Today we discussed hypoglycemia in the context of medications.
For a discussion of the differential diagnosis of hypoglycemia, see
this post
Some considerations for dealing with hypoglycemia on the wards:
2 issues: 1. Increase blood glucose. 2. Determine reason
Gucose is below 4: If patient is awake, not NPO,
1. Need 15g carbohydrate (in the form of glucose tabs, 3 packs table sugar in water, 3/4 cup of juice or regular soft drink, 6 life savers)If BG is below 2, need at least 20g glucose.
2. Check glucose q 15 min until above 5, and repeat 15g CHO as needed
3. If over 1h until next meal, snack (e.g. 1/2 sandwich)
4. Look for cause, address.
5. Do not stop insulin in a type 1 diabetic
Pt NPO:
1. 25g CHO in form of D50 (50mL amp) push or D10 500cc. May also give glucagon 1mg sc/im if delay.
2. Check glucose q15 min until it is over 5 and give more D50 or D10 as needed
3. Pt may need ongoing glucose infusion after (e.g. D5 or 2/3+1/3 or D10)
4. Look for cause
5. Do not stop insulin in a type 1 diabetic
Reasons: Insulin or sulfonylurea excess or decreased PO intake.
NB- in sulfonylurea-induced hypoglycemia, consider octreotide as reviewed
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