Hypoglycaemia SSOU Guideline
Definition
Blood glucose < 3.5mmol/l on arrival to ED, now normalized requiring ongoing glucose monitoring and supplementation
Admission Criteria
- Diabetic patient with simple, identifi ed cause for hypoglycaemia eg: accidental overdose / inadequate oral intake
- BSL controlled in ED
Exclusion Criteria
- Unlikely to tolerate diet < 24 hours
- Oral hypoglycaemic or intentional insulin overdose
- Unable to monitor BSL on discharge
- Febrile / septic
- Persisting altered conscious state/ neurological deficit
- Major co-morbidities
Investigations
- Glucose (BSL every 30 minutes until stable for > 2 hours
- FBE
- UEC
- Urinalysis
- Investigation of precipitants as indicated clinically
Suggested Medications
50% Dextrose is no longer used for treatment of hypoglycaemia at Bendigo Health Encourage early oral feeding Drug Dose Frequency Route Dextrose 10% boluses 250mL prn if BSL < 4mmol/L and conscious state affected IV Dextrose 10% boluses 15/mL/kg/hr IV infusion IV Consider Glucagon 1mL prn if BSL < 4 mmol/L IV/IM Specific Observations
- 30 minutely BSL (bedside) until >3.5 mmol/l for 2 hours then 4 hourly
Specific Management Issues
- Early feeding is the best way to prevent rebound
- Diabetes educator if poor understanding of diabetes management
Discharge Criteria
- Glucose normal and stable, tolerating oral diet & fluids
- Adequate social supports
- Precipitants identifi ed and treated
- Follow up arranged
Hospital Admission Criteria
- Persisting low blood sugars
- Poor social supports
