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Insulin therapy in type 1 diabetes - Management
How should severe hypoglycaemia be managed in a person with type 1 diabetes?

  • Severe hypoglycaemia is when the person is semi-conscious or unconscious or in a coma with or without convulsions, and will require parenteral therapy (glucagon or intravenous glucose). These people are unable to swallow safely. Some authorities consider severe hypoglycaemia to be any episode requiring third-party assistance.
  • Advise the person's family or carer to immediately telephone 999:
    • If glucagon is not available, or
    • If they are not trained to administer glucagon, or
    • If alcohol is the cause or has contributed to the development of hypoglycaemia (intravenous glucose is required as glucagon may be ineffective if liver glycogen stores are reduced).
  • If the person's family or carer is trained to administer glucagon:
    • Glucagon should be administered immediately (subcutaneously or intramuscularly).
      • For children younger than 8 years of age (or body weight less than 25 kg): give 500 micrograms glucagon.
      • For all other people: give 1 mg glucagon.
    • If the person responds to glucagon treatment within 10 minutes and is sufficiently awake and able to swallow safely:
      • Give them some oral carbohydrate (to replace the body's supply and to prevent relapse of hypoglycaemia).
      • Advise that vomiting is common in the recovery phase and recurrent hypoglycaemia may recur. Consequently, the person should be closely monitored with regular checking of blood glucose.
      • If hypoglycaemia recurs, the person may require additional oral carbohydrate (if symptoms are mild or moderate) or urgent hospital admission (if symptoms are severe, as intravenous glucose is required).
    • If the person does not respond to glucagon treatment within 10 minutes:
      • Immediately telephone 999 (intravenous glucose is required).
  • Do not apply a rapid-acting source of glucose (such as glucose gel or honey) into the buccal pouch if glucagon is not available for the management of severe hypoglycaemia.

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