Hi Melissa,

Great question and certainly an issue we encounter with some our diabetic patients. I will share our policy/procedure with you which offers additional information regarding for hypoglycemia during and after HBOT. Please reach out if you have additional questions.

Warm regards,

Tiffany

PURPOSE

To ensure that all patient who are currently being treated for irregular blood glucose levels, do not experience

a hypoglycemic event as result of ongoing hyperbaric oxygen therapy.

POLICY ELEMENTS

Studies suggest that blood glucose (BG) decreases in diabetics undergoing Hyperbaric Oxygen Therapy (HBOT). This decrease in BG is estimated at 50 mg/dl. The effect of HBOT may also be less on non-insulin dependent diabetes mellitus patients. (1)

The following standards should be utilized for those patients receiving hyperbaric oxygen therapy.

• Diabetic Patients (IDDM and NIDDM): blood glucose measurements by fingerstick are mandatory for all diabetic patients prior to and after hyperbaric oxygen treatment due to the hypoglycemic effect of HBO.

• Recommend to the patient/ caregiver that patients eat one hour prior to their hyperbaric treatment assuring complex carbohydrates have been eaten, e.g., multigrain & vegetables

• Document the time, quantity and food consumed prior to arrival in the hyperbaric suite.

• Document the time and specific glycemic control medication taken prior to arrival in the hyperbaric suite.

o Staff should consider the timing of short and long-acting glycemic control medications when scheduling HBO to avoid peak action time while at depth in the chamber.

o Consider holding insulin until after the treatment.

• Diabetic Inpatients:

o If the patient's Blood Glucose Level has been checked while inpatient within 1 hour of the hyperbaric treatment, the HBO staff does not need to repeat the Blood Glucose Level unless insulin was given.

o If more than an hour has passed since BG was checked, the HBO staff should recheck BG before treating the patient.

• Diabetic Outpatients: Blood glucose level must be checked by the hyperbaric staff on ALL diabetic patients prior to initiation of hyperbaric oxygen therapy.

• The following Blood Glucose level guidelines should be used for all diabetic patients.

o < 120mg/dl: Hold HBO treatment until further direction is given by the hyperbaric physician.

o Blood Glucose level: 120mg/dl – 130mg/dl:

 Patient should be given a complex carbohydrate and 4 ounces of juice to drink pre-treatment and also 4 ounces to drink during treatment.

o For Diabetic patients, blood glucose measurement should be performed after every treatment.

o No patient should be released with a blood glucose of less than 120mg/dl even if asymptomatic. It is possible that the blood glucose will continue to decrease after the patient is removed from the chamber.

 Patients with a blood glucose of less than 120 mg/dl should be fed prior to leaving the facility.

o Glucose gel should always be kept available for use.

HYPOGLYCEMIA DURING HBOT

• Consider Oxygen Toxicity and the need for an air break

• Identify signs of hypoglycemia in the patient e.g., confusion, dizziness, feeling shaky, hunger, headaches, sweating, pale skin,

• Note the time of occurrence of the symptoms.

• Ask the patient to place their air mask to their face to be worn during ascent

• Report the reaction to the Hyperbaric Physician and proceed as ordered

• Reduce chamber pressure to zero. If signs of seizure activity occur. halt decompression immediately. (Wait until seizure has ceased and adequate ventilation is observed

• At surface, check blood sugar.

• Treat per physician order

HYPOGLYCEMIA POST HBOT

Post blood glucose findings <120 mg/dl should receive be given 1-2 carbohydrate servings to prevent continual drop in blood sugar, especially in those patients who experience hypoglycemia more frequently. This is also an important implication if the patient is driving him/herself from the appointment.

Note: Carbohydrates convert to blood glucose within 5 minutes of ingestion and will continue to convert for up to 3 hours. 1 Carbohydrate serving is equal to 15 grams of carbohydrates or approximately 80 calories. Examples of 1 carbohydrate serving or 15 gm or carbohydrate.

1 slide medium bagel, 1 small apple, 1 cup of milk, 4 crackers, 1 container of pudding or apple sauce

Follow facility policy and procedure guidelines for pre- and post-treatment glucose control