Hypoglycemia in hospitalized adults.(Clinical Practice)

Hypoglycemia in hospitalized adults.(Clinical Practice)
February 1, 2008
Anthony, Maureen
MedSurg Nursing

Hypoglycemia, defined as a blood glucose (BG) of less than 70 mg/dL (Cryer, Davis, & Shamoon, 2003), occurs commonly among hospitalized patients. Most cases of hypoglycemia in acute care settings occur in patients with diabetes. Diabetes results in diminished or absent glucose utilization, which raises blood glucose levels beyond the normal range of 70-100 mg/dL (Clement et al., 2004). Chronic hyperglycemia is associated with microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (cardiovascular disease) complications (Franz, 2003). Results of the Diabetes Control and Complication Trial (DCCT) (1993) in type 1 diabetes and the United Kingdom Prospective Diabetes Survey (1998) in type 2 diabetes suggested that reduction of blood glucose to near-normal levels was associated with a delay or prevention in the onset of microvascular complications of diabetes. Insulin and other oral glucose-lowering drugs are used to reduce BG as close as possible to the non-diabetic range; however, these drugs also can induce hypoglycemia (see Table 1).

Although the relationship between chronic hyperglycemia and long-term complications has been well-documented, attention has turned only recently to the effect of hyperglycemia on patient outcomes in acute care settings. Recent research demonstrated that achieving normo-glycemia in hospitalized patients may improve patient outcomes (Van den Berghe et al., 2001). Maintaining normo-glycemia in hospitalized patients, however, is time-intensive and challenging to nurses. It requires frequent bedside monitoring of blood glucose and attention to caloric intake, as well as current knowledge of the action and timing of the many medications that lower blood glucose (Braithwaite et al., 2004).

The prevalence of diabetes in hospital settings is high (Centers for Disease Control and Prevention, 2005). Between 1980 and 2001, the number of patients with diabetes admitted to hospitals increased more than 100%, from 2.2 million to 4.6 million. In 2001, diabetes as a primary or secondary reason for admission to the hospital accounted for 24.2 million hospital days. The high prevalence of diabetes and the recent emphasis on normalization of BG in hospitalized patients makes hypoglycemia a serious threat to the safety of many hospitalized patients.

Hypoglycemia is categorized as mild or severe depending upon the extent of symptoms, not the actual blood glucose (Franz, 2003). Symptoms of mild hypoglycemia include sweating, trembling, lightheadedness, and hunger. The victim is able to self-treat by ingesting carbohydrates. The term mild refers to the ability to self-treat and does not reflect the severity of symptoms. Severe hypoglycemia occurs when the victim suffers from mental confusion or loss of consciousness and requires the assistance of another person (Franz, 2003). Symptoms of hypoglycemia are distressing to patients, and some authors have asserted that patients avoid hospitalization due to fear of its occurrence (Fischer, Lees, & Newman, 1986). In addition to causing unpleasant physical symptoms, hypoglycemia places the person at risk of social embarrassment, injury, accident, and although rare, brain damage, and death (Franz, 2003).

Pathophysiology of Hypoglycemia

Glucose is the primary source of fuel for the human body and is critical to brain functioning (Cryer et al., 2003). Because the...

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