Private: Chapter 9. Blood Glucose Monitoring
9.3 Hypoglycemia and Hyperglycemia
The overlapping symptoms of hypo- and hyperglycemia (e.g., hunger, sweating, trembling, confusion, irritability, dizziness, blurred vision) make the two conditions difficult to distinguish from one another (Pardalis, 2005). Since the treatment is different for each condition, it is critical to test the patient’s blood glucose when symptoms occur. The risk factors that may have led to the condition and the recent medical history of the patient also help to determine the cause of symptoms.
Hypoglycemia
Hypoglycemia is a condition occurring in diabetic patients with a blood glucose of less than 4 mmol/L. If glucose continues to remain low and is not rectified through treatment, a change in the patient’s mental status will result. Patients with hypoglycemia become confused and experience headache. Left untreated, they will progress into semi-consciousness and unconsciousness, leading rapidly to brain damage. Seizures may also occur.
Common initial symptoms of hypoglycemia include:
- Cold, clammy skin
- Weakness, faintness, tremors
- Headache, irritability, dullness
- Hunger, nausea
- Tachycardia, palpitations
These symptoms will progress to mood or behaviour changes, vision changes, slurred speech, and unsteady gait if the hypoglycemia is not properly managed.
The hospitalized patient with type 1 or type 2 diabetes is at an increased risk for developing hypoglycemia. Potential causes of hypoglycemia in a hospitalized diabetic patient include:
- Receiving insulin and some oral antidiabetic medications (e.g., glyburide)
- Fasting for tests and surgery
- Not following prescribed diabetic diet
- New medications or dose adjustments
- Missed snacks
Hypoglycemia is a medical emergency that must be treated immediately. An initial blood glucose reading may confirm suspicion of hypoglycemia. If you suspect that your patient is hypoglycemic, obtain a blood glucose level through skin puncture. A 15 g oral dose of glucose should be given to produce an increase in blood glucose of approximately 2.1 mmol/L in 20 minutes (Canadian Diabetes Association, 2013). Table 9.2 outlines an example of a protocol that may be used in the treatment of hypoglycemia.
Table 9.2 Hypoglycemia TreatmentDisclaimer: This is one example of a hypoglycemia protocol. Always follow the protocol of your agency. |
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Capillary Blood Gas (CBG) |
Able to Swallow |
Patient Is Not Able to Swallow but Has IV Access |
Patient Is Able to Swallow but Has No IV Access |
| ≥ 4 mmol/L | No treatment necessary | No treatment necessary | No treatment necessary |
| 2.2 to 3.9 mmol/L | Give 15 g of glucose in the form of:
Note: Milk, orange juice, and glucose gels increase blood glucose (BG) levels more slowly and are not the best choice unless the above alternatives are not available. Repeat CBG every 15 to 20 minutes and repeat above if BG remains below 4 mmol/L. Once BG reaches 4 mmol/L, give patient 6 crackers and 2 tablespo