Handling Muscle-Injected Long-Acting Insulin Hypoglycemia
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I suddenly received a call from a sugar baby mother in the morning. Her daughter Huahua is 10 years old this year and was diagnosed with type 1 diabetes a year ago. On the phone, she said anxiously: "I gave my child 8 units of long-acting insulin this morning. Within 10 minutes, the child's blood sugar dropped to 2.5mmol/L. I immediately gave her 30 ml of beverage, but the blood sugar did not rise. Should I call 120 immediately?" I told her not to worry, and asked: "Is the child awake now? Why is she uncomfortable?" She said: "Awake, a little headache and dizzy."
I also asked her if she had glucose tablets at home (each tablet contains 3 grams of glucose), and told her to give the child 5 glucose tablets quickly, and then sent me the nutritional composition table of the beverage the child had just drunk. It only said that 8 grams of carbohydrates were contained per 100 ml. In other words, the child drank 30 ml of beverage and only supplemented 2.4 grams of carbohydrates.
After a while, Huahua's mother told me that after the child took the glucose tablets, the blood sugar had risen to 5.0mmol/L. After eating breakfast, the blood sugar was 10.0mmol/L. Usually they take 3.5 units of rapid-acting insulin before breakfast, but this time I suggested 1.5 units. She said worriedly that the child had to take an exam in the morning. I said that she should take the exam as usual, but she should explain the child's condition to the teacher. The child was wearing a dynamic blood glucose monitoring device, and both the child and the parents could see her blood sugar status on the mobile phone. I also asked her to bring sugar with her, and eat sugar as soon as the blood sugar was less than 3.9mmol/L.
Sure enough, at about 10 o'clock in the morning, the child's blood sugar dropped to 4.0mmol/L. After eating 3 grapes and two glucose tablets, the blood sugar returned to normal. After that, the child's blood sugar was relatively stable throughout the day. In the evening, I analyzed the cause of Huahua's hypoglycemia and the treatment experience with Huahua's mother.
First of all, I analyzed with her that the reason for the child's hypoglycemia should be that the long-acting insulin in the morning was not injected into the subcutaneous tissue, but into the muscle, so it was quickly absorbed into the blood, leading to the occurrence of hypoglycemia. How can we ensure that the insulin is injected subcutaneously? The key is to pay attention to pinching the skin. The correct method is to gently pinch the skin with two fingers, insert the needle at a 45-degree angle during injection, stay for 10 seconds after injection, then pull out the needle, and then release the skin after pulling out the needle. This will not easily inject into the muscle layer.
Secondly, when hypoglycemia occurs, parents give their children too little sugar. To rescue hypoglycemia, we must follow the principle of eating 15 and waiting for 15. When a child has hypoglycemia, as long as he is awake and can eat, he should immediately eat food containing 15 grams of carbohydrates, preferably glucose. It is recommended that diabetic patients should carry glucose tablets with them. If there is no sugar, you can drink sugary drinks, honey, etc., or eat foods with a relatively high glycemic index (such as white bread). Measure blood sugar again 15 minutes after eating. If blood sugar has returned to normal, you don’t need to eat sugar. If blood sugar has not returned to normal, continue to eat food containing 15 grams of carbohydrates. If the patient is already unconscious, go to a nearby hospital for rescue, and do not feed the patient yourself to avoid airway obstruction.
Finally, parents should fully communicate with teachers so that teachers can understand the child’s condition and help the child when necessary.
I also asked her if she had glucose tablets at home (each tablet contains 3 grams of glucose), and told her to give the child 5 glucose tablets quickly, and then sent me the nutritional composition table of the beverage the child had just drunk. It only said that 8 grams of carbohydrates were contained per 100 ml. In other words, the child drank 30 ml of beverage and only supplemented 2.4 grams of carbohydrates.
After a while, Huahua's mother told me that after the child took the glucose tablets, the blood sugar had risen to 5.0mmol/L. After eating breakfast, the blood sugar was 10.0mmol/L. Usually they take 3.5 units of rapid-acting insulin before breakfast, but this time I suggested 1.5 units. She said worriedly that the child had to take an exam in the morning. I said that she should take the exam as usual, but she should explain the child's condition to the teacher. The child was wearing a dynamic blood glucose monitoring device, and both the child and the parents could see her blood sugar status on the mobile phone. I also asked her to bring sugar with her, and eat sugar as soon as the blood sugar was less than 3.9mmol/L.
Sure enough, at about 10 o'clock in the morning, the child's blood sugar dropped to 4.0mmol/L. After eating 3 grapes and two glucose tablets, the blood sugar returned to normal. After that, the child's blood sugar was relatively stable throughout the day. In the evening, I analyzed the cause of Huahua's hypoglycemia and the treatment experience with Huahua's mother.
First of all, I analyzed with her that the reason for the child's hypoglycemia should be that the long-acting insulin in the morning was not injected into the subcutaneous tissue, but into the muscle, so it was quickly absorbed into the blood, leading to the occurrence of hypoglycemia. How can we ensure that the insulin is injected subcutaneously? The key is to pay attention to pinching the skin. The correct method is to gently pinch the skin with two fingers, insert the needle at a 45-degree angle during injection, stay for 10 seconds after injection, then pull out the needle, and then release the skin after pulling out the needle. This will not easily inject into the muscle layer.
Secondly, when hypoglycemia occurs, parents give their children too little sugar. To rescue hypoglycemia, we must follow the principle of eating 15 and waiting for 15. When a child has hypoglycemia, as long as he is awake and can eat, he should immediately eat food containing 15 grams of carbohydrates, preferably glucose. It is recommended that diabetic patients should carry glucose tablets with them. If there is no sugar, you can drink sugary drinks, honey, etc., or eat foods with a relatively high glycemic index (such as white bread). Measure blood sugar again 15 minutes after eating. If blood sugar has returned to normal, you don’t need to eat sugar. If blood sugar has not returned to normal, continue to eat food containing 15 grams of carbohydrates. If the patient is already unconscious, go to a nearby hospital for rescue, and do not feed the patient yourself to avoid airway obstruction.
Finally, parents should fully communicate with teachers so that teachers can understand the child’s condition and help the child when necessary.