Adjusting for Hypoglycemia

In evaluating episodes of hypoglycemia, one must first establish whether the lows are explained or unexplained as this will impact whether or not insulin doses need to be adjusted as the corrective action of choice. An exploration of variables that may be causing the hypoglycemia should be undertaken. Is the hypoglycemia explained by a decreased food intake, e.g., skipped meal or bedtime snack; an increase in the number of insulin doses taken, e.g., serial correction doses to treat a high; an increase in the number of units of insulin taken in a dose, e.g., a large correction dose; or by an increase in physical activity? If the explanation was an isolated occurrence, then the corrective action is to try and avoid the circumstances that caused it, e.g., to carry a snack when it is likely a meal will be skipped. If it is known that the explanation is going to be an ongoing phenomenon, e.g., beginning of an effort to lose weight through a cut in caloric intake or initiation of a regular exercise program, then the responsible insulin is adjusted downward to avoid further recurrences, per the general guidelines for basal and bolus insulin adjustment discussed earlier in this section.

Guidelines for Treating Hypoglycemia

Simple carbohydrate is taken to treat hypoglycemia. The patient should be advised to avoid indiscriminately ingesting large quantities of food or calories-containing beverages (such as regular soda or juice) in response to symptoms of hypoglycemia, as this will contribute to subsequent hyperglycemia. In general for BG of 51 to 70 mg/dL, treatment with 10 to 15 g of fast-acting carbohydrate is recommended; BG less than or equal to 50 mg/dL is treated with 20 to 30 g. BG should be retested 15 minutes after carbohydrate ingestion and repeat treatment taken as needed, based upon the BG result. The patient should also be advised to eat a more substantial snack or a meal that was missed or is late following initial treatment of a hypoglycemic reaction. This will prevent a recurrence. Once BG is more than 70 to 80 mg/dL, the patient can generally safely take an appropriate prandial dose to cover carbohydrate intake with the next scheduled meal to be eaten.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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