Hypoglycemia

Definition/Etiology:

• Definition
  • Blood sugar < 60 mg/dL and is a common endocrine emergency.
  • Think of an airplane.
    • Fly too high will give you altitude sickness. (Make you sick)
    • Fly to low = you crash and die
• Etiology
  • Diabetic
    • Excessive insulin or oral agent
  • ETOH – Liver stores glycogen
  • Procedures – VGS
    • “Dumping syndrome”
  • Diseases
    • Pancreatic Disease
    • Cancer

Pathophysiology:

• Glucose is the primary fuel for Brain and CNS
• The brain cannot make or store glucose, so it relies on circulating blood sugar
• ↓ 60 or Rapid BS decline = SNS Activation AKA EARLY WARNING SYSTEM
  • BETA BLOCKERS HIDE THESE
    • Epinephrine
    • Glucocorticoids
• ↓40 = Cerebral Dysfunction
  • Coma to DEATH

Noticing: Assessment & Recognizing Cues:

• Nocturnal Hypoglycemia
  • Severe Symptoms – 50% happen at night
  • DM Type 1
• Subjective (DELIRIUM)
  • Slurred Speech
  • Blurred vision
  • Psychosis → Injury
  • Seizures
• Objective
  • Vitals
    • Tachycardia & Hypotensive

Interpreting: Analyzing & Planning:

• Labs
  • Finger stick
  • Serum Blood Glucose
  • Look for underlying cause
    • LIVER Failure or ETOH
      • AST/ALT
    • Pancreatic Disease/Cancer
      • Amylase/Lipase
• Diagnostics
  • Heart Monitor- Dysrhythmias
    • Remember our airplane – We can die from this

Responding: Patient Interventions & Taking Action:

• ABCs & Underlying Cause
  • Maintain airway if unconscious
  • Supplemental 02
• Pharmacology
  • IV GLUCOSE BOLUS 50% dextrose
  • Follow D10W IV infusion until patient can eat
  • No IV Access = glucagon
  • If ETOH abuse = thiamine
• Nonpharmacological
  • Monitor for seizure activity
  • Seizure precautions
• Adjunct medical therapy
  • Endocrinology, Diabetic Educator

Reflecting: Evaluating Patient Outcomes:

• Hypoglycemia
  • High rate of injury from falls
• ABCs
  • Remember that your patient can die from this. They will code.
• Blood glucose normalized = Prevent Seizure
• Patient teaching – Beta blocker hide s/s of hypoglycemia

Linchpins (Key Points):

• Notice
  • Symptoms of hypoglycemia
  • EARLY WARNING
  • DOn’t forget that BB hide sx
• Interpret
  • Blood glucose level
• Respond
  • QUICKLY
  • Under 40 = Coma
• Reflect
  • Symptoms resolved?
  • Seizure free?
  • Blood glucose check compliance