STP 06 Hypoglycemia Treatment

1. STP 06 Hypoglycemia Treatment Review of STP Policy with Rationale

2. Criteria for Hypoglycemia/Treatment • Patient blood sugar is 70 mg/dL or below • Treatment guidelines are provided for patients who are • able to take oral forms of glucose, and • unable to take oral forms of glucose and have no IV access

3. If the patient is able to take oral glucose Policy Rationale The desired treatment for a patient who is conscious and able to take oral is food rather than IV Dextrose Please do not add sugar packets to juice!!! Juice has enough natural sugar to correct hypoglycemia. Provide 15- 30 grams of fast acting carbohydrates unless the patient is on acarbose (Precose): Examples of 15 grams fast acting carbohydrates: • 8 oz milk (non fat preferred) • 4 oz juice • 1 serving regular jello • 1 tube glucose gel

4. For Patients on Precose / Acarbose Medication Policy Rationale Acarbose lowers post prandial (after meal) blood glucose by inhibiting the enzymes that break starches to sugar so juice will not be as effective in treating the hypoglycemic episode Acarbose does not inhibit the action of lactase • If patient is on acarbose (Precose), provide 8 oz non-fat milk or 1 tube of glucose gel

5. If patient is unable to take oral and does not have IV access Policy Rationale Administering glucagon prevents a delay in treatment that would occur in needing to establish IV access for IV Dextrose. If the patient has a patent IV, administer IV Dextrose • Administer Glucagon 1 mg IM

6. Administration of Glucagon Policy Rationale After reconstitution, use solution immediately. Discard any unused portion Glucagon may cause vomiting The buttocks is the preferred site of injection To prevent rebound hypoglycemia Initial response is 4-10 minutes, duration of a single dose is 12 – 32 minutes • Reconstitute with supplied 1 mL of sterile water. Shake vial gently • Turn patient to the side and administer glucagon in the buttocks • May repeat 1 mg Glucagon IM in 15 minutes if IV access is not available

7. Blood Glucose After Treatment Policy Rational With the initial glucose rescue, the brain/central nervous system is nourished with glucose first Hypoglycemia can reoccur if the brain requires the initial glucose rescue and not enough is left for the rest of the body Repeat POC blood glucose every 15 minutes x 4, or until POC blood glucose reading are greater than 100 mg/dL x 2 readings

8. Post Procedure- Give Food if Possible Policy Rationale IV Dextrose and IM glucagon have a limited duration of action (they will wear off) Giving a protein with a carbohydrate will help to minimize rebound hypoglycemia • If able to take oral, provide meal tray or protein and carbohydrate snack • Examples: • Milk and 2 graham crackers • ½ meat sandwich • 2-3 crackers with cheese or peanut butter