V09/14/08

TREATMENT OF HYPOGLYCEMIA
Hypoglycemia (low blood sugar, insulin reaction) is most likely to occur before meals, at peak times of insulin action, and during or after exercise. Symptoms of MILD HYPOGLYCEMIA Blood Glucose usually 50 -70 mg/dl Shaky Irritable Sweaty Clumsy Pale Nervous Weak Hungry Tingling lips Symptoms of MODERATE HYPOGLYCEMIA Blood Glucose usually less than 50 mg/dl Symptoms of ADVANCED HYPOGLYCEMIA In addition to previous symptoms: Unconscious Convulsions TREATMENT-GLUCAGON First call 911. Glucagon is kept in the fridge. We do not give glucagon to all, so there may not be any. The instructions are with the glucagon. If you do not have Glucagon, turn the person onto their side and use 2 tablespoons of honey on the inside of the cheek. Do NOT try sweet drinks due to risk of inhaling a liquid when unconscious. When the person comes to, feed them a sugared beverage (2 cups of juice or regular soda) followed by 60 g of slower carbohydrate (bread, fruit, crackers) + meat or cheese + fat. If you have had a severe low blood sugar, allow your blood sugars to run higher for the next 24 48 hours as there is a higher risk of another low blood sugar. One way to do this is to raise your goal range by 40 mg/dl.

In addition to symptoms of mild hypoglycemia: Confused Headache Double vision Restless Poor coordination Test to confirm hypoglycemia (if the blood sugar is greater than 80 mg/dl you are not having symptoms of hypoglycemia) TREATMENT-QUICK SUGAR TREATMENT-QUICK SUGAR 15 g Carbohydrate 30 g Carbohydrate Glucose tablets (check carbohydrate content) Glucose tablets (check carbohydrate content) 1/2 cup juice 1 cup juice 1/2 cup regular soda 1 cup regular soda 4 sugar cubes 8 sugar cubes 15 g Glucose gel 30 g Glucose gel Do NOT subtract food from next meal!!! Do NOT subtract food from next meal!!!

Test your blood sugar after 15 minutes. If the blood sugar doesnt rise, repeat the treatment, wait 15 minutes again and re-test. If the blood sugar still does not rise above 70 mg/dl, repeat the treatment but also notify your physician. Once you have corrected the blood sugar to above 70 mg/dl AND if you will not be eating a meal within 1 hour, eat a combination of protein, fat and carbohydrate - for instance, 3 peanut butter crackers or 1/2 a sandwich, to help maintain the blood sugar until your next meal. Note: Driving:

As everything in diabetes, the above treatment may need to vary based on individual experience. If you feel the symptoms of hypoglycemia while driving, STOP THERE (not the next exit, UniMart, restaurant). Do start driving again until you have treated yourself, feel better and have confirmed that your blood sugar is back up. If you have nothing to eat in the car to treat hypoglycemia, knock on a door, flag down a car, etc., but do not drive on. Always carry fast acting glucose in the car. Driving even another 100 feet while you are hypoglycemic could cause an accident.
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V09/14/08

ANGER DURING LOW BLOOD SUGAR* OVERVIEW

During hypoglycemia, the ability to think or reason may become impaired because the brain can only use glucose as fuel. Confusion and irrational behavior can result. Reactions to this lack of fuel can vary tremendously and anger is a common response. It helps to treat hypoglycemia quickly. 6. Ask for help from others whenever needed. 7. Stay rational and calm. This will minimize embarrassment to the person with diabetes. 8. If you feel that you cannot handle the situation, call 911.
*adapted from Anger during Low Blood Sugars by John Walsh, P.A., C.D.E. and Ruth Roberts.

FOR THE HELPER

Generally a person having a hypoglycemic reaction will not need help. If a person having a low blood sugar becomes angry, confused or irrational try the steps below: 1. Take charge of the situation. Be gentle but firm. 2. Control your own emotions. Dont take the other persons behavior personally. 3. Say, Here, eat these glucose tablets. or Drink some of this drink. or You need to eat (drink) this. 4. Avoid indirect questions like, Do you need to test? or Do you need to eat? If a persons blood sugar is low, the easiest answer during the confusion may be, NO. 5. Do NOT let the person drive a car, run machinery or participate in any other dangerous activity that requires coordination.
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