Hypoglycaemia

Question 1

What is the minimum flush for IV Dextrose?

Answer 1

10mL before and after Dextrose admin.

Question 2

What steps need to be taken for a hypoglycaemia pt who has fully recovered but does not fit the Treat and Refer guideline who refuses transport?

Answer 2

1. Rpt advice for transport using friend/relative assistance
2. Document refusal and leave pt in care of third party
3. Advise the pt of actions to take if symptoms reoccur
4. Advise of need to make early contact with LMO for follow up

Question 3

When should you consult for further Dextrose doses?

Answer 3

1. In a suspected insulin overdose, even if pt BGL >4 and pt obeying commands
2. If both doses of Dextrose have been administered but BGL <4 and unable to admin oral carbohydrates.

Question 4

What is the management for BGL <4, Responds to Commands?

Answer 4

Glucose 15g oral gel, rpt once after 15mins if inadequate response. If continues to respond poorly, Rx with Dextrose/Glucagon.

Question 5

If poor response to oral gel then?

Answer 5

If poor response, consider Dextrose or Glucagon 1IU IM

Question 6

What is the management if BGL <4, Does Not Respond to Commands?

Answer 6

IV cannula in large vein
CONFIRM IV PATENCY WITH LARGE FLUSH
Dextrose 10% 150mL (15g) IV, with a minimum of 10mL flush

If unable to insert IV, Glucagon 1IU IM

Question 7

How is pt response to “BGL <4, Does Not Respond to Commands” management assessed for adequacy?
What is the further management?

Answer 7

After 5-10 minutes, assess patient GCS/BGL.
If GCS <15, further 100mL Dextrose IV, titrate to conscious state.

If GCS 15, cease Dextrose admin, consider TnR.

Question 8

Per the CPG’s, what are the signs and symptoms of a suspected hypoglycaemic episode?

What do these symptoms indicate?

Answer 8

Hx diabetes
Unconscious/altered conscious
Pale
Diaphoretic

Indicate a need to assess BGL.

Question 9

If next meal is more than _____ mins away, encourage patient to…?

Answer 9

20 min.

Encourage to eat long acting carb such as sandwich, fruit, glass of milk.