How to deal with hypoglycemia in diabetic patients

MSc. Dr. Nguyen Thi Kim Hoan, Department of Endocrinology - Diabetes (Bach Mai Hospital) guides on how to treat hypoglycemia in diabetic patients.

Specifically, when there are signs of hypoglycemia, the patient needs to be assessed for the level of hypoglycemia to have appropriate treatment. After that, it is necessary to perform initial emergency measures for the patient, and perform specific emergency treatment measures.

When there are signs of hypoglycemia, the patient needs to quickly stop using oral hypoglycemic drugs or insulin.

In case of hypoglycemia without impaired consciousness, the 15-15 rule should be followed with the patient.

In this case, the patient is completely conscious, blood sugar is determined to be below 3.9mmol/l. The patient needs to be provided with 15g of glucose orally (eating or drinking), fruit juice (such as apple juice, grape juice; 300ml contains about 15g of glucose) is a good choice to maintain blood glucose levels or a light meal is suitable.

The patient should have their capillary blood sugar monitored after 15 minutes. If the capillary blood sugar is above 3.9 mmol/l, the patient should be instructed on diet and the cause should be investigated to avoid recurrent hypoglycemia. If the patient's capillary blood sugar remains below 3.9 mmol/l, continue to treat the hypoglycemia according to severity.

In case of hypoglycemia with impaired consciousness: If the patient does not have an intravenous line, 1 mg of Glucagon can be injected intramuscularly. Because Glucagon can be injected intramuscularly, all diabetic patients using insulin (or the patient's family) should always carry Glucagon and know how to inject it in case of need.

If the patient has an intravenous line, inject 50 ml of 50% glucose solution (containing approximately 25 g of glucose, which can resolve most episodes of hypoglycemia).

The patient should be monitored for consciousness and capillary blood glucose rechecked 15-30 minutes after the 50% glucose injection. Repeated doses of 50% glucose solution or intravenous infusion of 5-10% glucose solution may be necessary to maintain adequate blood glucose levels.

Patients with cerebral glucose deficiency (impaired consciousness, seizure-like symptoms, central nervous system lesions) may require some time to fully recover. If abnormalities persist for more than 30 minutes after glucose infusion and hypoglycemia does not return (no longer hypoglycemia), other causes should be sought with a head CT scan and appropriate tests.

As soon as the patient regains consciousness, they should be given fruit juices such as apple juice or grape juice (300 ml contains about 15 g of glucose); this is a good choice to maintain blood glucose levels, or a light meal is suitable for the patient.

The doctor also noted how to monitor the patient after treating hypoglycemia: It is necessary to pay attention to the duration of action of insulin or oral hypoglycemic drugs the patient has used. The patient needs to have capillary blood sugar checked every hour until the blood glucose concentration is stable.

According to MSc. Dr. Nguyen Thi Kim Hoan, hypoglycemia is common and has signs of rapid progression. Therefore, in addition to treating the disease, patients should proactively prevent and control their daily blood sugar levels to protect their own health with some simple measures such as:

- Build a scientific diet, eat enough carbohydrates before exercising and snack during exercise if necessary.

- Eat extra meals as soon as your blood sugar shows signs of being low or when new signs of illness appear.

- Regularly check blood sugar and follow treatment as directed by your doctor. Do not take medication without a prescription or stop taking medication when symptoms improve.

- Always have sugar or sugary products such as candy, cakes, chocolate in your bag or briefcase in case of hypoglycemia.