Understanding Hypoglycemia

As a CMAII in a healthcare setting patients may experience hypoglycemia, Hypoglycemia is a life threatening condition in which a patient’s blood sugar is lower than it is normally. It’s also called “low blood glucose” or “low blood sugar”. It is important to recognize the life threatening condition in order to provide the best care to patients.

Hypoglycemia is usually related to diabetes (often type I), it is most common in patients who have issues with medicine, food, or exercise.

For individuals with diabetes hypoglycemia is when the blood sugar level drops below 70 mgs/dL. For individuals without diabetes hypoglycemia is  when your blood sugar level drops below 55 mgs/dL

Studies have found that 4 in 5 people with Type I Diabetes, and nearly 50% of all people with Type II Diabetes who take insulin suffer a low blood sugar episode 1 time every 4 weeks.

Understanding Hypoglycemia in non-diabetic patients

How can patients without diabetes suffer hypoglycemia

• Heavy Etoh Consumption (too much Jack Daniels) Drinking a lot without eating anything can stop the liver from releasing sugar from glycogen.
• Sepsis/Infection: Sepsis is a critical condition when the chemicals in the immune system that fight infections cause life threatening inflammation throughout the body. This critical condition can cause blood sugar to spike very high (Hyperglycemia) or plunge very low (Hypoglycemia)
• Insulin – an accidental overdose. A patient or a CMAII can administer too much synthetic insulin, or administer too much oral medication. Notify the nurse immediately for any medication errors.
• Failure to thrive: in older adults that have a loss in appetite, eat and drink less and lose weight. They usually have memory loss, trouble thinking, and trouble completing activities in daily living. Leading to lack of adequate nutrition (carbohydrates) that the patient requires to make enough glucose for energy.
• Gastric Bypass surgery: Patients often have “reactive hypoglycemia” when you experience low blood sugar 2 or 3 hours after consuming a meal. In gastric bypass surgery the body absorbs sugars very quickly which stimulates excess insulin production that leads to hypoglycemia.
• Advanced Liver Disease: Hepatitis and cirrhosis can cause the liver to not work properly, leading to low blood sugar.

Symptoms of Hypoglycemia can start quickly and vary from patient to patient. The patient can experience different signs and symptoms with each episode. CMAII should stay vigilant in reporting symptoms of hypoglycemia to the nurse.

• Pale
• Sweating
• Nausea
• Anxiety/Irritability
• Headache
• Hunger
• Fatigue
• Lightheaded
• Elevated Heart Rate
• Tingling/numbness of the lips cheeks or tongue
• Clumsiness, stumbling, trouble with coordination

As Hypoglycemia worsens signs and symptoms are more serious:

• Confusion
• Slurred speech
• Blurry vision
• Loss of coordination

Severe Hypoglycemia symptoms

• Unresponsive (unable to wake)
• Seizures

Patients can experience hypoglycemia while they are asleep.

Symptoms may include:

• Sweating a bunch, wet sheets and pajamas
• Restless, tossing and turning all night
• Crying out
• Night terrors
• Feeling tired, disoriented or confused after waking up.

How to Treat Mild to Moderate Hypoglycemia

After notifying the nurse, direct care staff can treat Hypoglycemia by eating or drinking carbohydrates (sugar).

The American Diabetic Association utilizes the “15-15” rule to treat an episode of mild to moderate hypoglycemia.

Have patients eat or drink 15 grams of fast acting carbs. ex: ½ fruit or ½ cup of fruit juice.

After 15 minutes check the patient’s blood sugar, if the blood sugar reading is still below 70 mgs/dL have the patient eat 15 more grams of fast acting carbs.

Keep repeating until blood sugar is above 70 mgs/dL. CMAII’s that notice a patient is having a mild to moderate hypoglycemia episode should notify the nurse and follow facility protocol.

How to Treat Severe Hypoglycemia

Severe hypoglycemia events require the use of emergency glucagon. CMAII should notify the nurse immediately if they witness a patient having a severe hypoglycemic episode. The nurse should administer an injection, nasal powder, or concentrated gel. These trigger the liver to release stored glucose.

Preventing Severe Hypoglycemia Episodes

Fixing the problem may be as simple as changing the times of day they take medications, eat meals or exercise. This will help the patient to avoid hypoglycemic episodes.

Important actions in preventing Hypoglycemia

• Administer medications to the patient exactly as they are prescribed.
• Use continuous glucose monitoring to check their blood sugars regularly
• Follow the doctors/prescribers’ instructions on exercise and what foods to eat.