Recognising Hypoglycaemia for Student Nurses
Learn how to recognise a low blood glucose, identify common warning signs and understand why prompt assessment, treatment and reassessment are important.
What is hypoglycaemia?
Hypoglycaemia means that the blood glucose concentration has fallen too low. In adults with diabetes, a blood glucose below 4 mmol/L is commonly treated as hypoglycaemia and remembered using the phrase βfour is the floorβ.
Autonomic symptoms
Sweating, trembling, hunger, palpitations and anxiety may occur as glucose falls.
Neuroglycopenic symptoms
Confusion, unusual behaviour, difficulty concentrating, drowsiness or weakness may develop.
Reduced consciousness
Severe hypoglycaemia may lead to seizures, reduced responsiveness or unconsciousness.
Think glucose when behaviour changes unexpectedly
Sudden confusion, agitation, sweating or altered consciousness can have many causes. A blood glucose check may form an important part of the assessment where clinically appropriate.
What might you notice?
| Finding | Possible presentation | What to consider |
|---|---|---|
| Sweating | Patient becomes unexpectedly sweaty or clammy. | Consider glucose alongside the wider clinical assessment. |
| Trembling | Shaking or tremor may develop. | This may be an early warning symptom. |
| Hunger | Patient reports sudden or intense hunger. | Ask about recent food intake and diabetes treatment where relevant. |
| Confusion | New disorientation or difficulty concentrating. | Check for physiological causes rather than assuming behavioural change. |
| Behaviour change | Irritability, unusual behaviour or agitation. | Hypoglycaemia may alter cognitive function. |
| Reduced consciousness | Drowsiness, seizure or unconsciousness. | This represents serious deterioration requiring urgent help. |
Assess the patient, not just the glucose result
Recognise symptoms
Notice sweating, tremor, hunger, confusion, weakness or changes in behaviour and consciousness.
Check blood glucose
Measure capillary blood glucose when indicated and within your competence and local procedure.
Assess consciousness
Determine whether the patient is alert, able to communicate and able to swallow safely.
Seek appropriate help
Inform the registered nurse and follow the organisation's hypoglycaemia treatment pathway.
Reassess
Treatment should be followed by appropriate repeat glucose measurement and reassessment according to local guidance.
Escalate deterioration
Reduced consciousness, seizures or inability to swallow safely require urgent clinical support.
Why might hypoglycaemia occur?
Several factors can contribute to low blood glucose. Recognising the context can help the clinical team understand why the episode occurred and reduce the risk of recurrence.
Glucose-lowering treatment
Insulin and some other diabetes medicines can contribute to hypoglycaemia.
Reduced carbohydrate intake
Missed meals, reduced appetite, fasting or vomiting can affect the balance between treatment and glucose availability.
Changing circumstances
Acute illness, activity and changes in the patient's condition can alter glucose requirements.
Severe hypoglycaemia requires systematic assessment
Airway
Ensure the airway is patent, particularly when consciousness is reduced.
Breathing
Assess respiratory rate, oxygen saturation and respiratory effort.
Circulation
Assess pulse, blood pressure, perfusion and other circulatory observations.
Disability
Assess consciousness and blood glucose and identify confusion, seizures or reduced responsiveness.
Exposure
Consider medication, food intake, illness and other factors that may have contributed.
Escalate
Follow local hypoglycaemia and emergency procedures and obtain appropriate registered support.
Recognise the developing picture
Patient well
Patient is alert, communicating normally and has eaten earlier in the day.
Early symptoms
They become shaky, sweaty and say they feel suddenly hungry and weak.
Neurological change
They appear confused and have difficulty answering questions normally.
Sudden confusion has a cause
Do not automatically attribute unusual behaviour or confusion to anxiety, dementia or non-compliance. Consider physiological causes, including hypoglycaemia, as part of the assessment.
Putting the findings together
Example
You are caring for a patient with diabetes who received their usual glucose-lowering treatment earlier in the day but ate very little at lunchtime.
They now appear sweaty and shaky and tell you they feel weak. A few minutes later they become confused and struggle to answer your questions.
The pattern of reduced food intake, autonomic symptoms and developing neurological change should prompt consideration of hypoglycaemia.
Check the patient's blood glucose where appropriate, obtain registered clinical support and follow the local hypoglycaemia pathway.
Hypoglycaemia recognition errors to avoid
- Missing behavioural change. Confusion or irritability may have a physiological cause.
- Waiting for severe symptoms. Sweating, shaking and hunger can be early warning signs.
- Ignoring recent food intake. Missed meals can be clinically relevant.
- Looking only at the glucose number. Assess the patient's condition too.
- Failing to reassess. Response to treatment and repeat glucose monitoring are important.
- Giving oral treatment when swallowing is unsafe. Reduced consciousness changes the immediate management.
- Failing to escalate deterioration. Seizures or reduced consciousness require urgent support.
Communicate the glucose result and the clinical change
Example escalation
βI'm concerned about Mrs Jones. She has diabetes and ate very little after her medication earlier. She has become sweaty, shaky and confused, and her blood glucose is below her target range.β
This communicates the clinical change, relevant context and objective finding.
Recognise β assess β communicate β escalate
Notice the symptoms
Identify sweating, tremor, hunger, confusion or other sudden neurological changes.
Check glucose and patient
Assess blood glucose where appropriate and consider consciousness and the wider ABCDE picture.
Act promptly
Follow local hypoglycaemia guidance and obtain appropriate clinical support.
Build your acute-assessment skills
Continue developing your ability to recognise deterioration, assess clinical changes and communicate concerns through the NurseNet Clinical Confidence pathway.
Explore Clinical Confidence β