An insightful presentation on issue of Hypoglycaemia in patients of Diabetes Mellitus with focus on causes, symptoms and management. Also find included experience based inputs on issue of vehicle driving and hypoglycaemia

1. Hypoglycaemia

5. Causes of Hypoglycaemia

6. Hypoglycemia: Possible Causes
 Diet changes
 Insufficient carbohydrate intake
 Lack of food
 Delayed food intake
 Skipping a meal
 Changes in physical activity/Extra/unanticipated physical activity
 Excess walk, gym, exercise
 Exercise without food intake, on empty stomach
 Medication changes
 Sulphonylureas, meglitinides: intiation, dose changes
 Insulin: initiation, intensification
 Illness
 Stress
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12. Low blood glucose
Presence of symptoms Reversal of these symptoms when
blood glucose levels are restored
Whipple’s triad - Hypoglycaemia

14. 14
Hypoglycemia: Possible Signs & Symptoms
Mild Symptoms
Hunger Sleepiness
Shakiness Changed behavior
Weakness Sweating
Paleness Anxiety
Blurry vision Dilated pupils
Increase heart rate or palpitations
Moderate to Severe Symptoms
Yawning Confusion
Irritability/frustration Restlessness
Extreme tiredness/fatigue Dazed appearance
Inability to swallow Unconsciousness/coma
Sudden crying Seizures

21. Management of Hypoglycaemia

22. HYPOglycemia = LOW Glucose
(sugar)
Onset:
• sudden, must be treated immediately
• may progress to unconsciousness if not treated
• can result in brain damage or death
DMMP should specify signs and action steps at each
level of severity:
• mild
• moderate
• Severe
DMMP – Diabetes Medical Management Plan
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23. Hypoglycemia: Risks &
Complications
 Early recognition and intervention can prevent an
emergency
 Greatest immediate danger
 Not always preventable
 Impairs cognitive and motor functioning
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24. Mild/Moderate Hypoglycemia: What to do
Intervene promptly:
• Check blood glucose if meter is available.
• If no meter is available, treat immediately, on the spot.
• NEVER send the patient with suspected low blood
glucose anywhere alone
• When in doubt, always treat. If untreated may progress
to more serious events.
• Consider “Rule of 15”
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25. “Rule of 15”
General guidelines:
• Have the patient to eat or drink fast acting carbs (15g)
• Check blood glucose 10-15 minutes after treatment
• Repeat treatment if blood glucose level remains
low or if symptoms persist
• If symptoms continue, call physician
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26. Quick Acting Glucose for
Mild/Moderate Hypoglycemia
Treatment for Lows: 15 g Carbohydrate
• 4 oz. fruit juice
• 15 g. glucose tablets (3-4 tablets)
• 1 tube of glucose gel
• 4-6 small hard candies
• 1-2 tablespoons of honey
• 6 oz. regular (not diet) soda (about half a can)
• 3 tsp. table sugar
• One-half tube of cake mate
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29. Severe Hypoglycemia: What To Do
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46. Hypoglycaemia and driving
 Safe driving requires constant integration of mental integration of mental functions,
includes:
 Visual and auditory processing,
 Motor skills;
 Reasoning, logic or problem solving
 1st symptoms of hypoglycaemia appears when blood glucose < 70 mg/dl
 Varies from person to person
 Hypoglycaemia causes nervousness, tremors, tiredness, confusion and retarded
mental functions
 Functions, mainly affected by hypoglycemia include:
 Rapid decision making,
 Sustained attention,
 Analysis of complex visual stimuli
 Hand-eye coordination

47. Precautions to be taken:
 Avoid driving if possible
 Do not drive alone
 Measure blood glucose level before driving and no drive if it is below
5 mmol/L (90 mg/dL)
 Frequently recheck blood glucose levels when on long journey (2 hourly)
 Always carry rapid acting carbohydrate eg. Glucose sachets
 If BG < 90 mg/dL or symptoms of hypoglycaemia, discontinue driving
and consume rapid acting carbohydrate
 Not to drive till 30 to 45 min after restoration of blood glucose
 To carry “I am a diabetic” card and emergency contact no. and stick “I
am a diabetic” stickers on car with emergency contact no.