a. Hypoglycemia, also referred to as insulin reaction or insulin shock, is caused by too little sugar in the blood (in relation to the amount of insulin in the blood).

This situation may be caused by any of the following:

(1) Missed or delayed meals and/or snacks.

(2) Over exertion or strenuous exercise.

(3) Excessive vomiting.

(4) Insulin overdose.

b. Signs and symptoms of hypoglycemia include the following. Onset may be quite sudden.

(1) Pale, cool, clammy skin.

(2) Cold sweat.

(3) Nervousness, trembling.

(4) Dizziness.

(5) Weakness, fatigue.

(6) Tachycardia.

(7) Hypertension.

(8) Hunger, often quite sudden.

(9) Low blood sugar level.

(10) Small urine output (oliguria).

(11) Urine frees of sugar and acetone.

c. Pathophysiology.

(1) The symptoms of hypoglycemia are a reflection of the effects of a low blood glucose level upon the central nervous system, along with the release of epinephrine.

(2) Decreasing uptake of glucose by the CNS and lowered utilization of oxygen by the brain will result in permanent damage to CNS neurons.

(3) The primary factor in prevention of the problems of hypoglycemia is early recognition of the symptoms. Initiation of treatment can eliminate the reaction and its consequences.

d. Nursing management.

(1) Administer glucose immediately.

(a) A conscious patient may be given some form of sugar by mouth. (Table sugar, orange juice, cola, honey, syrup, jelly, or candy.)

(b) An unresponsive patient may be given “instant glucose,” a form of rapidly absorbed glucose that is squeezed out of a tube into the patient’s mouth for oral absorption.

(c) An intravenous infusion of dextrose in water should be initiated if possible.

(2) Have the patient stop all activity and rest to conserve energy.

(3) Notify the physician.

(4) Draw blood for a glucose level.

(5) Monitor vital signs and level of consciousness carefully.

(6) Document all information in the patient’s clinical record.