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1	Hypoglycemia Prevention & Treatment Gary Scheiner MS, CDE Owner, Integrated Diabetes Services 333 E. Lancaster Ave., Suite 204 Wynnewood, PA 19096 877-SELF-MGT (735-3648) (610) 642-6055 www.integrateddiabetes.com garyscheiner@prodigy.net
2	Hypoglycemia: Definitions “Mild”: Adrenergic (BG<70) “Moderate”: Cognitive (BG<50) “Severe”: Unconscious (BG ???)
3	Hypoglycemia: Cause Imbalance between factors raising and lowering blood glucose levels
4	Hypoglycemia “The Greatest Limiting Factor In Diabetes Management”
5	The Great Limiting Factor Performance Impairment
6	The Great Limiting Factor Accident Risk
7	The Great Limiting Factor Anxiety / Embarrassment
8	The Great Limiting Factor Lasting Damage?
9	The Great Limiting Factor Diminished Symptoms (Hypoglycemic Unawareness)
10	The Great Limiting Factor Rebound
11	The Great Limiting Factor Weight Gain
12	Hypoglycemia: Targets/Goals Unable to recognize & verbalize lows: >80 Able to recognize & verbalize lows: >70 Pregnancy: >60 <10% of readings below target at each time of day No severe lows
13	Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
14	Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
15	Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
16	Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
17	Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
18	Hypoglycemia Prevention Strategies 1b. Insulin Program Setup (Meal/Bolus)
19	Hypoglycemia Prevention Strategies 2. Meal/Snack Timing
20	Hypoglycemia Prevention Strategies 1500-Rule (aggressive) 1800-Rule (conservative) (Total Daily Ins.)/1500 or 1800 May vary day vs. night (nighttime often 50% more than day)
21	Hypoglycemia Prevention Strategies I:C Ratio that matches pre-meal BG 3-4 hours (not 2!) after eating I:C Ratio often varies from meal to meal (bkfst dose > lunch & dinner)
22	Hypoglycemia Prevention Strategies
23	Hypoglycemia Prevention Strategies
24	Hypoglycemia Prevention Strategies
25	Hypoglycemia Prevention Strategies
26	Hypoglycemia Prevention Strategies 8. Adjustment for Physical Activity
27	Hypoglycemia Prevention Strategies 8. Watch Out for D’OH! (Delayed Onset Hypoglycemia)
28	Hypoglycemia Prevention Strategies 9. Adjustment for Alcohol
29	Hypoglycemia Prevention Strategies 10. Consistent Monitoring
30	Hypoglycemia Prevention Strategies 11. Recording & Analysis
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32	Hypoglycemia Prevention Strategies 11. Recording & Analysis
33	Hypoglycemia Prevention Strategies 12. Caffeine
34	Hypoglycemia Treatment Mild/Moderate Low Check BG First Treat w/High-Glycemic Index Food Treat w/Proper Amount Re-Check in 15 Minutes
35	Hypoglycemia Treatment
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37	Hypoglycemia Treatment Always Carry Rapid-Acting Carbs!
38	Hypoglycemia Treatment
39	Hypoglycemia Treatment Severe Low Unconscious / Unresponsive Seizure Uncooperative
40	Take-Home Messages Quantify Your Lows Strategize to Minimize Plan for Proper Treatment
41	The Source of My Highs and Lows