- Hypoglycemia
- Rule of 15
- If Glucose < 70 mg / dl : 15 gm of CHO
- If < 50 : 30 gm of CHO
- Acceptable CHO choices = 15 gm of CHO
- 4 glucose tab
- 1/2 cup (4 oz) of juice or regular soda
- 1 Tablespoon of sugar
- Recheck in 15 min; retreat if <70 mg / dl
- if > 70, and meal will not be provide in 30 min, give a snack of graham crackers / peanut butter or milk (slower acting CHO the will keep glucose at goal)
- If patient is unresponsive:
- 1/2 - 1 amp of D50 % Or
- 1 mg of Glucagon 1 mg SC or IM, feed after waking up
HYPOGLYCEMIA: Mostly in Renal Failure Patient / DM à insulin stacking / Sulphonylurea (avoid SSI; give low does basal and meal time)
Rapid overview for hypoglycemia in adults, other than significant sulfonylurea overdose Up-to-date
Causes of hypoglycemia in adults Up-To-Date
Drugs other than anti hyperglycemic agents and alcohol reported to cause hypoglycemia Up-To-Date
Hypoglycemia: Interpretation of laboratory tests Up-To-Date
Arterial calcium stimulation with hepatic venous sampling for insulinoma Up-To-Date
Nurse-initiated strategies for treating hypoglycemia JCEM 2013
- DKA
- Low insulin
- Fat: Lipolysis: FFA (goes to liver for Ketoacidosis, and Glycerol (goes to liver for gluconeogenesis)
- Protein
- Glucose: Hyperglycemia (usually > 250)
- If < 250, think of
- alcoholic ketoacidosis
- starvation ketoacidosis
- Partially treated DKA (insulin will drop glucose down quickly)
- Ketoacids
- Acetone
- Acetoacetone
- B - Hydroybutyrate
- Treatment: Only REGULAR Insulin
- Continue IV Insulin until
- Acidosis is clear (ideally if no urine ketones, that is the end of the need of IV insulin)
- So, Monitor HCO3-, CO2, and Anion Gap
- Potassium supplement can be started if good urine output, even if K 4 - 5.
- HCO3 : pH < 6.9, otherwise do not give. Given as a drip over 30 min (not as a bolus)
- HHS
- Osmolality > 320, Glucose > 600
- Rapid drop in blood glucose will put them at risk of cerebral edema
- Ketone will be in trace (1+ in Urine)
- References:
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