Should I administer D50 (50% dextrose solution) for hypoglycemia with a blood sugar level of 65?

From the Guidelines

No, you should not administer D50 for a blood sugar level of 65 mg/dL. This level represents mild hypoglycemia, and D50 is typically reserved for severe hypoglycemia (blood glucose <40 mg/dL) or patients with altered mental status. For a blood sugar of 65 mg/dL in a conscious patient, oral carbohydrates are the appropriate first-line treatment.

Key Points to Consider:

• Provide 15-20 grams of fast-acting carbohydrates such as 4 ounces of fruit juice, 6-8 ounces of regular soda, 3-4 glucose tablets, or 1 tablespoon of honey or sugar.
• Wait 15 minutes, then recheck the blood glucose.
• If it remains below 70 mg/dL, repeat the oral carbohydrate treatment.
• D50 is a highly concentrated glucose solution that can cause tissue damage if extravasated and may lead to rebound hyperglycemia.
• It should be used only when oral intake is not possible or in emergency situations with severe hypoglycemia.
• After treating the immediate hypoglycemia, it's essential to follow with a more substantial snack containing protein and complex carbohydrates to maintain stable blood glucose levels, as recommended by recent guidelines 1.

Rationale:

The most recent and highest quality study, published in 2022 1, supports the use of fast-acting carbohydrates as the first-line treatment for mild hypoglycemia, with a hypoglycemia alert value of 70 mg/dL or less. This approach prioritizes the patient's safety and well-being, minimizing the risk of complications associated with D50 administration.

From the FDA Drug Label

For peripheral vein administration: ... In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. A specimen for blood glucose determination should be taken before injecting the dextrose In such emergencies, dextrose should be administered promptly without awaiting pretreatment test results

The blood sugar level of 65 is considered hypoglycemia. According to the drug label, D50 (50% dextrose solution) can be administered for hypoglycemia. The recommended dose is 20 to 50 mL of 50% dextrose, which is usually adequate for insulin-induced hypoglycemia 2.

Administration of D50 is indicated for a blood sugar level of 65. However, it is essential to administer the solution slowly and monitor the patient's condition. Additionally, repeated doses and supportive treatment may be required in severe cases 2.

From the Research

Administration of D50 for Hypoglycemia

• The question of whether to administer D50 (50% dextrose solution) for a blood sugar level of 65 mg/dL can be informed by several studies 3, 4, 5, 6, 7.
• These studies compare the efficacy and safety of different concentrations of dextrose solutions (D10, D20, D25, D50) in treating hypoglycemia.

Efficacy of D10 vs. D50

• A systematic review 3 found that D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia, although the desired effect can take several minutes longer.
• The review also noted that D10 may result in fewer adverse events and a lower post-treatment glycemic profile compared to D50.

Safety and Feasibility of D10

• A 24-month observational cohort study 5 demonstrated the feasibility, safety, and efficacy of using 100 mL of D10 as an alternative to D50 in the treatment of prehospital hypoglycemia.
• The study found that D10 was effective in increasing blood glucose levels, with no reported deaths or adverse events related to D10 administration.

Comparison of Different Dextrose Concentrations

• A randomized controlled study 6 compared the efficacy and safety of 10%, 25%, and 50% dextrose in the treatment of hypoglycemia in the emergency department.
• The study found no difference in the median time to achieve a Glasgow Coma Scale of 15 among the three treatment arms.
• Another study 7 found that 20% glucose solution was effective in treating hypoglycemia in diabetic patients, with a similar curative effect to 50% glucose solution and fewer adverse events.

Considerations for Administration

• The decision to administer D50 for a blood sugar level of 65 mg/dL should take into account the patient's clinical presentation, medical history, and the potential risks and benefits of different treatment options 3, 4, 5, 6, 7.
• The studies suggest that D10 or other lower concentrations of dextrose may be a viable alternative to D50 in certain situations, with potential benefits including reduced risk of adverse events and more stable blood glucose levels.