Patients with mild to moderate hypoglycemia, who have the ability to swallow, can be managed conservatively via the administration of simple, and then complex carbohydrates.
If conscious, the patient should be given simple carbohydrates orally, as their basic structure allows for them to be easily digested and then absorbed into the bloodstream. Examples of simple carbohydrates include oral dextrose, fruit juice, skim milk, sugar, hard candies, saltine crackers, and honey.
If the patient is conscious after receiving simple carbohydrates and the ability to swallow is intact, the patient should then be given a more complex carbohydrate. This is done to prevent a rapid drop of blood glucose levels, as simple carbohydrates are easily metabolized, while complex carbohydrates are broken down and absorbed slower. This allows a slow and steady rise in blood glucose, without an abrupt decrease in blood sugar. Complex carbohydrates include breads, grains, cereals, legumes, fresh fruits and vegetables, and do not lead to a rapid spike with subsequent drop in blood sugar. Complex carbohydrates are classified as oligosaccharides and polysaccharides.
Patients with severe hypoglycemia, or those that are unconscious, and/or those that are unable to swallow should be given glucagon and dextrose. These interventions can be given intramuscularly (IM) or intravenously (IV). Loss of consciousness and severe hypoglycemia are emergencies, and the patient should be taken to the hospital, while their primary care physician should also be notified.
Dextrose may be administered intravenously (IV) as ordered in cases of severe hypoglycemia. Direct administration of dextrose into the intravenous system increases blood glucose levels immediately, reducing the risk of hypoglycemic complications.
Glucagon is a hormone which stimulates the liver to release stored glucose into the bloodstream. Glucagon can be administered intramuscularly (IM) or subcutaneously. Friends and family members should be educated about how to properly administer glucagon to the patient at risk of severe hypoglycemia.
In the event of a hypoglycemic episode, blood glucose levels should be reassessed every 10-15 minutes. This should continue after intervention until it is seen that blood sugar levels remain stable for several hours.
Once the patient is conscious, the patient should be advised to eat a small meal that includes protein, as this will prevent a recurrent drop in blood glucose levels.
Education about scenarios that precede hypoglycemic events, such as skipping meals, improper insulin dosing, and exercising without eating, will help prevent recurrent hypoglycemic events.
Educating patients on how to self-monitor blood glucose levels provides valuable information to those at risk for developing hypoglycemic events. Proper education engages the patient and involves them in their own healthcare, and decreases adverse outcomes.
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