 What comes to nursing school explain in today's video about hypoglycemia? Typically hypoglycemia is defined as a blood glucose level of less than 70 milligrams per deciliter. But that can be a little bit different depending on the facility that you're working at or with. Sometimes the level can be maybe 65 maybe 75. So just make sure that you're familiar with what that means. But the important thing is that we understand what hypoglycemia is how it occurs and what kinds of signs and symptoms we're going to see in the patient and then of course how we're going to treat them. So let's start here. So causes of hypoglycemia are either not enough food or too much medication meaning too much insulin usually in the patient system although oral antidiabetic agents can also stimulate insulin production and they can also lead to hypoglycemia. Mistimed food intake. Think about a patient who gets a meal coverage dose of an insulin and then the meal doesn't arrive on time, the patient gets taken to a procedure. Something like that happens that that mistimes or that the patient misses that meal intake that can definitely lead to hypoglycemia and then certainly vigorous exercise because if we are burning up all the glucose that we have in our bloodstream then we don't have enough glucose available to sustain ourselves and we're going to become hypoglycemic. So pathophysiologically when we have an episode of hypoglycemia our bodies are designed to activate the autonomic nervous system and two things happen with the autonomic nervous system. The insulin release is decreased because we don't even have enough glucose to sustain ourselves right now so we don't want to break down more glucose and the glucagon and epiproductions are increased and glucagon and epinephrine help to bring the blood sugar up. Now glucagon binds or causes release of glycogen stores from the liver and therefore glucose production to bring up the blood sugar naturally and epinephrine also helps to kind of kick start everything to make that happen. Now signs and symptoms that we're going to see in the patient who's hypoglycemic they might have palpitations, anxiety, tachycardia, their skin might change into pale, cool and diaphoretic kind of like a shocky response if you think about it and of course they're going to be hungry because they don't have enough carbohydrates or glucose in their system and these symptoms all happen because of the release of epinephrine so when you think about it the signs and symptoms that you might see think about what does epinephrine do in the body and it causes all these things but of course decreased levels of blood sugar also cause some neurologic effects because the brain needs glucose to function so when we don't have enough sugar in our system the patient might be altered, they might have vision changes, blurry vision, double vision, they might have slurred speech, they might actually exhibit seizures or develop a coma and eventually they will die because the body just doesn't, does not have enough glucose available to sustain themselves and then if we look over here so patients at high risk certainly are patients who are diabetic because they already take in medication to help lower their blood sugar so if something interferes with their food intake or they mistime it or maybe there's a medication change or an addition or a subtraction then they are at high risk. The other patients that are at high risk are those that take beta blockers because beta blockers inhibit the epinephrine and the glucagon response which is also what the antidote to beta dose or beta blocker overdose is glucagon so that's a nice little tidbit here for you. Now treatment for hypoglycemia, all hospitals have a hypoglycemia protocol so make sure that you're familiar with that and that you know the decision tree and how you can go about it to help your patient get better because the symptoms of hypoglycemia they might come on little gradually but once the patient has altered and the glucose goes below 70 then we need to really react quickly because coma and death are imminent if the blood glucose level continues to drop and we can't administer any kind of source of glucose then the patient actually might have very bad outcome. So a hypoglycemia protocol usually includes and this is a very simple explanation here if the patient can take PO fluids or food and they are alert we want to give them by mouth simple carbohydrates and simple because that they are easy to digest and they can enter the bloodstream quickly so those are things like orange juice, honey, syrup, jelly anything that you can get into the patient that will elevate the blood glucose quickly. Now keep in mind that the patient has to be alert because if they're altered and have slurred speech we always worry about their airway and their ability to swallow so we should not give any patient anything PO if we're not sure or if they are altered. After we've given the simple carbs we want to recheck their blood glucose level in 15 minutes and then repeat the simple carbs if we're still below 70 and the hypoglycemia protocol will give you the exact numbers that you need to treat to here and then if the blood glucose level is not normal the patient's symptoms resolve we need to follow their oral intake with complex carbohydrates so that's something that also contains carbohydrates but that will take a longer to digest to kind of keep the blood sugar up not just increase it and then drop it down again and these complex carbohydrates should also be accompanied by fat as well as protein because they slow the absorption of those complex carbohydrates. However if the patient is NPO and or they have an altered level of consciousness so now we don't want to feed them anything by mouth because that could be dangerous or that's not part of their of their allowed diet we have two options we can give them intramuscular glucagon basically to help that response or we can give them IV dextrose and that'll depend on the sugar level and on the protocol that you're following. Now for nursing care it's very important to know the signs and symptoms of hypoglycemia and also educate your patients and their family members about the signs and symptoms so that they know and they can react just like you would in the hospital. Know the patient medications and their food intake because we know an imbalance here can cause their blood glucose to drop. Check the blood sugar quickly even if you just have the slightest suspicion that with the patient presenting with any of these symptoms just check a blood sugar it's the best thing you can do. Remember we also check a blood sugar if the patient exhibits stroke symptoms so that kind of ties in with those neurologic symptoms I talked about and maybe it's just a low blood sugar and it can be resolved that we don't have a call to call a code stroke but always keep your eye on the patient and then follow the protocol and after the episode is resolved so now the patient is better the blood sugar is staying up investigate as to why this happened what happened with their medications with their beta blockers with their food intake so that we can prevent it from happening again because it can be very scary and it can be dangerous when the blood sugar goes too low and we don't recognize that. So thank you for watching this video about hypoglycemia also check out the other video I have coming up about the opposite hyperglycemia as well as a separate video about the hypoglycemia protocol where I actually go over an example and explain and break it down how it relates to this video thanks for watching see you soon