Should I administer D50 (Dextrose 50%) for hypoglycemia in an unconscious patient?

From the Guidelines

No, you should not administer D50 for a blood sugar of 65 in an unconscious patient without considering alternative treatments like glucagon first. According to the most recent guidelines, glucagon is the preferred treatment for hypoglycemia in individuals who are unable or unwilling to consume carbohydrates by mouth, as stated in the 2024 standards of care in diabetes 1. The use of glucagon is indicated for the treatment of hypoglycemia in people unable or unwilling to consume carbohydrates by mouth. Some key points to consider when treating hypoglycemia in unconscious patients include:

• The importance of having a glucagon prescription for individuals at high risk of hypoglycemia, as well as educating those in close contact with them on its use 1
• The availability of intranasal and ready-to-inject glucagon preparations, which are preferred due to their ease of administration and rapid correction of hypoglycemia 1
• The need to replace glucagon products when they reach their expiration date and store them according to specific product instructions to ensure safe and effective use 1 It's essential to prioritize the use of glucagon in unconscious patients with hypoglycemia, as it is a more targeted and effective treatment in this scenario.

From the FDA Drug Label

For insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. In such emergencies, dextrose should be administered promptly without awaiting pretreatment test results

Administration of D50 is indicated for hypoglycemia in an unconscious patient.

• The patient's blood sugar is 65, which is considered hypoglycemic.
• According to the drug label 2 and 2, D50 (Dextrose 50%) can be administered to restore blood glucose levels in cases of insulin hypoglycemia.
• The recommended dose is 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose), which can be administered promptly without awaiting pretreatment test results.

From the Research

Administration of D50 for Hypoglycemia in Unconscious Patients

• The decision to administer D50 (Dextrose 50%) for hypoglycemia in an unconscious patient should be based on the patient's blood glucose level and clinical presentation 3.
• A study comparing D10 (Dextrose 10%) to D50 found that both treatments had nearly complete resolution of hypoglycemia, but D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia with fewer adverse events 3.
• However, the mean time to resolution was approximately four minutes longer in the D10 group, and there was a greater need for subsequent doses with the use of D10 3.

Considerations for D50 Administration

• The American College of Endocrinology and the American Association of Clinical Endocrinologists suggest that octreotide may be an effective treatment for patients with refractory hypoglycemia attributable to sulfonylureas 4, 5.
• A study on the blood glucose response to rescue dextrose in hypoglycemic, critically ill patients receiving an insulin infusion found that the overall median blood glucose response was 4.0 mg/dL per gram of D50W administered 6.
• The response to D50W increased with increasing insulin infusion rate, and burn patients experienced a significantly larger blood glucose response compared with other patient groups 6.

Alternative Treatments

• Octreotide has been shown to reverse hyperinsulinemia and prevent hypoglycemia induced by sulfonylurea overdoses, and may be a logical therapeutic alternative for this metabolic emergency 5.
• A case report described a patient with prolonged and recurrent hypoglycemia unresponsive to large intravenous doses of glucose, who was treated successfully with intravenously administered octreotide 4.