Hypoglycemia Associated With Insulin Therapy

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A hypoglycemic reaction can vary in severity and may occur in anyone with diabetes. Insulin therapy significantly increases the risk, incidence, and severity of hypoglycemic reactions.

Hypoglycemia can be the result of too much insulin, too little food (i.e., skipped or delayed meals and snacks), alcohol intake, or exercise. It can often be prevented by monitoring blood glucose levels, taking insulin and oral medications as prescribed, following a meal plan, limiting alcohol intake, and planning extra snacks if needed to cover the hypoglycemic effects of exercise. The symptoms of hypoglycemia include hunger, headache, irritability, confusion, lethargy, and, in severe cases, seizure or loss of consciousness. Patients treated with insulin or oral hypoglycemic medications should know how to recognize and promptly treat hypoglycemic reactions.

Hypoglycemia should be treated immediately if the blood glucose level is less than 70 mg/dl, even if the patient is not experiencing symptoms. The patient's first step in treating hypoglycemia is to check his or her blood glucose level if possible. Foods and beverages that contain quick-acting carbohydrates are recommended to treat hypoglycemic reactions because foods that are high in fat take longer to elevate blood glucose levels. Patients should always keep a source of quick-acting carbohydrate on hand to treat hypoglycemic reactions. If

Table 4 Foods Containing 15 Grams of Carbohydrate for Treating Hypoglycemia

Food source

Amount

Glucose tablets

Three or four

Glucose gel

1 tube

Hard candy

4-6 pieces

Fruit juice

4 oz

Sports drinks

8 oz

Honey or corn syrup

1 tbsp

Raisins

2 tbsp

Skim milk

8 oz

Regular (non-diet) soda

4 oz

the blood glucose level is between 50 and 70 mg/dl, the patient will need to consume a food or beverage containing 15 grams of quick-acting carbohydrate. Examples of such foods and beverages and the appropriate amount to consume are listed in Table 4. This treatment should increase the blood glucose level by 30-45 mg/dl over 15 minutes.

If the initial blood glucose level is less than 50 mg/dl, 30 grams of quick-acting carbohydrate should be consumed. The blood glucose level should be re-checked after 15 minutes and an additional 15 grams of quick-acting carbohydrate consumed if the blood glucose level is still below 70 mg/dl. If a meal is not planned within 1-2 hours of treating a hypoglycemic reaction, a snack containing 15-30 grams of carbohydrate should be consumed to prevent another hypoglycemic reaction. For many years, consuming a protein-containing snack was recommended to prevent recurrent hypoglycemia. However, current guidelines indicate that this is not necessary (4).

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