Hypoglycemia (Low Blood Sugar)
By MJ Wainwright, RN
Monday, October 15, 2001Hypoglycemia (Low Blood Sugar)
In Type I diabetes we always try to balance the amount of insulin, exercise and food the person needs to maintain a normal blood sugar. Sometimes an imbalance will occur and low blood sugar, called hypoglycemia, will happen. Hypoglycemia can occur rapidly (over minutes to an hour) and needs to be treated immediately!
Hypoglycemia is caused by:
- Too much insulin
- Too little food
- Too much exercise
When insulin is given it lowers blood sugar by allowing the sugar in the blood to be used by the cells as fuel. Insulin is only given before a meal, so that sugar (in the form of carbohydrates) is available for the body to use. If insulin is given but there is not enough sugar in the bloodstream, hypoglycemia will occur. Low blood sugar (Hypoglycemia) is defined as a blood sugar level LESS THAN 70.
Low blood sugar must always be treated right away. However, treatment depends upon how low the blood sugar is and how the patient is acting!
Mild Hypoglycemic Reaction
Mild reactions, sometimes called "early" reactions, occur when the sugar becomes lower than normal. Our bodies detect a low blood sugar and start to produce adrenalin, which increases the level of sugar in the blood. (Adrenalin is a hormone that increases blood sugar in an emergency).
Symptoms: Hunger, sweaty, nervous, shaky or pale.
Treatment: If symptoms are mild try to test the blood sugar before treating. (Don't delay treatment if testing is not available. If the blood sugar is less than 70 give 15 carbohydrate grams of FAST acting sugar.
15 Grams of Fast acting sugar (carbs) are equal to:
- 4 oz. of juice or non-diet soda
- 3 glucose tablets
- 3 packets of sugar or 3 tsp. of honey
- 8 0z. of milk is 12 carbs. but it doesn't act as quickly as juice, we use milk a lot for mild reactions at night.
After 15 minutes, retest the blood sugar. If it is still less than 70 give 10 to 15 more carbohydrate grams and test again in 15 minutes.
Moderate Hypoglycemic Reactions
Moderate reactions occur when mild reactions have not been treated and a lack of sugar is provided to brain cells.
Symptoms: Extreme fatigue and hunger, confusion and behavior changes like short temper, anger crying, whining. Slurring of speech may be noticed or poor balance.
Treatment: If a moderate reaction is suspected TREAT FIRST. If you really think the person has a moderate low blood sugar reaction, give them some quick acting sugar BEFORE you test. But test as quickly as possible after treatment has been given. (e.g. test while they are drinking the juice.)
After 15 minutes retest the blood sugar. If it is still less than 70 give 10 to 15 more carbohydrate grams and test again in 15 minutes.
If the person is not able to swallow, place them on their side and put honey or a sugar gel into the side of their cheek. The cells in the mouth will absorb the sugar. (You will be taught how to do this by your diabetic educator.
Severe Hypoglycemic Reactions
If hypoglycemic reactions are not treated by giving sugar, the blood sugar will continue to decline, leading to a severe lack of sugar to the brain causing a seizure or unconsciousness.
Symptoms: A seizure or coma is medical emergency requiring prompt treatment.
Treatment: Emergency treatment of a severe reaction can be provided at home by administering Glucagon. Glucagon is the OPPOSITE hormone of insulin and it raises blood sugar. Glucagon is usually only given when a person is unconscious or having a seizure. More detailed instruction on glucagon administration is attached. A prescription for glucagon will be given to you before you leave the hospital.
TYPE I DIABETICS SHOULD ALWAYS WEAR A MEDICAL EMERGENCY IDENTIFICATION BRACELET!
Every drugstore sells I.D. bracelets for diabetics. Emergency personnel can get more information if you choose a bracelet that provides computer access to details about your child's medical condition. It is very important that your child at least wear a bracelet or necklace that identifies them as a Type I diabetic.
MJ Wainwright, CCRN
Fountain Valley Community Hospital
Inservice - June 21, 2001
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