H: Hypoglycemia

Without adequate glucose suppy cells will not be able to carry out metabolism and will die. However, hypoglycemia is not always considered part of the "H's and T's"

One reson for this is that most of the body's cells (the heart included) will usually find an alternate method of metabolism (for instance glycogen, fat or protiens etc.) so even when you're not eating, you still have access to energy.

Another is that the heart will not be the first organ to fail when glucose is very low. The brain will because it cannot metabolize any other source of energy besides glucose.

A hypoglycemic person eventually will suffer from cardiac arrest, but first they'll feel tired, maybe a bit cranky (maybe have a seizure) and pass out (sometimes it looks like they just went to sleep, this is why the nurse will wake you up to check your blood sugar)

...AND THEN they'll stop breathing.

The most common condition to precipitate profound hypoglycemia is insulin overdose in a diabetic patient. This is why many hospitals have introduced protocol for two licensed nurses to verify the insulin type and dose before administration (and also why nurses can be very anal about making sure you eat after you take your insulin, they're just trying to keep you safe!).

I had a habit of checking the drug, dose, time and patient before giving insulin from nursing school so it was a bit of an adjustment not having that protocol at my first job. I got in the habit or doing that with the patient whenever possible. Sometimes they are too confused or it pisses them off, but I think it's really importiant to get it right.

If a nurse gives a fast acting insulin and the patient doesn't eat right away, the blood sugar will drop. If the nurse gives a longer acting insulin & a regular insulin the patient might have hypoglycemia in the early morning before breakfast. (depending on the level of functioning the pancreas has, remember if your type 2 diabetic your pancreas is still making some of it's own insulin and that has to be factored in to your insulin dose...but I'll save that for a later post.)

This is why the nurse pokes your finger so much.

Yes, I'm sorry I hate to do it :-(

Luckily there is an antidote for hypoglycemia. Because insulin is a naturally occuring hormone, it is counteracted by another naturally occuring hormone called glycogen...which is availible in commercial drug form as glucagon gel (squirted on the gums) or give intramuscularly. (It works pretty quickly!)

So even though its not part of the "H's and T's" its still a good idea to check a patient's blood sugar if you're concerned they are deteriorating, esspecially if they are diabetic and recieving insulin therapy.