Hypoglycaemia 🍬
Emergency management of hypoglycaemia. Recognition, treatment protocol, glucagon, and prevention strategies for on-call doctors.
🧠 Definition
- Plasma glucose <4.0 mmol/L = biochemical hypoglycaemia
- <3.0 mmol/L = clinically significant and requires immediate treatment
- Can be asymptomatic or present with neuroglycopenic symptoms (confusion, slurred speech, drowsiness)
📞 What to Ask / Orders to Make
- Is patient known diabetic? Type 1 or 2?
- Is patient eating normally?
- When were last oral hypoglycaemics or insulin given?
- Recent illness, vomiting, reduced intake?
- Symptoms: confusion, sweating, tremor, palpitations, seizures?
- Check for insulin sliding scale or recent dose errors
- Order capillary and lab glucose
📋 Causes
- Excess insulin / sulfonylureas
- Inadequate food intake or missed meal
- Increased exercise or illness (↑ insulin sensitivity)
- Sepsis or renal impairment
- Alcohol ingestion
🩺 Examination
- AVPU or GCS, look for confusion or drowsiness
- HR, BP, temperature
- Signs of infection or dehydration
- Neurological exam – assess for focal signs (stroke mimic)
🔍 Investigations
- Capillary blood glucose (urgent)
- Lab glucose to confirm
- U&E, renal function (↓ insulin clearance)
- LFTs, CRP if infection suspected
- Drug chart review: insulin, sulfonylureas (gliclazide, glibenclamide)
💊 Immediate Management
- If alert & able to swallow: 15–20g fast-acting carbohydrate (e.g. 150ml Lucozade or 4 glucose tablets)
- If drowsy or unable to swallow:
- → Give 200ml of 10% glucose IV over 15 minutes
- → Consider Glucagon 1mg IM if IV access difficult (ineffective if malnourished or alcohol abuse)
- Recheck glucose after 10–15 min
- Once >4.0 mmol/L: give long-acting carbohydrate (e.g. toast, sandwich, meal)
📌 Ongoing Management
- Search for the cause – treat infection, review insulin doses
- Monitor CBGs regularly (q1–2h) for 12–24h
- If on sulfonylureas – observe for 24h as long duration of action
- Inform diabetes team for review
- Document episode clearly in notes