Do you administer glucose with insulin for hyperkalemia in diabetic patients?

From the Guidelines

Glucose should be administered along with insulin when treating hyperkalemia in diabetic patients to prevent hypoglycemia, as stated in the most recent and highest quality study 1. The typical regimen includes 10 units of regular insulin IV push, accompanied by 25 grams of glucose (usually as 50 mL of 50% dextrose solution) to prevent hypoglycemia.

• For diabetic patients with elevated blood glucose levels, the glucose component may be reduced or omitted based on their current blood glucose reading, but insulin should still be given.
• This treatment works because insulin drives potassium into cells, thereby reducing serum potassium levels.
• The glucose is primarily included to prevent hypoglycemia from the insulin administration. After treatment, it's essential to monitor both potassium and glucose levels closely, as diabetic patients are at higher risk for hypoglycemia, as mentioned in 1. Additional doses may be needed if hyperkalemia persists, and underlying causes of hyperkalemia should be addressed simultaneously. This approach provides rapid but temporary reduction in serum potassium while more definitive treatments are implemented, and is supported by the most recent evidence 1.

From the FDA Drug Label

OVERDOSAGE Excess insulin may cause hypoglycemia and hypokalemia, particularly after intravenous administration. The FDA drug label does not answer the question.

From the Research

Administration of Glucose with Insulin for Hyperkalemia in Diabetic Patients

• The management of hyperkalemia often involves the administration of insulin, which can be accompanied by glucose to prevent hypoglycemia 2, 3, 4, 5, 6.
• Studies suggest that the administration of glucose with insulin is crucial, especially in diabetic patients, to avoid hypoglycemia 2, 4, 6.
• The optimal dose and method of administration of intravenous insulin in the management of emergency hyperkalemia are still debated, but most studies recommend administering glucose with insulin to prevent hypoglycemia 4.

Prevention of Hypoglycemia

• Hypoglycemia is a common complication of insulin therapy for hyperkalemia, and several strategies can be used to reduce this risk, including administering glucose with insulin 2, 3, 4, 6.
• The use of weight-based dosing of insulin, alerts identifying patients at higher risk of hypoglycemia, and tools to guide decision-making based on the preinsulin blood glucose level can also help reduce the risk of hypoglycemia 6.
• Regular monitoring of glucose levels after insulin administration is essential to prevent and detect hypoglycemia 2, 6.

Recommendations for Diabetic Patients

• Diabetic patients with hyperkalemia should receive glucose with insulin to prevent hypoglycemia, taking into account their individual glucose levels and insulin dose 2, 4, 6.
• The dose of glucose administered with insulin may vary depending on the patient's glucose level and insulin dose, but most studies recommend administering 25-50 grams of glucose with 10 units of insulin 3, 4.