Strategies and Options for the Management of Hypoglycemic Emergencies - Episode 6

Long-Term Monitoring for Hypoglycemic Episodes

June 22, 2021
Peter Salgo, MD, Columbia University Irving Medical Center

Columbia University College of Physicians and Surgeons

,
Elaine Apperson, MD, University of South Carolina School of Medicine

,
Davida Kruger, MSN, APN-BC, BC-ADM, Henry Ford Health System

,
Anne Peters, MD, Keck School of Medicine of the University of Southern California

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Jay Shubrook, DO, FACOFP, FAAFP, BC-ADM, Touro University California College of Osteopathic Medicine

Panelists consider the importance of long-term approaches to monitoring hypoglycemic episodes and discuss the role of education and awareness, patient questionnaires, and effective communication with physicians.

Peter Salgo, MD: The other term that I heard is long-term monitoring. What is it? When is it indicated for hypoglycemia? Jay, can you help us out on that?

Jay Shubrook, DO, FACOFP, FAAFP, BC-ADM: Sure; I think you should be having a regular conversation with your patients and their families: “Do you have lows? What do they feel like?” Not everyone has the same type of symptoms and even different types of hypoglycemia have different symptoms. Then, “What do you do about it?” I think, quite honestly, this is the basis of prevention. If you can identify and they can identify the symptoms, that is going to help them be active to prevent an episode. I think, often, it is the family that knows it before the person who has the hypoglycemic episode. Making sure the family also is clued in is really important. I would also say, from the provider side, I put hypoglycemia as one of my codes because it then reminds me that is something I need to circle back to with my patient. They also see, when they see the chart, that I care not only about their glucose but I also care about hypoglycemia. I think it is a matter of awareness, regular conversation, and talking about it just like we would talk about high blood glucose at every visit.

Peter Salgo, MD: What about the Hypoglycemia Patient Questionnaire? That is a buzz phrase that is coming to more prominence lately. What is it? Where does that fit? Are we using it in this country?

Jay Shubrook, DO, FACOFP, FAAFP, BC-ADM: I think we may have our own methods by which we screen. I do not particularly use that questionnaire, but it does raise some important factors: “Are you feeling low? What do you do? What do you feel?” I have my own set of questionnaires that I use, but I do like the concept of a standardized questionnaire that could be used in the waiting room or while the patient is waiting for the provider, so that piece of information is not lost in the conversation. That is, to me, the main value, even though I do not use that questionnaire.

Davida Kruger, MSN, APN-BC, BC-ADM: I think the issue is more about making sure the questions are asked. If you have a questionnaire that makes you ask those questions; if you have diabetes, every time you go to see your health care provider, those questions need to be asked. “Are you having hypoglycemia? Does your family member think you are having hypoglycemia? What time of day do you have hypoglycemia? Do you check your blood sugar? Are you wearing a CGM [continuous glucose monitor]? What happens when you have more physical activity?” I saw someone this morning who said, “I don’t have any hypoglycemia,” and I was doing a video visit, and the next thing I know his wife was behind him and said, “That’s not true!” I said, “OK, tell me when he is having hypoglycemia.” She said, “Well, any time he goes to do more activity.” This tells me that for this man, when he was having it, I needed to look at his basal rates because I asked the questions about his activity and we could adjust them. Whenever he moved around, he was having low blood sugar issues. I think, during every visit, we have to ask those questions.

Peter Salgo, MD: Why was he denying it? Was he insensitive to it, or was he simply in denial.

Davida Kruger, MSN, APN-BC, BC-ADM: I think he was used to it—too used to it.

Peter Salgo, MD: This is what we were talking about before.

Davida Kruger, MSN, APN-BC, BC-ADM: Right, and it became part of his life. He said, “Well, usually I am OK.” Well, he went out and worked in the garden and became hypoglycemic. I think he assumes that is how he has to live; he does not seem to grasp that we have ways we can handle it. We made a fix, and we will look again in 2 weeks as to whether that fix works to prevent it. There is no reason he should not be able to go, on a whim, work out in the yard. He could come work in mine, I told him, and I would watch for his hypoglycemia. I think that we have to ask those questions, and I do think they become very much part and parcel of their life, and they do not remember to tell you about it if you do not ask poignant questions.

Peter Salgo, MD: It sounds to me as if he thought, “Well, this way that I feel when I get low is simply part of my diabetes. It’s normal, and it’s what I have.”

Davida Kruger, MSN, APN-BC, BC-ADM: Yes. I have heard that, too. I have a couple of diabetes educators in my group who have type 1 diabetes. And you must be sensitive to not interfere with the way they manage their diabetes and say things like, “Do you want me to get you some juice, or do you want me to get you some glucose tablets?” You must be very sensitive to that. Often what I hear them say is, “Some hypoglycemia is expected with diabetes, if I’m going to get to my treatment goal.”

Peter Salgo, MD: I want to thank all of you at home for watching this HCPLive® Peer Exchange. If you enjoyed the content, I want you to subscribe to our e-newsletter to receive upcoming Peer Exchanges and other great content right in your inbox.

Transcript edited for Clarity

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