From the Guidelines
Intravenous glucose is the preferred treatment for severe hypoglycemia in patients who cannot take oral glucose, with a recommended dose of 20-40 ml of 50% glucose solution IV for adults, as stated in the 2019 standards of medical care for type 2 diabetes in China 1. When treating hypoglycemia with IV glucose, it is essential to consider the patient's consciousness and cognitive impairment.
- For conscious patients, oral administration of 15-20 g glucose-containing food is preferred, but if this is not possible, IV glucose can be administered 1.
- For patients with cognitive impairment, 20-40 ml of 50% glucose solution IV is recommended, and additional glucose can be administered if blood glucose remains low 1. The American Heart Association and American Red Cross guidelines for first aid in 2024 also support the use of intravenous dextrose as a lifesaving measure for people with hypoglycemia who are unable to swallow 1. It is crucial to monitor blood glucose levels every 15 minutes after treatment and provide additional glucose if necessary to maintain euglycemia 1. In cases where IV access cannot be established, intramuscular or subcutaneous glucagon can be used as a temporary measure, with a dose of 0.5-1.0 mg for adults and 0.5 mg for children <20 kg 1.
From the Research
Treatment Options for Hypoglycemia with IV Glucose
- IV glucose can be administered in various concentrations, including 10%, 25%, and 50% dextrose solutions 2, 3, 4
- The choice of concentration may depend on the severity of hypoglycemia and the patient's response to treatment
- Studies have compared the efficacy and safety of different concentrations of dextrose solutions in the treatment of hypoglycemia
Efficacy of Different Concentrations
- A randomized controlled study found no difference in the median time to achieve a Glasgow Coma Scale (GCS) of 15 between patients treated with 10%, 25%, or 50% dextrose solutions 2
- Another study found that 10% dextrose was as effective as 50% dextrose in resolving symptoms and correcting hypoglycemia, although the desired effect took several minutes longer 3
- A randomized controlled trial found no statistically significant differences in median time to recovery or median post-treatment GCS between patients treated with 10% or 50% dextrose solutions 4
Safety Considerations
- The use of 50% dextrose solutions has been associated with a higher risk of adverse events, including extravasation injuries and hyperglycemic episodes 3, 4
- In contrast, 10% dextrose solutions have been found to result in lower post-treatment blood glucose levels and fewer adverse events 3, 4