02.06 Hypoglycemia

Overview

  1. Hypoglycemia
    1. Low blood sugar <70
    2. Not enough energy for body function

Nursing Points

General

  1. Blood sugar regulation
    1. Pancreas
      1. Releases insulin
      2. Insulin moves glucose into cells
    2. Liver
      1. Breaks down stored glycogen
      2. Gluconeogenesis=glucose produced from non-carbs (reserves in body)
      3. Glucose ready to use
  2. Alterations in blood sugar
    1. Sepsis
      1. Impairs gluconeogenesis
      2. Higher insulin release
    2. Alcohol
      1. Inhibits gluconeogenesis
    3. Medications
      1. Insulin
      2. Metformin
      3. Glipizide
    4. Over exertion

Assessment

  1. Presentation
    1. Sweaty
    2. Shaky
    3. Double vision
    4. Seizures
    5. Confusion/loss of consiousness
    6. Death
  2. Check blood sugar level
    1. Glucometer
    2. Lab work

Therapeutic Management

  1. Monitor blood sugar
    1. Low (<70)
      1. If conscious ->PO glucose, juice, food
      2. If unconscious ->IV glucagon
      3. Recheck blood sugar 15 minutes later
  2. ALWAYS double verify insulin

Nursing Concepts

  1. Glucose metabolism
    1. Break down of carbs
    2. Break down of reserves
    3. Glucose for body functions
  2. Lab values
    1. Blood sugar level
  3. Nutrition
    1. Balanced diet
    2. Diabetics
      1. Count carbs
      2. Take insulin with meals

Patient Education

  1. Eat well balanced diet
  2. Do not fast
  3. Diabetics -> check blood sugar levels regularly

Reference Links

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Video Transcript

Hey guys! Welcome to the lesson on hypoglycemia! 

Hypoglycemia is where the blood sugar is too low. Our body needs glucose to function, so if there isn’t enough, our body will begin to slow down and eventually shut down. Let’s explore how blood sugar is regulated in the body. 

So, to understand hypoglycemia, you need to know how blood sugar is regulated in the body. The pancreas releases insulin to move glucose into the cells for the body to use. The liver breaks down stored glycogen. Gluconeogenesis is the process of producing glucose from non-carbs when the body needs it. This happens if you’re not eating enough carbs, or you haven’t eaten in a while. Next let’s discuss alterations in the blood sugar levels. 

So sometimes things cause our blood sugar to decrease to the point where our body cells aren’t getting the energy that they need for body function. Sepsis impairs gluconeogenesis and can cause higher insulin release. I actually had a patient that was septic and her blood sugars were ranging 15-30 even after treating the hypoglycemia multiple times. Alcohol can also inhibit the breakdown of reserves for energy, so diabetics have to carefully check blood sugars when drinking. Medications like insulin, metformin, and glipizide are meant to decrease the blood sugar levels to normal levels when taken correctly. Too much or not enough food with these medications can cause hypoglycemia to occur. If we over exert ourselves by using more energy than our body has available, we may experience hypoglycemia. Next let’s talk about what this patient will look like. 

The patient with hypoglycemia may be sweaty and shaky and see double vision. This could result in seizures, confusion, loss of consciousness, and even death. Guys, remember that your patient may not have symptoms at all, and others may know right away that they have a low blood sugar because of the way they feel. Next let’s talk about how we check the blood glucose level. 

Now, there are two ways to check a patient’s blood sugar level. Glucometers small devices that can check the glucose level with a drop of blood from the patient’s fingertip. The doctor may also order glucose lab work where blood is drawn from the vein. So, if your patient has a low blood sugar shown on the glucometer or lab value, you will need to give them glucose. If they are alert and able to eat, they may either be given PO glucose tabs, juice, or food. If they aren’t alert or able to eat, IV glucagon may be given. There have also been times where I had to do both, like with that septic patient with super low blood sugars. Also remember that you should ALWAYS get someone else to verify that your insulin is correct before you administer it to the patient. This helps to avoid errors that could result in hypoglycemia. 

Our patient with hypoglycemia should be educated to eat a balanced diet, and avoid fasting. Diabetics need to check their blood sugars regularly with a glucometer at home. Some diabetic patients even have devices that attach to their side and let them know if their blood sugar is low. 

The priority nursing concepts for the patient with hypoglycemia are glucose metabolism, lab values, and nutrition. 

Let’s review the key points about hypoglycemia. Hypoglycemia is when the blood sugar is too low and the body is deficient in energy. Blood sugar is regulated by the pancreas and liver. The pancreas makes insulin which pushes the glucose into cells for use. The liver helps to breakdown non carbs into sugar for the body to use. Glucose levels may vary when the patient has sepsis or drink alcohol because they alter that gluconeogenesis process that occurs in the liver. Medications like insulin, metformin, and glipizide help lower the blood sugar in diabetics, but if taken too much or without food they could lower the blood sugar too far causing hypoglycemia. Exercising too much or not eating can also lead to low blood sugars. The hypoglycemic patient might be sweaty, shaky, or even have a seizure. They will eventually lose consciousness and die if the hypoglycemia isn’t treated. If a low blood sugar is suspected, a glucometer or lab draw may be used to check the level. If it is less than 70, we may give the patient glucose tabs, juice or food. If unconscious or unable to eat, we may administer IV glucagon to bring the sugar up. Make sure you recheck the blood sugar 15 minutes later if it was low. 

I hope you have a clear understanding of hypoglycemia and how to manage it. Now go out and be your best self today, and as always, happy nursing!

Read more

  • Question 1 of 5

A client is admitted for dehydration and on assessment complains of dizziness. The nurse takes the client’s vitals which are the following: BP 163/86 HR 88 Temperature 100.1 Respirations 18 Blood sugar 43 The nurse knows that which of the following orders should be implemented first?

  • Question 2 of 5

A client is admitted to the unit with a tumor on located on the pancreas. The nurse is performing an assessment and knows to assess for which of the following complications?

  • Question 3 of 5

The nurse checks a client’s blood sugar and it is 32mg/dl. The nurse immediately gives the client some orange juice and graham crackers. Which of the following should the nurse do next?

  • Question 4 of 5

A nurse is assigned 4 clients and receives report. The nurse knows to monitor which of the following clients for hypoglycemia?

  • Question 5 of 5

A nurse gave a diabetic client insulin with breakfast but the client did not eat any food. Two hours later, the client appeared diaphoretic and had slurred speech. The client became unconscious, so the nurse checked his blood sugar. The blood sugar was 15. Which of the following at is the next step that the nurse should take?