From the Guidelines
No, we do not prescribe insulin injections for the treatment of hypoglycemia, as insulin lowers blood glucose levels and would worsen hypoglycemia. For hypoglycemia treatment, we instead use glucose-raising agents. The standard emergency treatment for severe hypoglycemia is injectable glucagon, which can be administered as an intramuscular, subcutaneous, or intranasal preparation, as noted in various studies 1. Glucagon works by stimulating the liver to release stored glucose into the bloodstream. For conscious patients with mild to moderate hypoglycemia, oral glucose (15-20 grams) is the preferred initial treatment, followed by a more substantial snack containing carbohydrates and protein. In medical settings, intravenous dextrose (D50W) may be used for severe cases.
Some key points to consider in the management of hypoglycemia include:
- Identifying and addressing the underlying cause of hypoglycemia, which may include adjusting insulin dosing or other medications
- Using glucose-raising agents, such as glucagon or oral glucose, to rapidly increase blood glucose levels
- Providing education to patients on recognizing and managing hypoglycemia, including the use of emergency treatments like glucagon
- Implementing protocols for the prevention and treatment of hypoglycemia in clinical settings, as recommended by organizations such as the American Diabetes Association 1.
It's also important to note that insulin therapy is actually a common cause of hypoglycemia in diabetic patients, and adjusting insulin dosing is often part of preventing recurrent hypoglycemic episodes, as discussed in studies such as 1 and 1. Proper insulin injection technique is also critical for optimal control of diabetes, and recommendations for injection and infusion techniques have been published to help guide healthcare professionals and patients 1.
From the FDA Drug Label
Intravenous administration of Humulin R U-100 is possible under medical supervision with close monitoring of blood glucose and potassium levels to avoid hypoglycemia and hypokalemia. The answer is no, there is no injection prescribed for patients with insulin for the treatment of hypoglycemia, as insulin is typically used to treat hyperglycemia. However, intravenous administration of insulin, such as Humulin R U-100, can be used under medical supervision to avoid hypoglycemia and hypokalemia 2.
From the Research
Treatment of Hypoglycemia
- Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide 3.
- The current treatment for hypoglycemia typically involves oral carbohydrate or glucagon administration 4, 5.
- Insulin therapy is a major risk factor for hypoglycemia, and individualized therapy and glycemia goals are necessary to minimize this risk 6.
Insulin and Hypoglycemia
- Insulin therapy increases the risk of hypoglycemia, and it is the most important and common side effect of insulin therapy 6.
- Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia 3.
- Episodes of hypoglycemia are associated with physical and psychological morbidity, and the fear of hypoglycemia constitutes a barrier that impairs the patient's ability to reach good glycemic control 3.
Alternative Treatments
- Mini-dose glucagon has been shown to be effective in treating nonsevere hypoglycemia in adults with type 1 diabetes, and may be a useful alternative to treatment with oral carbohydrate 5.
- Continuous glucose monitoring (CGM) should be considered for all individuals with increased risk for hypoglycemia, impaired hypoglycemia awareness, frequent nocturnal hypoglycemia, and with history of severe hypoglycemia 7.
Prevention and Management
- Patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage is crucial in preventing hypoglycemia 3, 7.
- A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycaemic goals and promote new therapies to improve quality of life of patients 7.