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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 Gary@integrateddiabetes.com
2	Hypoglycemia: Definitions “Mild”: Adrenergic (BG<70) (<4mmol) “Moderate”: Cognitive (BG<50) (<3mmol) “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? ¯ Spatial memory / performance (if before age 5)
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 (4.5 mmol) Able to recognize & verbalize lows: >70 (4 mmol) Pregnancy: >60 (3.3 mmol) <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) (83 rule) 1800-Rule (conservative) (100 rule) (Total Daily Ins.)/1500 or 1800 May vary day vs. night (nighttime often 50% more than day)
21	Hypoglycemia Prevention Strategies Premeal: 100 (5.5) (aggressive) 120 (6.7) (typical) 140-150 (7.6-8.3) (cautious)
22	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)
23	Hypoglycemia Prevention Strategies
24	Hypoglycemia Prevention Strategies
25	Hypoglycemia Prevention Strategies
26	Hypoglycemia Prevention Strategies
27	Hypoglycemia Prevention Strategies 8. Adjustment for Physical Activity
28	Hypoglycemia Prevention Strategies 8. Watch Out for D’OH! (Delayed Onset Hypoglycemia)
29	Hypoglycemia Prevention Strategies 9. Adjustment for Alcohol
30	Hypoglycemia Prevention Strategies 10. Consistent Monitoring
31	Hypoglycemia Prevention Strategies 11. Recording & Analysis
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33	Hypoglycemia Prevention Strategies 11. Recording & Analysis
34	Hypoglycemia Prevention Strategies 12. Continuous Glucose Monitoring
35	Hypoglycemia Prevention Strategies 12. Continuous Glucose Monitoring
36	Hypoglycemia Treatment Mild/Moderate Low Check BG First Treat w/High-Glycemic Index Food Treat w/Proper Amount Re-Check in 15 Minutes
37	Hypoglycemia Treatment
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39	Hypoglycemia Treatment Always Carry Rapid-Acting Carbs!
40	Hypoglycemia Treatment DEXTROSE Rules!
41	Hypoglycemia Treatment
42	Hypoglycemia Treatment
43	Hypoglycemia Treatment Severe Low Unconscious / Unresponsive Seizure Uncooperative
44	Take-Home Messages Quantify Your Lows Strategize to Minimize Plan for Proper Treatment
45	The Source of My Highs and Lows