Hypoglycaemia

Patient profile:

- After running in a half marathon, F.W, a 24 year old woman with type 1 diabetes, was brought
to the first aid tent provided for participants in a charity run. She is well maintained on a
regimen of self- monitoring of blood glucose, insulin, and diet.

Subjective Data:

- States that she feels cold and has a headache; her fingers feel numb
- She took her usual insulin dose this morning but was unable to eat her entire breakfast because
of a lack of time
- Completed the half marathon in a personal best time

Objective Data

- Has slurred speech and unsteady gait

- HR: 120 bpm
- Appears confused
- Capillary blood glucose level: 48mg/dL (2.7 mmol/L)

Discussions:

1. Describe what F.W could have done to prevent this hypoglycaemic event.
Conscious:
- Administration of 5-20 g of quick acting CHO (eg. 6-8 oz regular soda pop, 1 tbsp syrup or honey,
4 tsp. jelly 6-8 oz orange juice, 2 ½ tsp. suga, commercial dextrose products (per label
instructions)
- Repetition of treatment in 15 min. (if no improvement)
- Administration of additional food for longeracting CHO (eg. Slice of bread, 4 oz milk) (after
subsiding of symptoms)
- Immediate notification of physician or emergency service (if client outside hospital ) (if
symptoms not subsiding after two to three administrations of quick-acting CHO)
Worsening symptoms or unconscious:
- SC or IM injection of 1 mg of glucagon
- Administration of 50 ml 50% IV glucose

2. What is the etiology of the manifestations that the patient displays?

Etiology:
- A decrease in blood glucose which is 48 mg/dL (2.7mmol/L) – this results in a sympathetic
nervous system response with the release of epinephrine that results in manifestations of cold
sweats, weakness, trembling, nervousness, irritability, pallor, and increased heart rate. The brain
 depends on a constant supply of glucose because it is unable to store glucose or glycogen. If the
supply is inadequate, the client will experience confusion, fatigue, and abnormal behaviour.

3. How would you expect to treat F.W’s hypoglycaemia

- The healthcare team would most likely to reverse the situation before medical assistance by
asking F.W to swallow quick-acting CHO source and if no improvement after 2- 3 times of
repetition of administration of quick-acting CHO, the healthcare team must immediately notify
the physician or emergency service. If F.W condition become worst the physician might inject 1
mg glucagon via SC or IM or administration of 50 ml of 50% glucose

4. Priority Decision: What are the priority teaching needs for this patient once her condition was
stabilized?
- Emphasize the benefits of eating right and on time. Explain the need to eat carbohydrate-rich
food before exercising.
- Instruct F.W that it is a good habit to carry glucose tablets or gel to treat low blood sugar. If
these reliable forms of glucose is unavailable, rapidly eat a quick source of sugar such as table
sugar, honey, or candy, or drink fruit juice or non-diet soda which rapidly raise blood sugar. Tell
physician about the reaction immediately. Low blood sugar is more likely if large amounts of
alcohol ingested, do unusually heavy exercise or do not consume enough calories from food. To
help prevent low blood sugar, eat and do not skip meals on a regular schedule.
- The best way to prevent low blood sugar is to monitor your blood sugar levels frequently and be
prepared to treat it promptly at all times.
- Glucose tablets are recommended since they have a pleasant taste, but are not likely to eat
them unless blood sugar is low.
- Low blood sugar can be frightening and unpleasant, and it is common to be fearful of future
episodes. This may lead to keep blood sugar level high, which can lead to long-term
complications.
- Avoid foods that contain fat (like candy bars) or protein (cheese) initially, since they slow
down body's ability to absorb glucose.
- Advise patient to avoid alcoholic drinks
- Familiarize the patients and their relatives with the common signs and symptoms of
hypoglycemia.

5. What adjustments in her diabetic regimen could F.W make to allow her to continue with her
exercise habits?
- Management of DM is primarily aimed at achieving a balance of diet, activity, and medications
together with appropriate monitoring and client and family education. These components are
equally necessary for good control of diabetes.
6. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?

Priority nursing diagnoses:

1. Disturbed thought process related to low blood glucose
2. Risks for unstable blood glucose related to deficient knowledge on diabetic regimen