presentation title emergency care part 2: treating and preventing hypoglycaemia
TRANSCRIPT
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Presentation title
Emergency Care
Part 2: Treating and Preventing Hypoglycaemia
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Emergency care
Slide no 2
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Managing DKA
Surgery in children with diabetes
Treating and preventing hypoglycaemia
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Hypoglycaemia
• One of the most common acute complications of diabetes
• Low blood glucose
• May causes severe symptoms• Coma or seizures
• Limitation in the management of diabetes
• Effective treatment and prevention are key
Slide no 3
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Criteria
Slide no 4
• Symptoms of hypoglycaemia occur around <3.5 mmol/l (but not always!)
• Awareness of symptoms depend on background values
• Confusion may occur with rapidly dropping BGs but also with only modest hypoglycaemic values
• Counter regulation in individuals without diabetes begins at <4 mmol/l
• “Hypo” or “low sugar” symptoms due to bodies’ self-correcting hormonal responses (adrenalin)
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Symptoms
• Trembling
• Rapid heart rate
• Pounding heart (palpitations)
• Sweating
• Pallor
• Hunger and/or nausea
• Irritability
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Neuroglycopenia
• Difficulty concentrating • Irritability • Blurred or double vision • Disturbed colour vision • Difficulty hearing • Slurred speech• Poor judgement and
confusion
• Dizziness and unsteady gait
• Tiredness • Nightmares • Inconsolable crying • Loss of consciousness • Seizures
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DCCT and now standard Classification of severity
• Mild Hypoglycemia• Recognition and self treatment• Usually <3.9 mmol/l
• Moderate Hypoglycemia• Aware of symptoms• Needs assistance to take care of themselves
• Severe Hypoglycemia• Loss of consciousness (coma), convulsion, marked
confusion• Usually <2.5 mmol/l
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Management
• Identify hypoglycaemia• Symptoms
• Blood glucose values
• Teach how to recognize and manage hypoglycaemia• Learn symptoms
• Learn responses to symptoms
• Re-enforcement by family and heath care workers
• Treat the hypoglycaemia
• Determine cause (when possible)
Slide no 8
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Treatment (1)
• Feed the child simple sugar• Rapid acting carbohydrate e.g. sweetened drinks, fruit
juices, glucose in water, sweets, packet of sugar
• Enough to make symptoms go away… don’t overtreat
• Give 0.3 g/kg of glucose if available
• Follow up with regular meal or snack – controversial but certainly reasonable if less than optimal monitoring possible
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Treatment (2)
• If the child has severe symptoms• Not able to eat• Glucagon (0.5 mg for age <12 yr, 1.0 mg for ages >12
yr)• IV glucose (3 ml/kg of 10% dextrose, 1 ml/kg of 30%
dextrose)• Oral rapid acting foods - glucose, sugar or honey
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Determine cause
• Too much insulin – dose error or timing• Too little/late food• Increased activity, sometimes hours later• Illness, esp. gastrointestinal viruses• Alcohol
• Does not cause hypo but makes it nearly impossible for body to self-correct since “liver is busy”
• Knowing cause helps to avoid future hypoglycaemia
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Prevention
• Reminders about the symptoms of hypoglycaemia
• Reminders about the causes
• Help to identify risk factors e.g. age, longer duration of diabetes, higher doses, etc.
• Repeated episodes of hypoglycaemia should result in specific advise to prevent recurrences
• Re-involve adults and caregivers/direct supervision
• Often some psychological issues
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Questions
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