Management of Hypoglycaemia and dilemma of driving vehicles - Indian Scenario

1. Hypoglycaemia

5. Causes of Hypoglycaemia

6. Hypoglycemia: Possible Causes
 Diet changes
 Insufficient carbohydrate intake
 Lack of food
 Delayed food intake
 Skipping a meal
 Changes in physical activity/Extra/unanticipated physical activity
 Excess walk, gym, exercise
 Exercise without food intake, on empty stomach
 Medication changes
 Sulphonylureas, meglitinides: intiation, dose changes
 Insulin: initiation, intensification
 Illness
 Stress
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12. Low blood glucose
Presence of symptoms Reversal of these symptoms when
blood glucose levels are restored
Whipple’s triad - Hypoglycaemia

14. 14
Hypoglycemia: Possible Signs & Symptoms
Mild Symptoms
Hunger Sleepiness
Shakiness Changed behavior
Weakness Sweating
Paleness Anxiety
Blurry vision Dilated pupils
Increase heart rate or palpitations
Moderate to Severe Symptoms
Yawning Confusion
Irritability/frustration Restlessness
Extreme tiredness/fatigue Dazed appearance
Inability to swallow Unconsciousness/coma
Sudden crying Seizures

21. Management of Hypoglycaemia

22. HYPOglycemia = LOW Glucose
(sugar)
Onset:
• sudden, must be treated immediately
• may progress to unconsciousness if not treated
• can result in brain damage or death
DMMP should specify signs and action steps at each
level of severity:
• mild
• moderate
• Severe
DMMP – Diabetes Medical Management Plan
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23. Hypoglycemia: Risks &
Complications
 Early recognition and intervention can prevent an
emergency
 Greatest immediate danger
 Not always preventable
 Impairs cognitive and motor functioning
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24. Mild/Moderate Hypoglycemia: What to do
Intervene promptly:
• Check blood glucose if meter is available.
• If no meter is available, treat immediately, on the spot.
• NEVER send the patient with suspected low blood
glucose anywhere alone
• When in doubt, always treat. If untreated may progress
to more serious events.
• Consider “Rule of 15”
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25. “Rule of 15”
General guidelines:
• Have the patient to eat or drink fast acting carbs (15g)
• Check blood glucose 10-15 minutes after treatment
• Repeat treatment if blood glucose level remains
low or if symptoms persist
• If symptoms continue, call physician
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26. Quick Acting Glucose for
Mild/Moderate Hypoglycemia
Treatment for Lows: 15 g Carbohydrate
• 4 oz. fruit juice
• 15 g. glucose tablets (3-4 tablets)
• 1 tube of glucose gel
• 4-6 small hard candies
• 1-2 tablespoons of honey
• 6 oz. regular (not diet) soda (about half a can)
• 3 tsp. table sugar
• One-half tube of cake mate
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29. Severe Hypoglycemia: What To Do
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46. Hypoglycaemia and driving
 Safe driving requires constant integration of mental integration of mental functions,
includes:
 Visual and auditory processing,
 Motor skills;
 Reasoning, logic or problem solving
 1st symptoms of hypoglycaemia appears when blood glucose < 70 mg/dl
 Varies from person to person
 Hypoglycaemia causes nervousness, tremors, tiredness, confusion and retarded
mental functions
 Functions, mainly affected by hypoglycemia include:
 Rapid decision making,
 Sustained attention,
 Analysis of complex visual stimuli
 Hand-eye coordination

47. Precautions to be taken:
 Avoid driving if possible
 Do not drive alone
 Measure blood glucose level before driving and no drive if it is below
5 mmol/L (90 mg/dL)
 Frequently recheck blood glucose levels when on long journey (2 hourly)
 Always carry rapid acting carbohydrate eg. Glucose sachets
 If BG < 90 mg/dL or symptoms of hypoglycaemia, discontinue driving
and consume rapid acting carbohydrate
 Not to drive till 30 to 45 min after restoration of blood glucose
 To carry “I am a diabetic” card and emergency contact no. and stick “I
am a diabetic” stickers on car with emergency contact no.