EMERGENCY MANAGEMENT OF DIABETIC MELLITUS PATIENT WITH HYPOGLYCAEMIA IN OUT PATIENT DEPARTMENT (OPD)
According to the hospital statistics where the author works, it is noted that emergency cases is becoming rampart in the OPD which 75% of the cases were diabetic patients presenting with hypoglycaemia. This happened with patients that:-
Come for Fasting Blood Glucose Test.
Diabetic Patient waiting longer in the clinic (delayed clinic).
Patients having Uncontrolled Diabetes.
In the United Kingdom (U K) over 25 million people according to Jarvis and Rubin (2003) are thought to have diabetes which 1.4 million already been diagnosed with the disease. Diabetes UK (2009) says there are about 2.5 people who diagnosed having diabetes in UK while people over 500,000 who have diabetes but don’t know of it.
The author cannot talk on hypoglycaemia without mentioning Diabetes Mellitus. What Is Diabetes Mellitus: It is a medical condition affecting the body when the beta cells in the pancreas are unable to produce enough insulin needed or the body does not react properly to insulin (Jereat, 2003).
What Is Insulin: It is a hormone that the body needs to convert sugar and other food into the energy needed for daily activities. When the glucose in the body builds up in the blood, the cells are unable to absorb it for these cells are not functioning properly.
What Is the Normal Blood Glucose Level?
The normal blood glucose level is between 4.0mmoi/l to 7.0mmol/L (Diabetes UK 2010). This could be higher or lower in diabetic patients due to the malfunction of the pancreas. Patients with any types of diabetes mellitus can have hypoglycaemia. Hypoglycaemia means low blood glucose level less than 4.0mmol/L in the body (Diabetes UK2010), if less than 2.5mmol/L it is considered pathological.
CAUSES
The commonest cause of hypoglycaemia is the side effect of insulin and sulphonylureas in the treatment of diabetes presenting a major barrier to a long term glycaemia control.
There are many other causes but the main cause with the diabetic patients in OPD where the author works are:
1. Timing of food intake and insulin injections or oral medications
2. Hypoglycaemia resulting from elevated insulin slowing down the blood glucose to low level.
3. The amount of food taken in, amount of glucose burn for energy and insulin circulatory in the body and ability to raise glucose by the liver. All these affect blood glucose level.
Alcohol
This can block the activity of the liver, thereby making the liver’s unable to release glucose. If you take insulin or any sulphonylurea drugs, you are advised not to drink alcohol without eating some food.
Signs and Symptoms: - The main possible symptoms associated with hypoglycaemia are: - Fatigue - Dizziness -Headache Other signs according to each patient’s reaction to low blood sugar.
EMERGENCY TREATMENT
Perform Blood Glucose Level Reading: If blood glucose level is less than 4.0mmol/L commence treatment (Diabetes .co.uk; Jarreat2003). Treatment depends on the severity of the symptoms.
If symptoms is mild presenting with any or more of these experience: - sweating, hunger, slight trembling, tingling of lips, quick acting carbohydrate drink should be given. This could be in form of
1. Three Dextrose tablets
2. Two to four teaspoonful of sugar dissolved in water
If symptoms are more severe and the patient is conscious but confused or aggressive, liquid form of carbohydrate should be given
. Ordinary Coca Cola or
. Fruit Juice or
. Lucozade
Recheck the blood glucose level after 10 minutes. If still less than 4.0mmol/L repeat the treatment and re-check the blood glucose level again.
If the blood glucose level is more than 4.0mmol/L when the symptom has resolved, give quick acting carbohydrate such as
1. High fibre snacks or
2. A meal containing high carbohydrate to prevent recurrence.
In case of severe hypoglycaemia characterised by unconsciousness, avoid food and drink. Give
