Hypoglycemia Management Protocol [3040300001] ? NOTIFY PHYSICIAN OF ALL BG less than 50 mg/dL ? Recheck blood glucose 15 minutes after intervention; if blood sugar remains less than 70 mg/dL, repeat intervention ? If repeat blood glucose remains less than 70 mg/dL, notify physician immediately ? If repeat blood glucose remains less than 70 mg/dL, monitor patient every 1 to 2 hours for a total of 6 hours ? Once hypoglycemia stabilized (BG greater than or equal to 70 mg/dL), give snack (e.g., sandwich, cheese & crackers) unless mealtime is within 30 minutes

Physician orders to have Nurse follow Hypoglycemia Management Therapy guidelines as required

Hypoglycemia assessment orders

[ ] Nurse to assess for hypoglycemia, and follow guidelines [ ] Assess and manage hypoglycemia Routine, Until discontinued, Starting S Open Hypoglycemia Management Protocol orderset to place X1 orders for blood glucose less than 70 mg/dL. [ ] Notify physician Routine, Until discontinued, Starting S Other: Notify physician of all Blood Glucose less than 50 mg/dL Per Hypoglycemia Protocol

Recheck blood glucose 15 minutes after intervention; if blood sugar remains less than 70 mg/dL, repeat intervention If repeat glucose remains less than 70 mg/dL, notify physician immediately

Orders for NURSE to place if Blood Glucose less than or equal to 50 mg/dL Blood Glucose mg/dL Patient Condition Intervention Less than or Equal to 50 and patient is ALERT and ABLE to swallow/eat (NOT NPO) Give oral glucose gel (15 grams carbohydrate) to swallow

and patient is NPO, or NOT ALERT, or is UNABLE to swallow/eat If IV access Give 1 amp (25 grams) of D50% intravenously (IV)

If NO IV access Give Glucagon 1 mg subcutaneously, then establish IV access (saline lock) and give 1 amp (25 grams) D50% IV

Orders for Blood Glucose less than or equal to 50 mg/dL (Single Response)

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If Blood Glucose is less than or equal to 50 mg/dL, AND patient:

( ) is ALERT and ABLE to swallow/eat or is NOT NPO [ ] Oral Glucose Gel 15 g, Oral, Once, For 1 Doses Per Hypoglycemia Protocol: Blood Sugar: less than or equal to 50 mg/dL. Patient Condition: patient is ALERT, ABLE to swallow/eat and NOT NPO. Intervention: Administer oral glucose gel (15 grams carbohydrate) to swallow. ( ) HAS IV access and is NPO, NOT ALERT, or UNABLE to swallow/eat [ ] dextrose 50 % in water (D50W) syringe 25 g, Intravenous, Once, For 1 Doses Per Hypoglycemia Protocol: Blood Sugar: less than or equal to 50 Patient Condition: and patient is NPO, or NOT ALERT, or is UNABLE to swallow/eat Intervention: Administer 1 amp (25 grams) of D50% intravenously (IV) ( ) Does NOT have IV access and is NPO, NOT ALERT, or "And" Linked Panel UNABLE to swallow/eat [ ] glucagon (human recombinant) injection 1 mg, Subcutaneous, Once, For 1 Doses Per Hypoglycemia Protocol: Blood Glucose: Less than or equal to 50 mg/dL Patient Care: NPO, or NOT ALERT, or is UNABLE to swallow/eat and NO IV ACCESS Intervention: Administer Glucagon 1 mg subcutaneously, then establish IV access (saline lock) and give 1 amp (25 grams) D50% IV [ ] Saline lock STAT, Continuous [ ] sodium chloride 0.9 % (NS) flush 5 mL, Intravenous, As needed, line care [ ] sodium chloride 0.9 % (NS) flush 5 mL, Intravenous, Every 8 hours Saline lock [ ] dextrose 50 % in water (D50W) syringe 25 g, Intravenous, Once, For 1 Doses Per Hypoglycemia Protocol: Blood Glucose: Less than or equal to 50 mg/dL Patient Care: NPO, or NOT ALERT, or is UNABLE to swallow/eat and NO IV ACCESS Intervention: Administer Glucagon 1 mg subcutaneously, then establish IV access (saline lock) and give 1 amp (25 grams) D50% IV

Orders for NURSE to place if Blood Glucose 51-69 mg/dL

Page 2 of 4 Blood Glucose mg/dL Patient Condition Intervention 51 - 69 and patient is ALERT and ABLE to swallow/eat (NOT NPO) Give oral glucose gel (15 grams carbohydrate) to swallow

and patient is NPO, or NOT ALERT, or is UNABLE to swallow/eat If IV access Give 1/2 amp (12.5 grams) of D50% intravenously (IV)

If NO IV access Give Glucagon 1 mg subcutaneously, then establish IV access (saline lock) and give 1/2 amp (12.5 grams) D50% IV

Orders for Blood Glucose 51-69 mg/dL (Single Response)

If Blood Glucose is 51-69 mg/dL, AND patient:

( ) is ALERT and ABLE to swallow/eat or is NOT NPO [ ] Oral Glucose Gel 15 g, Oral, Once, For 1 Doses Per Hypoglycemia Protocol: Blood Sugar: 51-69 mg/dL. Patient Condition: patient is ALERT, ABLE to swallow/eat and NOT NPO. Intervention: Administer oral glucose gel (15 grams carbohydrate) to swallow ( ) HAS IV access and is NPO, NOT ALERT, or UNABLE to swallow/eat [ ] dextrose 50 % in water (D50W) syringe 12.5 g, Intravenous, Once, For 1 Doses Per Hypoglycemia Protocol: Blood Sugar: 51-69 mg/dL. Patient Condition: and patient is NPO, or NOT ALERT, or is UNABLE to swallow/eat. Intervention: Administer HALF amp (12.5 grams) of D50% intravenously (IV) ( ) Does NOT have IV access and is NPO, NOT ALERT, or "And" Linked Panel UNABLE to swallow/eat [ ] glucagon (human recombinant) injection 1 mg, Subcutaneous, Once, For 1 Doses Per Hypoglycemia Protocol: Blood Glucose: 51-69 mg/dL. Patient Care: NPO, or NOT ALERT, or is UNABLE to swallow/eat and NO IV ACCESS. Intervention: Administer Glucagon 1 mg subcutaneously, then establish IV access (saline lock) and give half amp (12.5 grams) D50% IV. [ ] Saline lock STAT, Continuous [ ] sodium chloride 0.9 % (NS) flush 5 mL, Intravenous, As needed, line care [ ] sodium chloride 0.9 % (NS) flush 5 mL, Intravenous, Every 8 hours Saline lock

Page 3 of 4 [ ] dextrose 50 % in water (D50W) syringe 12.5 g, Intravenous, Once, For 1 Doses Per Hypoglycemia Protocol: Blood Glucose: 51-69 mg/dL. Patient Care: NPO, or NOT ALERT, or is UNABLE to swallow/eat and NO IV ACCESS. Intervention: Administer Glucagon 1 mg subcutaneously, then establish IV access (saline lock) and give half amp (12.5 grams) D50% IV.

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