When The Blood Sugar Goes Low, Here's What To Do and What Not To Do

When The Blood Sugar Goes Low, Here's What To Do and What Not To Do

There are 2 major life-threatening conditions in a patient with regards to the blood sugar.

  • Hypoglycemia (when the blood sugar is lesser than 70 mg/dl)
  • Hyperglycemia (when the blood sugar is more than 200 mg/dl)

It is classified into 3 types:

  • Mild: CBG between 50-70 mg/dl + Neurogenic Symptoms
  • Moderate: CBG between 50 - 70 mg/dl + Neuro-glycopenic Symptoms
  • Severe: CBG < 50 mg/dl

What can cause it?

  • Too little food or carbohydrates (poor oral intake)
  • Skipped or delayed meals
  • More active than usual
  • Too much insulin or too many diabetic pills
  • Infection

How does one recognize the signs and symptoms of hypoglycemia?

Depending on the blood glucose levels, patients can be asymptomatic or symptomatic with varying degrees of severity of signs & symptoms secondary to low blood glucose levels.

Patients with Mild Hypoglycemia present with the following symptoms:

  • Palpitations / fast heart beat
  • Tremors
  • Sweating
  • Anxiety
  • Hunger
  • Paraesthesia / numbness

Patients with Moderate Hypoglycemia present with the following symptoms:

  • Behavioural Changes
  • Confusion
  • Altered Mentation
  • Headache
  • Nausea
  • Extreme Sweating
  • Irritability
  • Dizzy / Giddiness

Patients with Severe Hypoglycemia present with the following symptoms:

  • Severe confusion
  • Lack of coordination
  • Extreme fatigue
  • Seizures / fits
  • Impaired Vision
  • Coma
  • Unconsciousness
  • Death

What to do when the blood sugar goes low?

  • Check the CBG if a capillary blood glucose testing machine is available.
  • If the patient is conscious and alert or talking and responding, yet symptomatic - Oral sugars (1-2 spoons of sugar mixed in 1 glass of milk or chocolate bar) can be given.
  • If the Patient is semi-conscious or unconscious - Pl take the patient to the hospital for IV dextrose correction and observation.

What should not be done?

  • Never Give Oral sugar water / ORS / water - to an unconscious or semi-conscious patient as one can aspirate these contents into the lungs causing further complications.
  • Do not ignore assuming patient is sleeping.
  • Do not delay to review with the Physician or Diabetologist.

Treatment of Hypoglycemic Episode:

  • For mild symptomatic hypoglycemic episodes - oral sugars (1-2 spoons with 1 glass of milk or Chocolate bar) can be given.
  • For Moderate and Severe Hypoglycemic Episodes - IV dextrose is suggested at hospital.
  • Review of medications by the Physician or Diabetologist.
  • Treatment of the cause:
    • If the precipitating factor is an infection - treat with appropriate antibiotics
    • If the precipitating factor is poor oral intake - improve nutrition
  • Prevent recurrent attacks by close monitoring of blood sugar levels.

Article by Dr. Aslesha Vijaay Sheth, MBBS., MRCEM (UK)
Consultant & In-Charge Emergency Medicine Department
Kauvery Hospital, Chennai

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