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Lesson 1, Topic 1
In Progress

Recognizing Low Blood Sugar and What to Do

Other Factors That Affect Blood Sugar

Besides the Four M’s of the Diabetes Management Plan, there are a few more factors that can affect
blood sugar and the use of prescribed insulin. To work safely with insulin, you need to know about all of the factors that can affect blood sugar.

Sick Days
When people are sick, their blood sugar usually gets higher. As a result, many people work with their diabetes care team to create a “sick day plan” to use when they have a cold, the flu, an infection, or some other illness. Your delegating RN will let you know if your client has a “sick day plan” and teach you about it.

Stress

Any time the body feels stressed, blood sugar usually gets higher. Stress can be emotional, such as when a person is afraid, angry, or anxious. Stress can be physical, such as when a person gets injured, goes through surgery, or feels pain. If a client’s blood sugar is higher because of these factors, be sure to follow your client’s plan for high blood sugar as instructed by your delegating RN.

Alcoholic Beverages

Alcohol can lower blood sugar. If people with diabetes drink alcohol, they should work with their diabetes care team to include these beverages in their overall dietary plan. If alcohol is part of your client’s dietary plan, it will be included in the care plan or in the instructions you receive from your delegating RN.
If your client is drinking alcohol that is not part of a dietary plan, notify your delegating RN and case manager immediately so important adjustments to the plan can be made.
If a person with diabetes makes a sudden change and increases the use of alcohol, blood sugar can get lower than usual. Taking the usual dose of insulin may cause dangerously low blood sugar.

Low Blood Sugar

In this Module, we have discussed prescribed insulin and other factors that affect blood sugar. We have focused on how insulin and certain factors together can cause low blood sugar.
As we said before, low blood sugar or hypoglycemia can lead to a medical emergency or death if left untreated. Let’s talk more about this.

LOW BLOOD SUGAR or HYPOGLYCEMIA is blood sugar that falls BELOW 70 mg/dl. If a person’s blood sugar is below 70 mg/dl, it is too low.

It is easy to remember these three blood sugar ranges by learning the normal range. From there, it makes sense that:

  • High blood sugar is any number above normal.
  • Low blood sugar is any number below normal.

Even though Target Ranges are sometimes individualized above 140 mg/dl,Target Ranges are not usually individualized below 70 mg/dl.
In other words, a blood sugar level below 70 mg/dl is considered low for people generally and means that the body needs more glucose to work normally.

To work safely with a client who has diabetes, you must be able to recognize LOW BLOOD SUGAR SYMPTOMS when you see them.

If the first symptoms of low blood sugar are not recognized and treated, a person can get worse and eventually pass out or lose consciousness.
A person who loses consciousness needs emergency medical help immediately. Without it, an unconscious person with low blood sugar can die.
Some people with diabetes can feel when their blood sugar is low and can recognize their symptoms. However, some people with diabetes can’t tell when their blood sugar is low and do not
recognize their symptoms.
These people count on glucose monitoring and the observations of others—like you—to help them recognize and respond to low blood sugar.
Please study and learn the symptoms of low blood sugar. You need to know them well enough to recognize them and respond if they occur in your client.

What to Do When Low Blood Sugar Occurs

If a person with diabetes shows symptoms of low blood sugar, then check his or her blood sugar level using a glucometer.
If a person’s blood sugar level is below 70 mg/dl, action steps need to be taken immediately to get the person a source of glucose (or sugar).
Healthcare providers often develop an individualized plan for their patients and caregivers to follow when low blood sugar occurs.
However, some people may not have an individualized plan to follow.
If your client does not have an individualized plan for low blood sugar, these standard steps can be taken for blood sugar below 70 mg/dl. These steps are called THE RULE OF 15.

There are a few important points to keep in mind about using The Rule of 15

  1. If your client has symptoms of low blood sugar and you aren’t able to check his or her blood sugar using a glucometer, go ahead and give him or her 15 grams of glucose. It is always safest to treat symptoms of low blood sugar, even if you can’t check the blood sugar with a glucometer.
  2. Have a source of glucose (such as candy or glucose tablets) available for your client at all times.
  3. After your client’s low blood sugar has been raised:
  • Observe your client for the return of low blood sugar symptoms.
  • Re-check your client’s blood sugar if symptoms return.
  • Have your client eat meals and snacks as planned to keep blood sugar up.

Call 911 immediately if your client passes out or loses consciousness. Never attempt to give an unconscious person a source of glucose by mouth.

  1. There are times when a person with low blood sugar is conscious, but may not be able to swallow food, drinks, or tablets safely. You know your client can’t swallow safely if the:
  • Client’s speech is very slurred.
  • Client is sleepy or not alert enough to follow directions.

Call 911 immediately if your client cannot safely swallow or use a source of glucose by mouth.

Your client may have an individualized plan and steps to follow for low blood sugar. Your client’s individualized plan and steps may be different from The Rule of 15.

Your delegating RN will:

  • Let you know if your client has an individualized plan to follow for low blood sugar.
  • Instruct you about the plan and steps to follow. Always follow the plan and steps that come from your delegating RN.