Hypoglycemia

Blood glucose less than 70 mg/dL, requiring prompt treatment

Definition

Hypoglycemia is a blood glucose level below 70 mg/dL. Severe hypoglycemia (less than 54 mg/dL) impairs brain function and requires urgent treatment.

Causes

Excess insulin or sulfonylureas
Missed meal
Increased exercise
Alcohol (especially without food)
Severe illness, renal/liver failure
Insulinoma (rare)

Signs and Symptoms ('Cool and Clammy, Need Some Candy')

Diaphoresis, tremor, tachycardia, anxiety, hunger; progressing to confusion, blurred vision, slurred speech, seizure, loss of consciousness.

Rule of 15

Alert adult: 15 g fast-acting carbs (4 oz juice, 3 glucose tabs, 1 tbsp honey), recheck in 15 minutes; repeat if less than 70. Follow with protein/complex carb snack. Unconscious: IV D50 (25 g in 50 mL) or glucagon IM.

Nursing Interventions

Identify cause, adjust medications, teach sick-day rules and glucose monitoring, provide glucagon kit education to family. Monitor for rebound.

NCLEX Relevance

Juice/glucose tabs for alert patient; D50 or glucagon if unconscious.