What is the treatment for hypoglycemia (low blood sugar) in a patient who is unresponsive (collapsed) and does not have access to glucagon (a hormone that raises blood glucose levels) injection?

From the Guidelines

For a collapsed patient with hypoglycemia when glucagon injection is unavailable, immediately call emergency services and position the patient in the recovery position if they are completely unconscious without a gag reflex, while for those with a gag reflex, administer 20 g of oral glucose or the equivalent in glucose-containing foods, such as glucose tablets, which have been shown to be superior in correcting hypoglycemia compared to other forms of glucose 1. When dealing with a collapsed patient due to hypoglycemia, it is crucial to act swiftly to restore blood glucose levels and prevent severe complications such as seizures, permanent brain injury, and death 1. Key considerations include:

• The patient's level of consciousness and ability to swallow safely
• The availability of different forms of glucose for administration
• The importance of seeking immediate medical help if the patient is unresponsive or unable to swallow Given the recent guidelines from the American Heart Association and American Red Cross in 2024 1, oral glucose administration is recommended for those who can swallow, with glucose tablets being a preferred option due to their effectiveness in rapidly restoring blood glucose levels. If intravenous access is available and the provider is trained, administering 25g (50ml) of 50% dextrose solution IV can be lifesaving for patients who are unable to swallow, as it directly addresses the critical need to raise blood glucose levels quickly 1. Once the patient regains consciousness, providing fast-acting carbohydrates followed by longer-acting ones is essential to maintain stable blood glucose levels and prevent recurrence. It's also important to note that for people with hypoglycemia who are unable to swallow, alternatives like intravenous dextrose are critical, highlighting the need for immediate medical intervention in such cases 1.

From the FDA Drug Label

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. The FDA drug label does not answer the question.

From the Research

Treatment of Hypoglycemia in a Collapsed Patient

In the absence of glucagon injection, the treatment of hypoglycemia in a collapsed patient can be managed with intravenous (IV) dextrose.

• The typical treatment provided is a 25g ampule of 50% dextrose (D50) 2.
• However, a lower concentration, such as 10% dextrose (D10), may improve symptoms while minimizing harm 2.
• Studies have shown that D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia, although the desired effect can take several minutes longer 2.
• The use of D10 may result in fewer adverse events and a lower post-treatment glycemic profile compared to D50 2.

Comparison of Dextrose and Glucagon

• Glucagon is an emergency medication that can quickly raise glucose in people who are unconscious or unable to consume glucose due to severe hypoglycemia 3, 4.
• However, in the absence of glucagon, dextrose can be used as an alternative treatment for hypoglycemia 2, 5.
• Studies have compared the effectiveness of glucagon and dextrose in treating hypoglycemia, with some showing that glucagon and dextrose are similarly effective 5.

Administration of Dextrose

• IV dextrose can be administered to severely hypoglycemic patients, with the goal of returning the patient to consciousness 2.
• The administration of dextrose should be done with caution, as it can cause harm and lead to difficulties regulating blood glucose levels (BGLs) post-treatment 2.
• The choice of dextrose concentration (D10 or D50) should be based on the individual patient's needs and medical history 2.