 • If next insulin injection is due following a severe hypo it would

• If next insulin injection is due following a severe hypo it would be wise to delay this until patient is fully recovered • The Insulin or Sulphonylurea doses will need reviewing • Consider why the hypo happened Slide 16

HYPOGLYCAEMIA AND DRIVING Slide 17

HYPOGLYCAEMIA AND DRIVING Slide 17

DVLA changes to driving and using insulin DVLA must be informed - 3 yr

DVLA changes to driving and using insulin DVLA must be informed - 3 yr driving licence • New rules brought in end of 2012 + Group 2 drivers ( lorry and bus drivers) can now use insulin • Testing before driving – 5 to drive – then every 2 hrs. Carry testing kit and hypo treatment always • Sulphonylureas • If hypo while driving what do you advise? • Informing DVLA of any severe hypos – 2 in 1 yr licence will be revoked - 1 in 1 yr for Group 2 drivers • Slide 18

Nottingham City. Care Partnership CIC 1 Standard Court Park Row Nottingham NG 1 6

Nottingham City. Care Partnership CIC 1 Standard Court Park Row Nottingham NG 1 6 GN e: [email protected] nhs. uk t : 0115 883 9600 www. nottinghamcitycare. nhs. uk