Treatment and Prevention

Symptoms of non-severe hypoglycaemia can be treated with 15 g fast-acting carbohydrate,4 such as a few small sweets or cup of juice, milk, or sweetened drink. Treatment is also advised in asymptomatic patients with blood glucose in the “alert range” of 3.5 to 3.9 mmol/L (63 to 70 mmol/L). If glucose levels remain low after 15 minutes, treatment should be repeated.1,2

In a conscious person, severe hypoglycaemia can be treated in a similar manner with 20 g fast-acting carbohydrates. If glucose remains low after 45 minutes, IV glucose can be considered if available.3 In an unconscious person, hypoglycaemia is treated with IV glucose or with glucagon.

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  • Patient education:7 informing patients and caregivers about hypoglycaemia risk factors
  • Diet and exercise:8 establishing a predictable eating plan that accounts for exercise; adjusting exercise that has previously led to hypoglycaemia
  • Glucose monitoring, possibly with continuous glucose monitoring (CGM) technology: looking for trends in glucose values and making adjustments (such as changes in medication dosing or regimen) if a pattern of lows is detected4-6

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The following guiding principle can help set glycaemic goals: “Aim for the lowest HbA1c not associated with frequent hypoglycaemia.” Relaxing glucose targets may be an appropriate prevention strategy for patients with advanced diabetes complications or limited life expectancy.8
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References

  1. Deary IJ et al. Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factor analysis. Diabetologia 1993;36:771.
  2. Cryer PE. Management of hypoglycemia during treatment of diabetes mellitus. UpToDate review, last updated May 15, 2014.
  3. Canadian Diabetes Association 2013 clinical practice guidelines. Chapter 14: Hypoglycaemia. Can J Diabet 2013;A3.
  4. The hospital management of hypoglycaemia in adults with diabetes mellitus. NHS [/fusion_builder_column][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][U.K.] guidelines 2010. Accessed at http://www.diabetologists-abcd.org.uk/jbds/JBDS_IP_Hypo_Adults.pdf
  5. McIntyre HD et al. Dose Adjustment for Normal Eating: A Role for the Expert Patient? Med J Aust 2010; 192:637.
  6. Eng C et al. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet 2014;384:2228.
  7. UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007;50:1140.
  8. Edelman SV, Blose JS. the impact of nocturnal hypoglycemia on clinical and cost-related issues in patients with type 1 and type 2 diabetes. Diabetes Educ 2014;40:269.

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