Prevention and appropriate management of hypoglycaemia or ‘hypo’ (low blood glucose) in hospital

Background

People treated with insulin and/or diabetes medications such as gliclazide, glipizide, glimepiride, glibenclamide may be at risk of hypoglycaemia or ‘hypo’ (a low blood glucose level below 4mmol/L).

The Joint British Diabetes Societies (JBDS) for Inpatient Care recommend target blood glucose (BG) levels of 6.0-10.0mmol/L. (with 4-12 mmol/L acceptable) in hospital. In frail people, blood glucose levels of 4-6 mmol/L are viewed as ‘looming hypoglycaemia’ and thus treatment adjustment should be made to reduce the risk of problems.

The symptoms of hypoglycaemia include, feeling hungry, feeling shaky, feeling weak, tingling of the lips and finger tips, palpitations, feeling anxious. Some people can become drowsy or confused and in rare cases lose consciousness.

All hospital wards should have guidance on the prevention and treatment of hypo. All wards should have a ‘hypo box’ containing supplies for prompt treatment in the event of a person having a hypoglycaemic episode (low blood glucose).

Treatment for hypoglycaemia

• Local and national guidance is available to guide the treatment of hypoglycaemia.

• Glucose (sugar) is needed to treat hypo. This can be given in the form of sugary food or drink, for example glucose tablets or Glucojuice.

• If the person is confused or drowsy, glucose gel can be applied inside the mouth to the mucosa inside the cheek where it can be absorbed.

• In people who suffer hypo who are unable to eat and drink or unable to safely swallow then an intravenous drip with glucose will be required.

• After initial hypo treatment, providing you can eat and drink, you should be offered a snack containing complex carbohydrate, for example, a slice of toast or bread and a drink of fruit juice or milk. This snack will help keep blood glucose at a safe level.

• Blood glucose levels should be checked to assess recovery and/or need for further treatment.

THINK about what matters to you and your diabetes

• If you are treated with insulin or diabetes medications such as gliclazide, glipizide, glimepiride, glibenclamide you may be at risk of problematic low blood glucose levels (‘hypo’).

• If you are not treated with these treatments, it is unlikely that you will encounter problems with low blood glucose levels.

• A ‘hypo’ is likely to make you feel unsafe, uncomfortable and unwell.

• Having a ‘hypo’ can make you at risk of other health problems and can make your stay in hospital longer.

CHECK

• Check your risk and the causes hypoglycaemia. You may be at increased risk if your appetite is poor, you are nauseated and/or vomiting or if you have medical problems such as impaired kidney or liver function.

• Check, does your diabetes treatment need to be adjusted to reduce your risk of hypo? Does the dose of your insulin or diabetes tablets need to be reduced or changed?

• If you have experienced hypoglycaemia, or you are at risk ensure that you have appropriate information for treatment and how to prevent hypoglycaemia.
  

ACT 

• Ensure your medication details are discussed and agreed with you.

• Learn as much as possible about how your diabetes medications work.

• If you suffer from hypoglycaemia or think you may be at risk, discuss your medication diabetes with your health care professional.

• If you drive, check out DVLA diabetes and driving guidelines.

• Ask about hospital mealtimes and the access to food during your admission.

• You can bring your own suitable snacks in to hospital if you wish.

• Ask the ward staff if they have a fully stocked ‘hypo’ box.

• At discharge from hospital, you should be provided with an up-to-date list of your medication. Take time to ask questions so that you are fully informed about how your medicines work, when and how to take them.
  

Resources:-

Diabetes UK - www.diabetes.org.uk

Diabetes UK and ABCD Your Safe Discharge from Hospital, An Information Leaflet for People with Diabetes - http://www.diabetes-healthnet.ac.uk/Documents/Uploaded/COvIDPatientDischargev2.2.pdf 

DVLA Diabetes and Driving - https://www.gov.uk/diabetes-driving

DVLA Hypoglycaemia and driving - https://www.gov.uk/hypoglycaemia-and-driving

Joint British Diabetes Societies (JBDS) for Inpatient Care - https://abcd.care/jbds-ip

TREND leaflets for people living with diabetes - https://trenddiabetes.online/people-with-diabetes/