Hypoglycaemia, sometimes called a hypo or low, is a condition that occurs when a person’s blood glucose level (BGL) has dropped too low, below 4mmol/L. It is important to treat a hypo quickly to stop the BGL from falling even lower and the person becoming seriously unwell. Show Hypoglycaemia can make it hard to concentrate and carry out everyday activities. Some activities, such as driving and operating machinery, are not safe if BGLs are less than 5.0mmol/L. Hypoglycaemia is much more common in people who take insulin or certain other glucose lowering tablets, however it can occur in people with diabetes who are not using insulin. Causes of hypoglycaemiaHypoglycaemia can be caused by one or a number of events, such as:
*Hypoglycaemia may be delayed for 12 hours or more after exercise SymptomsSymptoms of hypoglycaemia vary from person to person. Early signs and symptoms may include:
If the BGL continues to drop, more serious signs and symptoms may occur. Later signs and symptoms of hypoglycaemia may include:
Hypoglycaemia can be classified as mild or severe. A mild hypo occurs when a person can treat their own hypo. A severe hypo occurs when a person needs help from someone else to treat their hypo. Treating hypoglycaemiaWhat should I do if I suspect I am having a hypo? Check your BGL. (If you can’t check your BGL, treat it as a hypo, just in case.) If your BGL is below 4 mmol/L: Step 1: Have 15 grams of fast acting carbohydrate such as
Step 2: Wait 15 minutes, re-check your blood glucose levels to see if your BGL has risen above 4mmol/L.
Step 3: Eat a snack or meal with longer acting carbohydrate such as:
What happens if I don’t treat hypoglycaemia?If not treated quickly, the BGL can continue to drop, which may result in the brain not getting enough glucose. This can cause unconsciousness or fitting. What to do if the person is unconscious, drowsy or unable to swallowIf a person with diabetes is unconscious, drowsy or unable to swallow THIS IS AN EMERGENCY. Do not give them any food or drink by mouth, treat as follows:
What is glucagon?Glucagon is a hormone which raises the BGL. It is injected into a muscle to reverse severe hypoglycaemia in people with diabetes. If you are able to treat your own ‘hypo’, you do not need Glucagon which is always given by another person. Your doctor or Credentialled Diabetes Educator will recommend you have Glucagon on hand in case of a severe ‘hypo’ and will show you, your family and friends how to use it. Impaired Awareness of Hypoglycaemia (IAH)Impaired Awareness of Hypoglycaemia (IAH) occurs when people do not feel the early warning symptoms of hypoglycaemia and only realise they are hypo when their BGLs drop very low or when they check their BGL. If you have had diabetes and hypos for many years the risk of not feeling the symptoms of hypos is more common. IAH can be dangerous because by the time you realise you are having a hypo you may find it hard to treat it and you could become unconscious. If you have ‘hypos’ without symptoms or your symptoms change, you may need to check your blood glucose more often. Always treat BGLs at 4mmol/L or below, even if you feel fine. If you have low BGLs without any symptoms you need to discuss this with your doctor or Credentialled Diabetes Educator. What else should I do?
Important tips:
Diabetes is a chronic condition in which the body struggles to produce or respond to insulin, the hormone which regulates blood sugar levels. A diabetic emergency happens when a person’s blood glucose level goes outside the normal range, resulting in either too much sugar in the blood (hyperglycaemia) or too little sugar in the blood (hypoglycaemia). 442 million adults have diabetes worldwide, or one in 11 people. The number of diabetes cases worldwide has quadrupled since 1990 (WHO, 2020). A high blood sugar level (hyperglycaemia) may evolve gradually and can be asymptomatic over several hours or even days. A low blood sugar level (hypoglycaemia) is usually sudden and life-threatening and therefore forms the focus of this topic.
> If glucose tablets are not available, various forms of dietary sugars such as Skittles, Mentos, sugar cubes, jellybeans or orange juice can be used to treat the symptoms of hypoglycaemia in a responsive person. *
Guideline classifications explained
Talk to the person. They may be able to tell you they are having a diabetic emergency and how you can help them. Someone with low blood sugar may experience:
First aid steps
_____________________________ CAUTIONOnly give the person something to eat or drink if they are responsive and able to swallow. ______________________________ Access help
Recovery
Systematic reviews The International Liaison Committee on Resuscitation (ILCOR) conducted two systematic reviews on hypoglycaemia. Dietary sugars versus glucose tabletsThe first systematic review looked at which dietary forms of sugar, compared to a standard dose (15g to 20g) of glucose tablets, should be used when providing first aid to someone experiencing hypoglycaemia (Carlson et al., 2017). The four studies identified all compared glucose tablets with sucrose, fructose, orange juice, jellybeans, Mentos and milk. For the important outcome of clinical relief from hypoglycaemia in 15 minutes or less, three randomised controlled trials were included. Pooled data from 502 people with diabetes treated with dietary sugars (sucrose, fructose, orange juice, jellybeans, Mentos, and milk) and 223 people treated with glucose tablets (15–20 g) showed a benefit with glucose tablets. There was a slower resolution of symptoms 15 minutes after a person with diabetes was treated with dietary sugars compared with glucose tablets. Low-certainty evidence downgraded for risk of bias and imprecision. For the important outcome of blood glucose (at least a 20-mg/dL increase of blood glucose by 20 minutes), one observational study is included. In it, 13 people with diabetes were treated with dietary sugars and nine were treated with glucose tablets. It showed a benefit with glucose tablets. Fewer people demonstrated a 20-mg/dL increase in blood glucose level 20 minutes after treatment when treated with dietary sugars compared with glucose tablets. Very low-certainty evidence downgraded for risk of bias and imprecision. For the critical outcome of time to resolution of symptoms, the important outcome of risk of complications (e.g., aspiration), and the low-priority outcome of hospital length of stay, there were no human trials found. First aid glucose administration routesIn the second systematic review, De Buck et al. (2019) identified the following four studies:
Providing sugar under the tongue (sublingual) resulted in a more significant rise in blood glucose after 20 minutes than giving the sugar orally. However, this was in a specific setting and included children with hypoglycaemia and symptoms of malaria or respiratory tract infection. On the other hand, giving glucose by inside cheek absorption (buccal) route resulted in a lower blood glucose concentration than giving it orally. For dextrose gel (where glucose is given through a combination of oral swallowing and via cheek absorption), results showed no clear benefit compared to oral glucose administration (taking glucose tablets or glucose solutions). Most studies did not report on time to resolution of symptoms, resolution of hypoglycaemia as defined by blood glucose levels above a certain threshold, time to resolution of hypoglycaemia, adverse events or treatment delay. The evidence is of very low certainty due to limitations in study design, few studies and the small number of participants in the studies, and because half of the studies were performed with healthy volunteers rather than in people with characteristic hypoglycaemia.
Carlson JN, Schunder-Tatzber S, Neilson CJ, Hood N. (2017). Dietary sugars versus glucose tablets for first-aid treatment of symptomatic hypoglycaemia in awake patients with diabetes: a systematic review and meta-analysis. Emergency Medicine Journal. Feb;34(2):100-106. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27644757/ De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djärv T. (2019) First aid glucose administration routes for symptomatic hypoglycaemia. Cochrane Database Systematic Reviews Rev. Apr 11;4(4): CD013283. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30973639/ Singletary, E. M., Zideman, D. A., Bendall, J. C., Berry, D. C., Borra, V., Carlson, J. N., … & Douma, M. J. (2020). 2020 International Consensus on First Aid Science with Treatment Recommendations. Circulation, 142(16_suppl_1), S284-S334. DOI 10.1161/CIR.0000000000000897 Singletary, E.M., Zideman, D.A., Bendall, J.C., Berry, D.C., Borra, V., Carlson, J.N., Cassan, P., …&, Lee, C.C., (2020). International Consensus on First Aid Science with Treatment Recommendations. Resuscitation. 2020 Nov;156:A240-A282. DOI 10.1016/j.resuscitation.2020.09.016 Non-systematic reviewsWorld Health Organisation, (2010). Diabetes. Diabetes Facts and Figures – Infographics. Retrieved from https://www.who.int/diabetes/infographic/fr/
Published: 15 February 2021
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