Hypoglycaemia

Diabetes & endocrinology
NHS Lothian

* Please note if you are concerned about hypoglycaemia in a patient who is not on a medication that may cause hypoglycaemia (gliclazide, other sulphonylurea, insulin), please discuss with the medical registrar on call or endocrinology team on call. *

 

Acute management

Acute management of hypoglycaemia can be found on the back of the insulin prescription chart.

 

Important Note 1: 20% dextrose is NOT available in NHS Lothian. If you need to treat hypoglycaemia with IV dextrose please use 100-200ml of 10% dextrose.

Important Note 2: Glucagon can be found stored in the ward fridge

 

Management of Hypoglycaemia guideline

 

Do I need to do anything after initial treatment?

1: Consider and treat the cause

A ‘one off’ hypoglycaemic episode (hypo) in a patient on insulin can occur and may need monitored. Please consider the below and always consider causes in recurrent hypoglycaemia:

  • Acute illness
  • Change in diet
  • Change in medication – have we started a medication? Are we giving the patient a medication they are prescribed at home but that they do not take or take a different dose?
  • Lipohypertrophy at insulin injection site.

This may be part of a more longstanding pattern of recurrent hypoglycaemia – consider sending HbA1c and asking the patient whether they ‘feel’ their hypos (a good question is ‘at what blood glucose level do you notice you are low’? Be concerned if the answer is 3 or less).

 

2: Adjust treatment

  • Gliclazide or insulin doses may need to be reduced. A reduction in insulin dose of 10% for a daytime hypo and 20% for a night-time hypo is a good start. Remember the hypo is caused by the previous insulin dose and shouldn’t stop the next dose being given. See insulin titration protocols
  • Diet or oral intake may need reviewed
  • Avoid areas of lipohypertrophy if present.

 

3: When to contact the Diabetes team

  • If initial management is unsuccessful or there is persistent clinical concern
  • If there is concern that hypoglycaemia may be a recurrent longstanding issue
  • If there is any concern about reduced hypoglycaemia awareness
  • If the patient does not know how to test their own CBG or have access to a meter

 

4: Remember driving

All people who have experienced hypoglycaemia need to be reminded about the DVLA driving guidelines.