Hypoglycaemia (HYPO)

Definition/Description

Hypoglycaemia, or a "hypo", is an abnormally low level of glucose in your blood (less than four millimoles per litre - 4mmol/mol).

Hypoglycaemia is most commonly associated with diabetes, and mainly occurs if someone with diabetes takes too much insulin, misses a meal, miscalculates carbohydrates or exercises too hard.

In rare cases, it's possible for a person who doesn't have diabetes to experience hypoglycaemia. It can be triggered by malnutrition, binge drinking or certain conditions, such as Addison's disease.

If left untreated hypoglycaemia can cause brain damage and in some cases can be fatal.

Red Flag Symptoms

Symptoms of hypoglycaemia

Most people will have some warning that their blood glucose levels are too low, which gives them time to correct them.

Typical early warning signs are feeling hungry, trembling or shakiness, and sweating. In more severe cases, you may also feel confused and have difficulty concentrating. In very severe cases, a person experiencing hypoglycaemia can lose consciousness.

It's also possible for hypoglycaemia to occur during sleep, which can cause excess sweating, disturbed sleep, and feeling tired and confused upon waking.

Guidelines on Management

Treating hypoglycaemia

In most cases, hypoglycaemia can be treated by the patient when and if they recognise the symptoms.

The immediate treatment for hypoglycaemia is to have some sugary food or drink (about 15 to 20g of rapidly acting carbohydrate) to end the attack.

For example, this could be:

a glass of fruit juice or non-diet soft drink
between three and five dextrose tablets
a handful of sweets

Avoid fatty foods and drinks, such as chocolate and milk, because they don't usually contain as much sugar and the sugar they do contain may be absorbed more slowly.

After having something sugary, a longer-acting carbohydrate food, such as a few biscuits, a cereal bar, a piece of fruit or a sandwich should be consumed to maintain glucose levels and avoid a subsequent hypo.

It will usually take around 15 minutes to recover from a mild episode of hypoglycaemia and it is recommended to measure blood sugar again after 15 to 20 minutes. If it's still too low (below 4mmol), consume some more sugary food or a drink before testing levels again in another 15 to 20 minutes.

When treating someone else with hypoglycaemia, if the above treatment isn't effective, you may be able to help them by applying glucose gel (or honey, treacle or jam if glucose gel isn't available) to the inside of their cheeks, and gently massaging the outside of their cheeks. This shouldn't be done if the person is drowsy or unconscious because of the risk of choking.

Referral Criteria/Information

If hypoglycaemia causes a loss of consciousness, an injection of the hormone glucagon can be given to raise blood glucose levels and restore consciousness. This is only if an injection is available and the person giving the injection knows how to use it.

You should dial 999 to request an ambulance if:

A glucagon injection kit isn't available
There's nobody trained to give the injection
The injection is ineffective after 10 minutes

Never try to put food or drink into the mouth of someone who's drowsy or unconscious as they could choke. This includes some of the high-sugar preparations specifically designed for smearing inside the cheek, such as hypo-stop.

If you're able to give a glucagon injection and the person regains consciousness, they should eat some longer-acting carbohydrate food, such as a few biscuits, a cereal bar or a sandwich.

You should continue to monitor the person for signs of recurring symptoms in case they need to be treated again.

If the patient has had several episodes of hypoglycaemia a week and or has become unconcious, contact should be made to their GP or diabetes care team to find out the underlying cause. Medication may need to be adjusted, or there may be another condition causing hypoglycaemia that needs to be treated such as viruses, infections or other hormone .related conditions.

Referrals

If you are unsure if the patient needs to be seen by the diabetes specialist team please use the advice and guidance for diabetes via NHS e-Referrals Service (further information is available via A&G).

If the patient is not recovering from the hypo or treatment is not available please call 999.

if the patient has recovered but there is still concern or to discuss a potential admission 24/7(For healthcare professionals only) Please call HEYHT switchboard (01482) 328541 and ask for the diabetes consultant on call for endocrinology.