Patient discussions

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Beleid bij acute hypoglykemie met verminderd bewustzijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022La prise en charge de l’hypoglycémie aiguë chez un patient présentant une diminution de la consciencePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022

Ensure that the patient and their family or carers understand:

  • How and when to monitor their blood glucose and the importance of doing this (see Monitoring).[38]​

  • How to recognise signs and symptoms of hypoglycaemia.[1][2]​​[38]

  • How to treat an episode of hypoglycaemia with glucose or glucagon and when to seek medical assistance.[2][38]​ Note that administration of glucagon is not limited to healthcare professionals and it may be given by family or carers if needed; ensure that it is prescribed for all patients at risk of level 2 or 3 hypoglycaemia.[3][59]​​​ Anyone who is in close contact with a patient who is prone to hypoglycaemia (e.g., family members, room-mates, school personnel, childcare providers, correctional institution staff, or co-workers) should be educated on how to administer glucagon.[3][38]​ Children and young people with diabetes should also have a school healthcare plan detailing their current diabetic treatments, and this should be reviewed by their diabetes team at least once a year.[38]​

  • Circumstances in which the patient is at increased risk of hypoglycaemia (e.g., when fasting for laboratory tests or procedures, when meals are delayed, during and after the consumption of alcohol, during and after intense exercise, during sleep).​[1][3][17][38]​ Educate the patient and their family or carers on how to adjust their insulin doses in these scenarios to reduce the risk of hypoglycaemia.[37]​[38]​

Advise the patient and their family or carers to seek emergency medical assistance if:[128]

  • The patient is unconscious and no glucagon is available

  • They need a second dose of glucagon

  • They have been given glucagon but are still confused

  • Their blood glucose remains too low 20 minutes after treatment, or does not respond to their usual treatments

  • They are concerned at any time about a severely low blood glucose.

When giving the patient advice about driving, check the regulations in your country or local area. In the US, there are a range of different licensing requirements applied by both state and federal jurisdictions for patients with diabetes, depending on the type of driving they are undertaking.[129][130]​​​

  • In general in the US, patients with diabetes who have experienced an episode of hypoglycaemia should have an evaluation of their fitness to continue to drive.[130] However, in some states all patients with diabetes require evaluation, even if they have not experienced hypoglycaemia.[130]

  • In addition, patients should check their role in reporting episodes of hypoglycaemia to the licensing authority; in some states this is mandatory.[130]

  • In the UK, patients with diabetes may need to notify the Driver and Vehicle Licensing Agency (DVLA) and in some instances be required to stop driving; this will depend on a number of factors, including the type of driving licence held, the type of treatment used to manage their condition, and having a history of experiencing certain complications of their condition (including hypoglycaemic episodes).[131]

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