Page 296 - fbkCardioDiabetes_2017

272 Hypoglycemia How Critical it is?

• Prolonged severe hypoglycemia results in depres- - Follow the treatment for hypoglycemia according
sion of myocardial function and causes LV dys- to the table below.
function.
- Notify physician for subsequent treatment orders
and reassessment of patient’s ability to safely
HEMODYNAMIC CHANGES DUE TO self-manage their insulin pump.
HYPOGLYCEMIA:-
- -Initiate seizure precautions for patients with al-
Hemodynamic changes are primarily due to epineph- tered consciousness.
rine
If patient on
• Systolic BP is increased
- FLUID RESTRICTIONS: recommend glucose gel
• Diastolic BP is decreased for treatment
• Pulse pressure is increased
- RENAL RESTRICTIONS: recommend glucose gel
• Increase in central aortic pressure for treatment. Avoid orange juice, colas, milk, pea-
nut butter or cheese.
• Heart rate is increased
- SWALLOWING PRECAUTIONS OR LEVEL ONE
Acute coronary syndrome PUREE DIET: recommend 4 oz of juice with 2 TBSP
thickener
• Moderate hypoglycemia acutely increases the cir-
culating levels of plasminogen activator inhibitor, - IF PATIENT ON Precose (Acarbose): only use glu-
vascular endothelial growth factor, vascular ad- cose gel to treat hypoglycemia. Treatment with su-
hesion molecules, Interleukin-6 and markers of crose (juice, jelly, pop, sugar) is ineffective.
platelet activation.
Important aspects of management : A
• In T2DM patients with coronary artery disease,
hypoglycemic episodes are associated with de- Hypoglycemia protocol
pressed heart rate variability. Clear definition of hypoglycemia
BG < 70 mg/dl (severe hypoglycemia: BG < 40)
Treatment:
If patient on a SUBCUTANEOUS INSULIN PUMP be- Nursing order to treat without delay Document the
comes hypoglycemic, incident
- Suspend the insulin pump until blood glucose>60 Look for the cause of hypoglycemia and determine
mg/dL. If patient has a change in level of con- if other treatment changes are needed.
sciousness (ranging from confusion to coma), pull Hypoglycemia Protocol: Follow-up
out infusion site to stop insulin administration if
unable to suspend infusion pump.

GCDC 2017