Protocol - Hypoglycemia

A physician's order is not required for implementation of the hypoglycemia protocol. Hypoglycemia is defined as a blood glucose result less than 60mg/dL even in the absence of obvious signs and symptoms.

Protocol:

Blood Glucose 50-69 in an ALERT resident

Give one of the following:

• 4 oz. orange/apple juice
• 3 Graham Crackers
• 1 tube of glucose Gel (if able to swallow thickened liquids)
• If NPO or unable to swallow 20ml D50 IV and start IV D5W at 100ml/hr.
• If unable to swallow AND no IV access: Glucagon 1mg IM
• Notify MD

Recheck Blood Glucose in 15 minutes

Blood Glucose <50 in an ALERT resident

Give one of the following:

• 8 oz. of milk or orange/apple juice and 3 Graham Crackers
• 2 tubes of glucose Gel (if able to swallow thickened liquids)
• If NPO or unable to swallow 20ml D50 IV and start IV D5W at 100ml/hr.
• If unable to swallow AND no IV access: Glucagon 1mg IM
• Notify MD

Recheck blood glucose in 15 minutes

Blood Glucose <70 in a resident with a DECREASING LEVEL OF CONSCIOUSNESS

Give one of the following:

• 50 ml D50 IV (1 amp) and start IV D5W at 100ml/hr.
• If no IV access - Glucagon 1mg IM
• If there is no change in level of consciousness from baseline, then call 911.
• Notify MD

Recheck blood glucose in 15 minutes

------------------------------------------------------------------------------------

Considerations:

1. Specific physician orders will always supersede this protocol
2. This protocol assumes that blood glucose determinations are obtained via capillary blood glucose (i.e. “fingerstick”)
3. Risk factors for developing hypoglycemia while in the facility include, but are not limited to:
1. history of diabetes
2. decrease PO intake
3. insulin administration
4. decreasing corticosteroid doses
5. patient/residents who are receiving oral hypoglycemics or Beta blockers and are NPO.
6. Acute decrease in kidney function and/or increased physical activity in diabetics and on antidiabetic medications.
7. Symptoms of hypoglycemia may appear not only when blood glucose level is below 60, but when blood glucose level has dropped significantly in short period of time (e.g. from 400 to 150)
4. Signs and symptoms of hypoglycemia may include but are not limited to:
1. nervousness, anxiety
2. diaphoresis, pallor
3. tachycardia, palpitations
4. tremors, irritability
5. altered state of consciousness or personality change
6. paresthesia (tingling sensations around mouth)
7. patient/resident report of “feeling hypoglycemic”
8. loss of consciousness, seizures (expect when FBS is < 40)
5. Hypoglycemia treatment should not be delayed pending confirmation of lab result or physician response.
6. If BG is greater than 60 mg/dL and patient/resident is “feeling hypoglycemic” or is symptomatic, the blood glucose is re-assessed in 15 minutes.
7. The physician should be consulted to determine if subsequent doses of insulin should be given or changed.

--

Protocol created by Nodar Janas, M.D.