Hypoglycaemia. What is hypoglycaemia. What causes hypos. Signs of a hypo

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1 Hypoglycaemia What is hypoglycaemia Hypoglycaemia is the full name for a hypo or low blood glucose level. Hypos occur when blood glucose levels fall too low for the body to work normally. For most people this happens when their blood glucose levels fall below 4 mmols/l. What causes hypos Hypos are caused by one or more of the following:- Too much insulin Not enough food (carbohydrate) Delayed or missed meals or snacks More exercise than usual Hot/cold weather Alcohol Stress or illness Signs of a hypo The signs and symptoms of a hypo vary from person to person and people soon learn to recognise their own early warning signs. Hypos are described as being either Mild, Moderate or Severe. Everyone with diabetes will have hypos at some time, but they will not become severe if they are recognised and treated early.

2 Mild Hypo usually recognised by the person experiencing the hypo. Signs & Symptoms Hunger Pallor or paleness Dizziness Trembling Tingling hands, feet, lips or tongue Sweating Blurred vision Difficulty in concentrating Palpitations How to treat NB. Wash your hands before each blood glucose check to remove any traces of food. If possible check blood glucose level as you can get similar signs when blood glucose levels are high. If below 4 mmols/l, immediately eat or drink something sugary (10-20 grams of carbohydrate) such as :- 3-6 glucose/dextrose tablets 3-6 Fruit Pastilles or Starburst sweets mls fizzy drink or squash (non-diet) mls Lucozade Energy Wait 15 minutes then re-check blood glucose levels. If still below 4mmols/l, eat more sugary food as above and repeat the process until blood glucose levels are above 4 mmols/l. Once Blood Glucose levels are above 4mmols/l and symptoms have resolved, eat your next meal or snack if due, or some starchy food such as :- Sandwich or toast Cereal bar Crisps Piece of fruit 2 biscuits Scone or muffin

3 Moderate Hypo may not be recognised by the person experiencing the hypo. Signs Odd behaviour e.g. Rudeness or silliness Bad temper or moodiness Confusion Aggressive behaviour Refusal to cooperate How to treat Immediately drink something sugary (10-20 grams of carbohydrate) such as: mls fizzy drink or squash mls Lucozade Energy 2-4 teaspoons of sugar dissolved in water 1-2 tubes of GlucoGel (to be used if in a confused state and refusing to eat or drink, but can still swallow effectively) Wait 15 minutes then re-check blood glucose levels. If still below 4mmols/l, have more sugary drink as above and repeat process until blood glucose levels are above 4 mmols/l. Once Blood Glucose levels are above 4mmols/l, eat your next meal or snack if due, or some starchy food such as:- Sandwich or toast Cereal bar Crisps Piece of fruit 2 biscuits Scone or muffin Severe Hypo Happens very occasionally. Person will become very drowsy or lose consciousness and possibly have a fit. How to treat Do not give anything by mouth! Place person in recovery position (lying on one side) in a safe area and call 999 for an ambulance. Anyone who has had a severe hypo should contact they diabetes team to review their diabetes treatment. NB. Untreated hypoglycaemia will usually resolve and the person should regain consciousness.

4 Hypos at night Hypos which occur during the night are understandably worrying for parents and individuals with diabetes. In most cases night time hypos will cause the person to become agitated, wake, and call out as if they have had a bad dream. However, it is possible for someone to sleep through a hypo, and signs that this is happening may include:- Frequent nightmares. Feeling lethargic/headache first thing in the morning. Blood glucose levels of less than 4 mmols/l before breakfast. Frequent high blood glucose levels before breakfast despite increases to the insulin dose in the evening. If any of the above occurs, check blood glucose levels at 3am and phone your diabetes team for advice, as adjustments to insulin doses may be needed. General Tips Avoid using chocolate to treat a hypo as the high fat content slows down the release of the sugar into the blood stream. To avoid hypos try not to miss meals & snacks. Always have a snack before unplanned exercise. Always carry some form of sugar with you. Try to teach family and friends how to manage a hypo. Always carry identification to let others know you have diabetes. Monday Friday 9am-5pm:- Contact details for more information Hospital doctors: - Dr Hinde, , Ext or Dr Gopalakrishna Ext Diabetes nurses: - Amanda Stephenson, Beth Hughes & Nicola Collins, Carol Metcalfe, Sean Petett After 5pm weekdays and 24 hours on weekends:- Children s wards:- Telford, ext 4002 or Shrewsbury,

5 References National Collaborating Centre for Women s and Children s Health (commissioned by NICE) Type 1 Diabetes - Diagnosis and Management of Type 1 Diabetes in Children and Young People. RCOG Press, London. Shropshire Community Health NHS Trust. Guideline for the management of Hypoglycaemia. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium Assessment and management of hypoglycaemia in children and adolescents with diabetes. Paediatric Diabetes, 10 (suppl. 12), Author: Shropshire Paediatric Diabetes team Implementation Date: February 2006 Last review: January 2014 Next Review: January 2015