From the Guidelines
Treating hypoglycemia that doesn't respond to glucose requires immediate and escalating interventions to prevent serious complications, and the most recent and highest quality study 1 recommends administering 15-20g of fast-acting carbohydrates like juice or glucose tablets, then rechecking blood sugar after 15 minutes. If levels remain low, repeat glucose administration and consider glucagon injection (1mg for adults, 0.5mg for children under 25kg) intramuscularly or subcutaneously, as suggested by 1. For severe cases unresponsive to these measures, IV dextrose (D50W, 25-50mL for adults) should be administered, and in hospital settings, continuous IV dextrose infusions (D10W at 100-200mL/hr) may be necessary, as indicated by 1 and 1. Some key points to consider when treating hypoglycemia include:
- Administering fast-acting carbohydrates like juice or glucose tablets as the initial treatment, as recommended by 1 and 1
- Rechecking blood sugar after 15 minutes and repeating treatment if necessary, as suggested by 1 and 1
- Considering glucagon injection for severe cases, as recommended by 1 and 1
- Addressing underlying causes of recurrent hypoglycemia, including adjusting insulin or diabetes medications, treating adrenal insufficiency with hydrocortisone, or managing insulinomas, as indicated by 1 and 1
- Using medications like diazoxide (3-8mg/kg/day) or octreotide (50-100mcg every 8-12 hours) for persistent hypoglycemia, as suggested by the example answer. It's crucial to prioritize the patient's safety and well-being, and to take a proactive approach to preventing and treating hypoglycemia, as emphasized by 1, 1, 1, and 1.
From the FDA Drug Label
For peripheral vein administration: Injection of the solution should be made slowly. The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body weight/hour. About 95% of the dextrose is retained when infused at a rate of 0. 8 g/kg/hr. In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. Repeated doses and supportive treatment may be required in severe cases.
When the patient has responded to the treatment and is able to swallow, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia.
To treat hypoglycemia not being fixed with glucose, intravenous dextrose can be administered. The recommended dose is 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) via peripheral vein administration. Repeated doses and supportive treatment may be required in severe cases. Additionally, glucagon can be administered if the patient is unable to swallow glucose. The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously. After the patient has responded to the treatment, oral carbohydrates should be given to restore liver glycogen and prevent recurrence of hypoglycemia 2.
From the Research
Treatment of Hypoglycemia Not Fixed with Glucose
- Hypoglycemia is a common complication in patients with diabetes, and it can be challenging to manage, especially when it does not respond to glucose treatment 3, 4.
- In cases where hypoglycemia is not fixed with glucose, glucagon can be an effective alternative treatment, especially in emergency situations 5, 6.
- Intravenous glucagon has been shown to be effective in treating severe hypoglycemia, although it may have a slower onset of action compared to intravenous dextrose 5.
- New formulations of glucagon, such as nasal powder glucagon and liquid-stable glucagon, have become available and offer improved ease of use and stability 6.
- Education and regular review are essential for patients with diabetes and their caregivers to recognize the symptoms, prevention, and treatment of hypoglycemia, including the use of glucagon 4, 7.
- Continuous glucose monitoring (CGM) can be beneficial for individuals with increased risk of hypoglycemia, impaired hypoglycemia awareness, or a history of severe hypoglycemia 7.
- Optimizing insulin doses, carbohydrate intake, and physical activity can also help prevent hypoglycemia 7.