Assess hypoglycemia prevention, detection, and treatment
STEP 1 — Gather Information
Collect hypoglycemia history (frequency, severity, timing), patient’s ability to recognize neuroglycopenic and autonomic symptoms, current action plan, carbohydrate sources, glucagon kit availability and training, recent glucose logs/CGM data, and any episodes requiring assistance.
STEP 2 — Rule In / Rule Out
Determine if the patient experienced severe hypoglycemia (requiring assistance from another person) in the past 3 months. If yes → rule in high risk; if no → rule out high risk.
STEP 3 — Classify or Stratify
For high‑risk patients, stratify readiness: (A) adequate prevention knowledge, supplies, and glucagon competence vs (B) gaps in symptom recognition, treatment steps, or glucagon availability. For low‑risk patients, still assess baseline competence.
STEP 4 — Decide
If gaps are identified → provide individualized hypoglycemia education, review and update the action plan, prescribe or refill glucagon, and demonstrate its use. If competent → reinforce current practices and schedule periodic reassessment.
Clinical Guardrails / Mimics / Pitfalls
Do not assume glucagon competence without a hands‑on demonstration; avoid relying solely on self‑report of symptom recognition without verification; do not overlook nocturnal hypoglycemia; do not delay glucagon prescription due to fear of misuse; avoid using expired or improperly stored glucagon.
Concrete Clinical Example
A 45‑year‑old with T1D on CSII reports two hypoglycemic events needing spouse assistance in the past month, cannot locate the glucagon kit, and mistakes sweating for anxiety. After information gathering, the patient is ruled in as high risk and classified as having a glucagon readiness gap. The clinician prescribes a new glucagon kit, conducts hands‑on training, reviews the action plan, and schedules follow‑up in 2 weeks.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2534