Hypoglycemia Nursing Guide

Etiology and Epidemiology

Hypoglycemia refers to low blood glucose, specifically a blood sugar below 70 mg/dL. Low blood glucose is common among people with both type 1 and type 2 diabetes who take insulin or other diabetes medications.

According to the National Institutes of Health (2021), approximately 80% of people with type 1 diabetes who are on insulin, reported at least one low blood sugar event in a 4-week period. Almost 50% of people with type 2 diabetes reported at least one blood sugar event in the same time period. Severe hypoglycemia occurs when an individual is unable to correct the low blood sugar on their own and is much less common.

The risks of a hypoglycemic episode increase if a person:

• Is a type 1 diabetic.
• Is taking diabetes medications or insulin.
• Is over the age of 65.
• Has had a prior incidence of hypoglycemia.
• Has another health condition such as kidney disease, heart disease, or cognitive impairment.

Individuals who experience a mild to moderate hypoglycemic event may experience chronic high blood glucose levels as a result of a hesitancy to take diabetes medications based on fear of another hypoglycemic episode. Additionally, hypoglycemic symptoms may go unnoticed after repeated episodes which may lead to severe hypoglycemia. Severe hypoglycemia can cause serious complications including syncope and coma.

Hypoglycemia can be caused by a number of events and circumstances including:

• Low carbohydrate intake
• Fasting while continuing to take diabetes medications
• Increasing physical activity without increasing carbohydrate intake
• Drinking too much alcohol without eating
• Being sick

Diagnosis

The diagnosis of hypoglycemia is made by a thorough history intake and physical examination by the healthcare provider. Signs and symptoms of hypoglycemia include (American Diabetes Association, 2021):

• Sweating or chills
• Irritability or anxiety
• Increased confusion
• Heart palpitations or racing heart
• Dizziness or feeling shaky
• Hunger
• Nausea
• Pallor
• Fatigue or decreased energy
• Blurry vision
• Tingling in mouth, lips, and tongue
• Headache
• Loss of coordination
• Nightmares if hypoglycemia occurs while sleeping
• Loss of consciousness, in severe cases
• Seizure, in severe cases

Diagnostic tests include a blood glucose test. Blood glucose levels will be checked every 15 minutes until the individual has returned to a normal blood glucose level above 70 mg/dL. Additional tests may include liver function tests, cortisol, and thyroid levels.

Hypoglycemia ICD-10 Code: E16.2

Source: ICD10Data.com

Managing Hypoglycemia

Management and treatment of hypoglycemia will depend on the cause as well as the severity. In the case of a hypoglycemic event, treatment may include the following:

• Administering 15 grams of carbohydrates (a glass of orange juice, a tube of glucose gel, or glucose tablets) and recheck of the individual’s blood glucose level in 15 minutes. If symptoms remain mild, this process is repeated until the individual’s blood sugar is at a normal level above 70 mg/dL.
• Holding diabetes medications until individual’s blood sugar is stabilized and they have ingested enough carbohydrates to maintain a normal blood sugar.
• Administering glucagon if the individual is unable to return to a normal blood sugar level, blood sugar levels are severely low, or the individual is unable to swallow.

Other ways to manage hypoglycemia may include:

• Monitor level of consciousness.
• Monitor psychosocial wellbeing.
• Monitor vital signs.
• Perform fingerstick glucose testing and monitor blood sugar levels.
• Provide calm environment.
• Initiate fall precautions.
• Initiate seizure precautions.
• Obtain ordered lab work.
• Medications as ordered.
• Provide nutrition and hydration.

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for hypoglycemia are listed below.

Assessment

Assess signs and symptoms, such as:

• Sweating, chills, or pallor
• Increased anxiety and confusion
• Irregular heartbeat
• Dizziness, shakiness, or loss of coordination
• Intake
• Nausea
• Weakness and fatigue
• Blurry vision
• Pain, headache

Nursing Diagnosis/Risk For

• Acute confusion related to insufficient blood glucose, evidenced by:
  • Imbalanced electrolytes
  • Decreased level of consciousness
  • Increased agitation or restlessness
  • Inability to follow through on goal directed behaviors
• Ineffective health management related to deficient knowledge regarding disease process, evidenced by:
  • Verbalized incorrect information
  • Questioned healthcare providers about disease process
  • Reported inadequate diabetes management measures
• Imbalanced nutrition: less than body requirements related to imbalance of glucose and insulin level, evidenced by:
  • Increased urinary output
  • Reported inadequate food intake
  • Weight loss
  • Weakness and fatigue
• Risk for unstable blood glucose levels related to lack of knowledge on blood glucose management evidenced by:
  • Blood glucose levels less than 70 mg/dL
  • Verbalized lack of knowledge
  • Incorrect statements regarding blood glucose management

  • Incorrect demonstration of fingerstick blood glucose monitoring

     

Interventions

• Administer fast acting carbohydrates or glucagon.
• Educate on appropriate diabetes management.
• Educate on medication administration.
• Educate on use of fingerstick glucose monitor.
• Monitor nutritional intake.
• Monitor neurological status.
• Provide psychosocial support to individual and family.

Expected Outcomes

• Returns to baseline cognition
• Demonstrates understanding of diabetes disease process
• Verbalizes correct diabetes medication administration
• Demonstrates correct self-monitoring of blood glucose
• Demonstrates appropriate nutritional intake

Individual/Caregiver Education

• Condition, treatment, and expected outcomes
• Side effects of diabetes medications and insulin, if prescribed
• Proper administration of diabetes medications and insulin, if prescribed
• How to treat hypoglycemia
• How to recognize signs of hypoglycemia
• How to monitor blood sugar levels
• Diabetes management nutrition guidelines
• Proper disposal of syringes and needles
• Notify healthcare provider or seek immediate medical care for:
  • Seizure
  • Uncontrollable blood sugar levels
  • Worsening diabetes symptoms
  • Difficulty managing blood sugar levels
• Recommended follow-up with healthcare provider

Additional Information

Content Release Date

6/11/2024

Content Expiration

12/31/2024

Course Contributor

The content for this course was created by Annette Brownlee RN, BSN

Annette Brownlee is an SME Writer for the Post-Acute Care team. She has a Bachelor of Arts in advertising from Michigan State University and a Bachelor of Science in nursing from the University of Northern Colorado. Annette has worked in skilled nursing and home health. Her most recent experience includes being a Staff Development Coordinator and

Infection Preventionist.

References

• American Diabetes Association. (2021). Hypoglycemia. https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia
• National Institutes of Health. (2021). Low blood glucose (hypoglycemia). https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood- glucose-hypoglycemia

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