Hypoglycemia - Clinical Management of

Hypoglycemia – Clinical Management 

Effective Date: [Original NPP Date] 

Revised Date: [Current Date] 

Policy: 

This policy outlines the clinical management of hypoglycemia for residents, ensuring timely and appropriate treatment to maintain resident safety and well-being. 

Definition of Hypoglycemia: 

• Fingerstick or serum glucose less than 60 mg/dL. 

Signs/Symptoms of Hypoglycemia: 

• Shakiness, irritability, nervousness 

• Tachycardia/palpitations 

• Hunger 

• Diaphoresis, paresthesias 

• Neurological symptoms of low blood sugar 

• Headache, change in mental status, level of consciousness or behavior 

• Slurred speech 

• Vision change 

• Seizure 

• Death 

Treatment: 

When a resident is symptomatic of hypoglycemia: 

3. Obtain a stat fingerstick blood sugar level. 

4. If a resident has a blood sugar under 60 mg/dL but is responsive and able to swallow: 

• Administer a carbohydrate snack (e.g., 4 ounces of apple juice, 3 graham crackers, or 8 ounces of skim milk) OR administer oral glucose. (No orange juice for dialysis residents). 

• Recheck blood sugar fifteen minutes after treatment. 

• If the resident’s blood sugar remains the same, has decreased, or if the resident has a change in level of consciousness, administer IM or SC Glucagon (must have an MD order). 

• If the resident’s blood sugar has increased, continue to check every fifteen minutes until greater than 70 mg/dL. 

• Notify physician for further directions. 

5. If the resident has a blood sugar below 60 mg/dL and is NPO, unresponsive, or unable to swallow: 

• Administer a vial of Glucagon. 

• Recheck blood sugar every fifteen minutes after treatment until the resident is asymptomatic and glucose is greater than 70 mg/dL. 

• Notify physician for further directions. 

Administration of Glucagon: 

• Glucagon stimulates the breakdown of glycogen stored in the liver and releases glucose. 

• How to use: This medication is given as an injection into the arm, leg muscle, or under the skin as directed. The glucagon powder must first be dissolved using the diluting fluid provided. Use this medication immediately after it has been mixed. 

References: 

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM] 

• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]