Hypoglycemia 低血糖
1. The glucose levels 血糖值
The glucose level is less than 3.9 mmol/L, 2.2 mmol/L, 1.1 mmol/L for mild hypoglycemia, moderate hypoglycemia, and severe hypoglycemia respectively.
轻度低血糖, 中度低血糖，和重度低血糖的血糖值分别低于3.9；2.2；1.1 mmol/L.
2. Manifestations 症状
Manifestations caused by responses of the autonomic nervous system include hunger, shakiness, nausea, irritability, anxiety, rapid pulse, pale on skin, hypotension, and sweating. Manifestations caused by impaired cerebral function are strange or unusual feelings, slurred speech, headache, blurred vision, decreasing levels of consciousness, difficult in thinking, inability to concentrate, seizures, change in emotional behavior, and even coma.
自主神经系统反应引起的症状包括饥饿、颤抖、恶心、易怒、焦虑、脉搏加快、皮肤苍白、低血压和出汗。而大脑功能受损引起的症状有怪异或不寻常的感觉、言语不清、头痛、视力模糊、意识状态下降、思考困难、注意力不集中、癫痫、情绪行为改变，甚至昏迷。
3. Causes 诱因
Hypoglycemia is commonly caused by too much insulin or too large an amount of an oral hypoglycemic agent, not enough food intake, skip meals, or excessive activity or intake of alcohol.
发生低血糖的常见诱因有注射胰岛素或口服降糖药剂量过多、进食量不足、没有进食、活动量过大或大量饮酒等。
4. Nursing Actions 护理举措
4.1 Food item to treat hypoglycemia (15g of rapid-acting carbohydrates or simple sugar)
纠正低血糖的食品（15克速效碳水化合物或单糖）
----1/2 cup （120ml）of fruit juice or regular soft drinks半杯（相当120ml）果汁或常规饮料
----8 oz of skim milk （235ml） 235ml左右的脱脂牛奶
----1 small box of raisins 1小盒的葡萄干
----6 hard or Life Savers Candies 6块硬或者Life Savers 糖果
----4 sugar cubes (1 tablespoon of sugar) 4块方糖（1汤勺糖）
----1 candy bar 1条含糖的小吃
----1 tablespoon of honey or syrup 1汤勺的蜂蜜或者糖浆
----2 or 3 glucose tablets 2-3块 葡萄糖片
4.2 Long-acting carbohydrates 长效的碳水化合物
----crackers or biscuits 薄饼干或者饼干
----a piece of bread 一片面包片
4.3 Interventions for hypoglycemia *The 15/15 rule* 干预低血糖 ‘15/15原则’
1. If a blood glucose monitor is readily available, check the client’s blood glucose level. If the client is experiencing symptoms suggestive of hypoglycemia such as diaphoresis, hunger, pallor, and shakiness, and a blood glucose monitor is not readily available, assume hypoglycemia and treat accordingly.
如果有血糖监测仪的情况下，检测病人血糖。如果发现病人出现可疑的低血糖症状如发汗、饥饿、脸色苍白和发抖等时，并无血糖监测仪检测的情况下，假定为低血糖并按其进行处理。
2. For the client whose blood glucose is below 70 mg/dL (3.9 mmol/L), or for the client with an unknown blood glucose who is exhibiting signs of hypoglycemia, administer 15 g of a simple carbohydrate.
对于血糖值小于3.9mmol/L, 或者血糖值未知但出现低血糖症状时，立即给予15克单糖。
3. Recheck the blood glucose level in 15 minutes.
15分钟后重新检测血糖值。
4. If the blood glucose remains below 70 mg/dL (3.9 mmol/L), administer another 15 g of a simple carbohydrate.
如果血糖值仍小于3.9mmol/L, 给予另一份15克的单糖。
5. Recheck the blood glucose level in 15 minutes; if still below 70 mg/dL (3.9 mmol/L), treat with an additional 15 g of a simple carbohydrate.
15分钟后复测血糖值。如果血糖值仍小于3.9mmol/L, 再给予一份15克单糖。
6. Recheck the blood glucose level in 15 minutes; if still below 70 mg/dL (3.9 mmol/L), treat with 25 to 50 mL of 50% dextrose intravenously or, if no intravenous (IV) equipment is present, treat with 1 mg of glucagon subcutaneously or intramuscularly.
15分钟后复测血糖值， 如果血糖值还是小于3.9mmol/L, 静脉给予25-50ml 的50%的葡萄糖。如果没有静脉输液设备的情况下，给予1 mg 胰高血糖素皮下或者肌肉注射。
7. After the blood glucose level has recovered, have the client ingest a snack that includes a complex carbohydrate and a protein.
等血糖水平达标以后，让其进食含复合碳水化合物和蛋白质的食物。
8. Document the client’s complaints, actions taken, and outcome.
做好记录：病人的主诉，护理处置和效果。
9. Explore the precipitating cause of the hypoglycemia with the client.
和病人一起探讨发生低血糖的诱因。
10. If the client is experiencing an altered level of consciousness, by pass oral treatment and start with injectable glucagon or 50% dextrose. If at any point the client becomes unconscious, the nurse should administer an injectable form of glucose to raise the blood glucose level. If the client is at home and does not have access to injectable glucagon, the client should seek immediate medical care.
如果病人发生意识水平改变，需略过口服治疗，开始给予注射胰高血糖素或者50%葡萄糖。如果病人失去意识，护士应注射葡萄糖以提高血糖水平。如果病人在家中发生该状况，并不能注射胰高血糖素，需要立即就医。
References:
Lemone, P., Burke, K.M., Levet-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K., Berry, K., Carville, K., Hales, M., Knox, N., Luxford, Y., & Raymond, D. 2014, Medical-Surgical Nursing: Critical Thinking for Person-Centred Care, 2nd Australian Edition. Person, Australia.
Silvestri, L.A. 2017, Saunders Comprehensive Review for the NCLEX-RN Examination, 7th edn, Elsevier, Missouri.