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 (50% dextrose solution) 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 1.
• Recheck blood glucose after 15 minutes and repeat treatment if levels remain below 70 mg/dL.
• D50 is highly concentrated and can cause tissue damage if extravasated, rapid hyperglycemia, and potential rebound hypoglycemia.
• It should be used only when oral intake isn't possible or for severe, symptomatic hypoglycemia requiring immediate intervention.
• Always follow up with a meal or snack containing protein and complex carbohydrates after treating hypoglycemia to prevent recurrence 1. The most recent and highest quality study, published in 2022, supports the use of fast-acting carbohydrates as the first-line treatment for hypoglycemia with a blood glucose level of 70 mg/dL or less 1. Therefore, for a blood sugar level of 65 mg/dL, oral carbohydrates are the preferred treatment.

From the FDA Drug Label

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, and D50 (50% dextrose solution) is indicated for treatment.

• The typical dose is 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) 2.
• Administration of dextrose should be done promptly in emergency situations, without waiting for pretreatment test results 2. Given the context, administering D50 for a blood sugar of 65 is appropriate, as it is a case of hypoglycemia that requires prompt treatment 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.