Prescribing Notes
Prevention and management of hypoglycaemia
Acute management:
- Hypoglycaemia is defined as blood glucose of less than 4mmol/L (if not < 4mmol/L but the patient is symptomatic, give a small carbohydrate snack for symptom relief).
- If the patient is conscious, able to swallow and co-operative, give 15-20g quick acting carbohydrate of the patient’s choice where possible. Examples are given in on the Diabetes UK website under ‘treating and managing a hypo’.
- Note: glucose tablets and glucose juice shots (e.g. Lift glucose Juice shots®, Lift Glucose tablets®, Dextro energy®, Lucozade tablets®, Glucotabs® and Glucojuice®) should not be prescribed; patients should purchase these products. Refer to HSC Prescribing Stop List.
- If the patient is conscious but not able to swallow and/or co-operate, give 2 tubes of oral glucose gel (squeezed into mouth between teeth and gums) OR glucagon 1mg IM (GlucaGen® Hypokit).
- Note: Rapilose® 40% gel (3 x 25g) is the most cost-effective glucose gel to prescribe.
- Once capillary blood glucose (CBG) is above 4mmol/L, give 20g of long acting carbohydrate, e.g. 2 digestive biscuits or a slice of bread or next meal if due. If IM glucagon (GlucaGen® Hypokit) has been used, give 40g of long acting carbohydrate in order to replenish glycogen stores.
- Adults with decreased level of consciousness due to hypoglycaemia who are unable to take oral treatment safely should be:
- given intramuscular glucagon by a trained user (intravenous glucose may be used by professionals skilled in obtaining intravenous access)
- monitored for response at 10 minutes, and then given intravenous glucose if the level of consciousness is not improving significantly
- then be given oral carbohydrate when it is safe to administer it, and placed under continued observation by a third party who has been warned of the risk of relapse