Transcript Document

Recognition & Prevention
of Hypoglycaemia.
&
Discharge Planning
Caroline Naughton
Credentialled Diabetes Educator
Royal Melbourne Hospital
Hypoglycaemia the facts
• BGL of less than 3.5mmol/L
• Hypoglycaemia - an excess of insulin relative to
carbohydrate intake.
• Can’t happen if treatment is diet alone
• Can’t happen if only on biguanide
• Can happen if on a sulphonylurea or insulin
The brain uses glucose as the
main energy source
•
Brain cannot make/store
glucose
• Making it the most susceptible
organ to episodes of
hypoglycaemia.
Regulation of Blood Glucose
• Normally maintained in a very narrow
range 4 – 7.6mmol/L
• Insulin & glucagon are the hormones
responsible for glucose regulation,
both are secreted from the
pancreas.
Normal regulation of blood
glucose (cont’)
BGL’s
• What is Normal?
• Depends on the individual
• Severity
– mild hypoglycaemic episode
– severe hypoglycaemic episode
Hypo’s S & S
• Autonomic
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Sweaty
Shaky
Tingling Lips
Hunger
Weakness
Palpitations
behaviour
– Zda
– Xds
Neurological
- Confusion
- Headache
- Unsteadiness
- Blurred vision
- Slurred speech
- Aggressive
- Unconsciousness
- Fitting
Contributing factors
• The presence of autonomic neuropathy or
recurrent hypo episodes can lead to
“hypoglycaemic unawareness”
• Asymptomatic until <2.5mmol
• Altered mental status leading to impaired
perception/recognition of hypo’s
• Decreased Renal function – impaired
excretion of medications
Contributing factors
• Poor or erratic nutritional intake
• PEG feeds
• Inadequate glucose stores for response to
hypo’s (malnutrition)
• Polypharmacy/non-compliance with
medications
• Dependence or isolation
Causes of Hypoglycaemia
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Insufficient carbohydrate
Increased activity
Excess diabetes medication
Excess alcohol
Vomiting
Diarrhea
Role of counter-regulatory
mechanisms
• Spontaneous recovery of
hypoglycaemia will nearly always
occur, even if hypoglycaemic
episodes are untreated
– Role of liver
– Hormone responses
• Tight glycaemic control; not always
appropriate treatment goal
• A more realistic goal is to prevent
hypo’s and reduce the signs and
symptoms of hyperglycaemia
Problem solving
• Management and prevention
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Review causes of hypoglycaemia
Education
Exercise planning
Carry quickly absorbed carbohydrate
Have glucagon available for Type 1
Starting the Discharge Plan
• Know your patient
–Type of diabetes?
How do they usually manage?
Testing?
What's normal for them?
Medications?
Why are they in hospital?
• What are the obvious gaps from a
nursing perspective?
• I – soft referral
• Diabetes Resource Nurse
Preparing for Discharge
• Medication Skills- drug knowledge,
self administration, need specialized
equipment?
• What are the patients perceived
gaps?
• Change of treatment impacts on
self management
The Patient
• Hospitals are not good learning environments
• Illness & stress affect learning & recall
• Repetition important
• Two sessions are more helpful than one for
reinforcing messages
• Family involvement for support
• Control interruptions / setting
• Don’t make assumptions / give clear messages
Type 1 & Type 2 DM
• Have similar educational needs &
management guidelines
• Require the same medical follow up
• Have the same potential for complications
• Complications screening recommendations
are the same
Matthew Type 1
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What is Type 1?
Teach Insulin administration
Teach BGM / Ketone testing
Diet basics
Hypoglycaemia recognition & treatment
NDSS
Sick Day Mx
Lena Type 2
• Greek speaking – Interpreter & family
• Hx diabetes for 12 years, max OHA’s –
Short/Long term insulin?
• Not SBGM - Teach blood testing, record
results
• Hypoglycaemia recognition & management
• Target BGL’s
Blood glucose monitoring
• Ability to make the connection between
food, exercise & medications
• Self confidence to make change
• Ability to recognize & manage high/low
BGL
• Considering patients financial & physical
ability.
Knowledge & support
• Is powerful
• Confidence building
• Allows person to make choices
• Referrals on discharge – CHC & diabetes
educators, GP, Local Podiatrist, Diabetes
Australia,