Hypoglycemia: A Case Study and Nursing Management

Running head: CASE STUDY
Case Report Assessment 1
Name of the Student
Name of the University
Author Note

1CASE STUDY
Part 1
Introduction-
Low blood glucose or hypoglycemia occurs in instances when the levels of sugar in
the blood are found much less than the normal range. Most people diagnosed with diabetes
mellitus have a mean blood sugar level of 70 milligrams per decilitre (mg/dL). Although the
symptoms of the physiological abnormality differs among people. However, the symptoms
reported by most individuals comprise of shaky and jittery feelings, headache, blurred vision,
dizziness, confusion, pale face, irritability, and irregular or fast heartbeat. Some of the severe
symptoms of the condition encompass convulsions and seizures, unconsciousness, and the
lack of ability to drink or eat (Seaquist et al. 2013, p.DC_122480).
This condition has most commonly been associated with adverse effects of insulin and
other kinds of diabetes medications. Some of the most common medications that lead to
hypoglycaemia include meglitinides and sulfonylureas (Pfeiffer 2016, p.117). Furthermore,
failure of the affected individuals to consume adequate amount of carbohydrates, skipping or
delaying meals, vigorous physical activity and alcohol consumption increases the risks of
hypoglycaemia. This essay will elaborate on a case study about a hypoglycaemic patient,
admitted to the emergency department in a hospital. Furthermore, it will also shed light on
the pathophysiology of the condition and explain the nursing management that will be
delivered to the patient.
Assessment data-
The case study is about Mrs. Anthony, aged 35 years who has been admitted to the
HHHS Ward 1. Some of her presenting complaints that resulted in her admission to the ED
include multiple fractures, loss of consciousness, and smoke inhalation. Her past medical
history includes diagnosis of diabetes mellitus (type 2). Upon conducting an assessment risks

2CASE STUDY
for hypoglycaemia were noticed. Some of her vital signs indicated hypotension, high pulse
rate, high body temperature and low amount of oxygen saturation. Her respiratory rate was
normal. Furthermore, the low amount of blood glucose levels were also observed in the
patient. Diastolic hypotension is evidenced by the fact that her blood pressure levels were
around 95/50. Diastolic blood pressure less than 60 mmHg is regarded as hypotension
(Halliwill et al. 2013, p.12). Abnormally reduced blood pressure results in fainting and
dizziness and can also be considered life-threatening. Her pulse rate of 120 beats per minute
indicated presence of tachycardia, a condition characterised by heart rate that exceeds the
resting or normal rate of 100 beats per minute (Fenoglio Jr et al. 2015, p.187). Presence of
type 2 diabetes can be considered as a risk factor that increased her susceptibility to report an
abnormally high pulse rate. Oxygen saturation generally measures the percentage of oxygen
binding sites that are associated with haemoglobin in the bloodstream.
The patient reported 92% SAO2, thereby indicating the presence of hypoxemia that
was characterised by an abnormal low amount of oxygen in the blood. This oxygen
deficiency results in failure to supply adequate oxygen to the blood. The normal blood
glucose levels are found to be 4.0 to 5.4 mmol/L during fasting and upto 7.8 mmol/L, after 2
hours of having a meal. The fact that Mrs. Anthony reported blood sugar levels of 2.8
mmol/L confirms the presence of hypoglycaemia that occurs when there is a drop in the
amount of blood sugar, below the normal levels. This in turn increases the risk of the patient
of suffering from trouble in talking, clumsiness, seizures, loss of consciousness, and
subsequent death. Thus, hypoglycaemia can be cited as the primary reason that resulted in her
loss of awareness, upon arrival to the ED.
Pathophysiology

3CASE STUDY
Showing similarity with most animal tissues, the metabolism of the brain principally
depends on glucose as the fuel. An inadequate quantity of glucose is generally obtained
from the glycogen stored in astrocyte cells, but gets consumed within less time. Thus, the
brain is highly dependent on a constant source of glucose that diffuses from the bloodstream
into interstitial cells and tissues, present within the central nervous system. Therefore,
reduction in the amount of glucose present in the blood primarily affects the brain. In most
individuals, this lowering of blood glucose level below 3.6 mmol/L (65 mg/dL) manifests in
the form of a lessening in the mental efficiency (Kovatchev & Cobelli 2016, p.508). This is
most commonly exhibited in the form of an impairment in judgement and/or action that
becomes more prominent at levels less than 2.2mmol/L (40 mg/dL). With a further reduction
in the sugar levels, seizures might also occur. The neurons enter a state of electrical silence
with a reduction in the blood glucose levels below 0.55 mmol/L (10 mg/dL), thereby leading
to coma (Bergenstal et al. 2013, p.227). These effects on the brain are together referred to
as neuroglycopenia.
There occurs huge number of hormonal, nervous and metabolic changes that occur in
the body in response to inadequate supply of blood sugar to the brain. Most of the changes
are adaptive or defensive, with an intent to increase the blood glucose levels by the process of
gluconeogenesis or glycogenolysis. Under conditions when there is a huge reduction in the
blood sugar levels, the liver is able to convert stored reserves of glycogen into glucose,
thereby releasing it into bloodstream (Cryer 2013, p.369). This in turn prevents the affected
individual from entering a state of diabetic coma. Mild or brief periods of hypoglycemia fails
to exert any lasting effects on the human brain. However, the brain responses get temporarily
altered. Severe hypoglycemia results in an impairment in motor control, cognitive function,
and/or consciousness. Majority of patients with type 2 diabetes, like Mrs. Anthony in the case
study are under the first line treatment that involves administration of compounds that