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All patients on sulfonylureas and/or insulin therapy should be able to self-monitor their blood glucose levels and be educated on the symptoms and signs and how to treat hypoglycaemia
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Symptoms and signs of hypoglycaemia (confirmed by BGL < 4 mmol/L)
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Sweating and fatigue
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Palpitations, tremors and anxiety
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Hunger
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Dizziness and weakness
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Confusion/cognitive impairment
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Seizure and coma in severe hypoglcaemia
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Older age
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Previous episodes of severe hypoglycaemia
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Loss of hypoglycaemic awareness
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Long duration of diabetes
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Erratic carbohydrate intake e.g. irregular meals, low carbohydrate diet
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Renal impairment
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Tight glycaemic control e.g. HbA1c < 48 mmol/mol
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Beta blockade
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Significant alcohol intake
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Autonomic neuropathy
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Severe hypoglycaemia or frequent episodes of mild hypoglycaemia requires urgent medical review to consider the cause(s) of hypoglycaemia and reduction in insulin and/or sulfonylureas as required
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Missed meals
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Exercise/physical activity
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Alcohol
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Too rapid an increase in insulin and/or sulfonylureas
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Accidental overdose – NB the majority of insulin overdoses are intentional so screen for depression
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Deterioration in renal function
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Administering insulin into new injection sites if previous sites had lipohypertrophy
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The law states that patients must not drive for 1 hour after an episode of mild hypoglycaemia and not for 24 hours after an episode of severe hypoglycaemia.
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Appropriate treatment of hypoglycaemia will likely prevent severe rebound hyperglycaemia
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Treatment of hypoglycaemia (blood glucose levels < 4 mmol/L)
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Weight-based management of hypoglycaemia is more effective
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Eat 0.3 grams/kg of body weight OR 30 grams of rapid acting carbohydrate
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How to get 30 grams of rapid acting carbohydrate
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10 Dextro or vita glucose tablets or 6 BD glucose tablets
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30 grams of glucose powder
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6 teaspoons of sugar dissolved in water
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350 mL of fruit juice or non-diet/zero soft drink
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18 jellybeans
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2 tablespoons of honey
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3 tablespoons of jam
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2 Hypofit gels
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Wait 10 minutes and re-check blood glucose level
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If glucose level < 4 mmol/L repeat steps above until glucose > 4 mmol/L
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Once glucose is > 4 mmol/L have a carbohydrate snack e.g. a slice of toast, 2 biscuits or crackers with cheese and recheck glucose levels in 30 minutes to ensure safe
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If the patient becomes unresponsive and is unable to take carbohydrate replacement an ambulance should be phoned for. Glucagon is not effective in type 2 diabetes.