Hypoglycaemia in surgery

Stepped management plan for hypoglycaemia

1) Treat acute event

a. Oral fast-acting glucose 10-20g is the best option if the patient is awake and cooperative

eg. (drink – sugar-solutions / =150ml of non-diet fizzy drink (eg Coke or similar)

or 150ml fruit juice) (solids – 3-4 jelly babies / 3-4 dextrose tablets / 5-6 jelly beans)

avoid complex carbohydrates such as cereal bars or chocolate as primary treatment as they are slow to be absorbed

b. If uncooperative or unconscious use 1mg Glucagon IM or 200-250mls 20% dextrose iv (250ml bags of 20% available via Baxter Healthcare)

2) Consider need for ongoing Carbohydrate

At this point 20-30g of a more complex carbohydrate intake is appropriate (eg a sandwich)

3) Take a history

a. Cause of event

Which insulin/medication is implicated?

Is there a co-morbidity to consider (hypothyroid / addisons / renal disease)

Is there an activity to consider (exercise / stress / alcohol etc)

b. Impact of event

4) Plan longer-term therapy changes investigations or referrals if recurrence considered a possibility

5) Advise the patient appropriately regarding avoidance strategies and risk of recurrence within the first 48hrs (statistically the most likely) in particular the need to monitor more frequently in the next 48hrs as an avoidance strategy (grade 1A evidence)