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blood glucose

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Urgently carry out a blood glucose level for any patient with suspected diabetic hypoglycemia, which is a finger stick test that is performed at the bedside or in an outpatient setting. In practice, if finger stick testing is not available, start treatment if the patient has typical symptoms and signs of hypoglycemia.

Confirm diabetic hypoglycemia if blood glucose is <70 mg/dL (<3.9 mmol/L).​[1][3][4]​​​​

  • In clinical practice, this is used as the clinical alert or threshold value that should prompt treatment for hypoglycemia in diabetes to prevent further fall in blood glucose.​[1][2][3]​​ However, be aware that hypoglycemia is defined as any fall in blood glucose that exposes a patient to potential harm as there is no single numerical definition of hypoglycemia for all patients and situations.[1]

  • Suspect nocturnal hypoglycemia if the patient's pre-breakfast blood glucose is low.[1]

Take appropriate action according to the severity of hypoglycemia. Start immediate treatment for any patient with level 2 or 3 hypoglycemia.[3] Severity of diabetic hypoglycemia is classified as follows:[3][4][17]​​

  • Level 3 (severe): no defined blood glucose. Severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia.

  • Level 2 (clinically significant; also referred to as clinically important or serious): blood glucose <54 mg/dL (<3.0 mmol/L). This is usually the threshold at which neuroglycopenic symptoms occur.[3] In addition, be aware that a patient with impaired awareness of hypoglycemia may not present with typical signs and symptoms of hypoglycemia.​[1][3]

  • Level 1 (alert value): blood glucose <70 mg/dL (<3.9 mmol/L) and ≥54 mg/dL (≥3.0 mmol/L). Advise the patient that this value should alert them to the possibility of developing level 2 hypoglycemia and can be used as a threshold to take appropriate actions to prevent this (e.g., carbohydrate ingestion, adjusting medication).[1][5]

Result

<70 mg/dL (<3.9 mmol/L)

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