Patient discussions

Ensure the patient and their family or caregivers understand:

  • How and when to monitor their blood glucose and the importance of doing this (see Monitoring).[70]​

  • How to recognize signs and symptoms of hypoglycemia.[1][2]​​

  • How to treat an episode of hypoglycemia with glucose or glucagon and when to seek medical assistance.[2] Note that administration of glucagon is not limited to healthcare professionals and it may be given by family or caregivers if needed; ensure it is prescribed for all patients at risk of level 2 or 3 hypoglycemia.[3]​ Anyone who is in close contact with a patient who is prone to hypoglycemia (e.g., family members, roommates, school personnel, childcare providers, correctional institution staff, or coworkers) should be educated on how to administer glucagon.[3]

  • Circumstances in which the patient is at increased risk of hypoglycemia (e.g., when fasting for laboratory tests or procedures, when meals are delayed, during and after the consumption of alcohol, during and after intense exercise, during sleep).​[1][3][17]​ Educate the patient and their family or caregiver on how to adjust their insulin doses in these scenarios to reduce the risk of hypoglycemia.[37]​[70]​

Advise the patient and their family or caregivers to seek emergency medical assistance if:[128]

  • The patient is unconscious and no glucagon is available

  • They need a second dose of glucagon

  • They have been given glucagon but are still confused

  • Their blood glucose remains too low 20 minutes after treatment, or does not respond to their usual treatments

  • They are concerned at any time about a severely low blood glucose.

When giving the patient advice about driving, check the regulations in your country or local area. In the US, there are a range of different licensing requirements applied by both state and federal jurisdictions for patients with diabetes, depending on the type of driving they are undertaking.[129][130]​​​

  • In general in the US, patients with diabetes who have experienced an episode of hypoglycemia should have an evaluation of their fitness to continue to drive.[130] However, in some states all patients with diabetes require evaluation, even if they have not experienced hypoglycemia.[130]

  • In addition, patients should check their role in reporting episodes of hypoglycemia to the licensing authority; in some states this is mandatory.[130]

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