HYPOGLYCEMIA

VS.
HYPERGLYCEMI
A
GODOFREDO M. MANZANO JR. , MAN
LORMA COLLEGES, CLINICAL INSTRUCTOR
 • HYPERGLYCEMIA AND
HYPOGLYCEMIA ARE TWO MEDICAL
CONDITIONS OCCURRING DUE TO
THE DEPLETED AND EXCESSIVE
MAIN AMOUNTS OF INSULIN SECRETION,
DIFFERENCE OF RESPECTIVELY.
HYPOGLYCEMIA • THEREFORE, THEIR MAIN
VS. DIFFERENCE IS
HYPERGLYCEMI THAT HYPERGLYCEMIA IS CAUSED
A BY AN EXCESS OF GLUCOSE IN THE
BLOODSTREAM
WHEREAS HYPOGLYCEMIA IS
CAUSED BY THE DEFICIENCY OF
 Utilizatio
n

Hypoglycemia
is common with Type I DM
mostly in patients receiving
insulin therapy.

Production is lower than what we are utilizing,

therefore there is a state of a deficit of glucose.
HYPOGLYCEMIA - a blood
glucose that is less than 60 mg/dl.
GLUCOSE is that primary
source of energy for our body
and our brain
and if it gets low enough

Coma Death
Acute hypoglycaemia can be fatal
if left untreated
 CAUSES

• 1. ENDOGENOUS (having an internal cause or

origin)
• 2. EXOGENOUS (growing or originating from
outside an organism)
• 3. FUNCTIONAL
 CAUSES
• 1. ENDOGENOUS
• A. TUMORS
• B. METABOLIC ERRORS

over use of glucose as a result on an over production of insulin and

these leading to a state of having too little glucose in the blood.
 CAUSES
• 2. EXOGENOUS
• A. Excessive Insulin
• B. Oral Antidiabetics
• C. Drugs (Insulin, Sulfonylureas, Thiazides
• D. Alcohol
 CAUSES
• 3. FUNCTIONAL
 Excessive muscle use - Going to burn up glucose
 Hypermetabolic state – Example: SEPSIS where
the body could be just overly utilizing glucose.
 Dumping syndrome - Where in the body is not able
to process what is ingested quick enough to get the
necessary from it.
SIGNS AND SYMPTOMS
•MILD
•MODERATE/SEVERE
 SIGNS AND SYMPTOMS
•MILD
• Diaphoresis, Tremors or Shakiness, Tachycardia,
Paraesthesia, Pallor, Excessive Hunger, Or Even
Anxiety.
 SIGNS AND SYMPTOMS
•MODERATE/SEVERE
• Headache, Mood Changes, Inability to Concentrate,
Drowsiness, Confusion, Impaired Judgement,
Staggering Gait or Slurred Speech, Double Vision,
Psychosis, Seizures or Coma.
DIAGNOSTIC
Check the
BLOOD SUGAR
 DIAGNOSTIC
Check the
BLOOD SUGAR

If the blood sugar ranges from 20-40 mg/dl

that is potentially we can see seizures and for
severe hypoglycaemia and if it is less than 20
mg/dl that is often times the patient will be in a
coma and risk of death.
 TREATMENT
1. Prevention – by monitoring the patient and education to
patients for the s/s. specially the mild s/s.
2. Giving 10-15 grams of oral glucose (snacks), repeat in 10
minutes if blood sugar still low.
3. Give them 1 -2 mg of glucagon IV or IM or even SC.
4. IV dextrose and this going to be 25 grams of a D50
solution by IV push.
 TREATMENT
• If the hypoglycaemia is occurring due to an underlying condition, that
condition should be addressed. For example: 
1. If the patient has a pancreatic tumor, then surgery may be necessary to
remove the tumor or even part of the pancreas.
2. Hypoglycaemia caused by culprit medications may warrant a change in
medication regimen.
3. Endocrine disorders should also be addressed accordingly and
treatment will vary based on each specific condition.
 HEALTH TEACHINGS
• Teach the patient/family the signs of hypoglycaemia. If the patient takes a
beta blocker, ensure they understand their signs/symptoms may not be as
noticeable.
• Teach the family not to place anything into the mouth of an unconscious
patient. 
• Teach the patient/family the importance of carrying a glucagon kit.
• Teach the patient to always carry a fast-acting carbohydrate such as
glucose tablets.
 HEALTH TEACHINGS
• If the patient is taking acarbose, ensure they understand to
use the glucose gel for treatment as sugary
foods/beverages will not be effective.
• Teach the patient to keep a log (document) of their blood
sugar levels and symptoms.
HYPERGLYCEMIA
 CAUSES
Non-compliant
Too much
insulin injections
carbohydrates for
or oral glucose- Infections
the amount of
lowering
insulin, taken
medicine

Physical Strenuous
Stress
inactivity physical activity
 CAUSES
Things to see on hospitalized patients
• Myocardial Infarction (MI)
• Stroke
• Trauma
• Pain
• Anything that trigger stress release in our patients.
 CAUSES
DIABETES Due to Inadequate Uptake of Glucose
 Type 1
 Type 2
 SIGNS AND SYMPTOMS

Trouble
Polydipsia Polyuria Headaches concentratin
g

Blood sugar
Blurred
Weight loss more than
vision
180 mg/dL
 MANAGEMENT
1. Frequent blood glucose monitoring.
2. Insulin management through continuous IV
infusion
TREATMENT AND MANAGEMENT

1. Those who have been diagnosed with diabetes should be aware

of signs suggestive of hyperglycaemia; these will need immediate
medical attention.
2. Drink more water to stay hydrated
3. Stay active
4. Get advice from a dietician in order to maintain a balanced diet.
5. Switch diabetic medications according to the latest requirements.
 DKA VS. HHS
• “DKA” means “diabetic ketoacidosis” and “HHS” means
“hyperosmolar hyperglycemic syndrome.”
• DKA and HHS are acute metabolic complications of diabetes mellitus
that can occur in patients with both type 1 and 2 diabetes mellitus.
• Mortality rates are 2–5% for dka and 15% for hhs, and mortality is usually a
consequence of the underlying precipitating cause(s) rather than a result of
the metabolic changes of hyperglycaemia.
DKA VS. HHS
• DKA
a. life threatening acidosis
b. less hypovolemia
“Insulin. Insulin, Fluid”
• HHS
a. life threatening hypovolemia
b. no acidosis
“Fluid, Fluid, Insulin”
 DKA VS. HHS
• Diabetic Ketoacidosis is seen mainly in type 1
diabetic patients but is also seen in some type 2
diabetic patients.
• Hyperosmolar Hyperglycemic Syndrome is mainly
seen in older patients having type 2 diabetes.
 DKA VS. HHS
• DKA is mainly characterized by hyperglycaemia, acidosis-
producing derangements, and dehydration. Infection, disruption of
insulin, and onset of diabetes are some of the common causes of
DKA.

Hyperglycemia, dehydration and hyperosmolarity are some of the

common characteristics of Hyperosmolar H
yperglycemic Syndrome. But HHS does not have ketoacidosis.
 DKA VS. HHS
• Some of the early symptoms of diabetic ketoacidosis
include increased thirst and increased urination.
• Other symptoms include malaise, weakness, and
fatigue. Bacterial infection, illness, insulin deficiency,
stress, and insulin infusion catheter blockage are
some of the causes that lead to DKA.
 DKA VS. HHS
• When compared to diabetic ketoacidosis, the
hyperosmolar hyperglycemic syndrome develops only
over the course of a week. Diabetic ketoacidosis
develops rapidly. Increased dehydration, acute illness,
vomiting, dementia, pneumonia, immobility, and
urinary tract infections are some of the common
causes of hyperosmolar hyperglycemic syndrome.
 DKA VS. HHS
• One of the main goals of treatment of DKA
involves correcting high blood glucose levels by
injecting insulin as well as replacing fluid lost
because of vomiting and urination.
• The main goal of HHS treatment includes
correcting dehydration which would improve
blood pressure, circulation, and urine output.
GLUCOMET
ER
GLUCOMETER
 GLUCOMETER ADVANTAGES

1. CONVENIENCE
2. ACCURACY
3. EASY MEDICAL DECISION
4. COST-EFFECTIVE
 ADVANTAGES OF GLUCOMETER :

• It helps to control your blood sugar if it is high or

low.
• You can identify the patterns regarding when you
have a high and low amount of glucose.
• Easy to check the levels of glucose after exercising.
 GLUCOMETER DISADVANTAGES

1. Painful
2. Non-compliance
3. Not always accurate
4. Might cause infection
7 STEPS
 7 EASY STEPS TO USE GLUCOMETER

1.Make sure about the below things

1.The insulin and glucometer test trips have not
passed expiry dates.
2.The correct type of batteries.
3.The box of test strips.
4.The code key number should be the same as
that on the box of test strips.
7 EASY STEPS TO USE GLUCOMETER

1.CALIBRATE THE GLUCOSE METER

1.Add the code key into the test strip slot.
2.After doing it, check the number that appears on
the screen is the same as that on the box of test
strips.
7 EASY STEPS TO USE GLUCOMETER

• Wash your hand with soap and water

 7 EASY STEPS TO USE GLUCOMETER
1.Prepare the lancet device
1.Remove the lancet cover and put the needle in.
2.By twisting the needle cap, remove it. Avoid touching the
needle.
3.Replace the lancet cover and adjust the depth of the lancet
device as per your skin thickness carefully.
4.By pressing the release button, prime the lancet device (you
need to pull and release the lever in some products)
 7 EASY STEPS TO USE GLUCOMETER
1.Preparing the glucometer
2.Remove the glucometer test strip from the foil
or from the glucometer test strip container.
Gently, insert it into the test strip slot and it will
turn on the meter automatically.
 7 EASY STEPS TO USE GLUCOMETER
1.Test your blood glucose level
1. Take one finger with an alcohol swab.
2. Press the lancet device against the side of your finger.
3. To release the needle, push the button. Squeeze your finger to get a drop
of blood.
4. Touch the end of the glucometer strip to the drop of blood.
5. Over the puncture site, apply a dry swab.
6. The level of your blood glucose level is displayed
7. Take a pen and paper and record your blood sugar level.
 7 EASY STEPS TO USE GLUCOMETER
1.Put all the items safely
1.Remove the lancet cover.
2.Before removing it, recap the needle. Throw the
used needle in the plastic container.
3.Replace the lancet cover and store away the
glucometer.
4.Consider washing your hands again WITH SOAP AND
WATER.