From the Guidelines
For a patient with a blood sugar level of 10 mg/dL, you should immediately administer intravenous (IV) dextrose, specifically D50W (50% dextrose in water), as the most recent and highest quality study recommends prompt treatment for hypoglycemia 1.
Treatment Approach
The treatment approach for severe hypoglycemia involves administering a concentrated dextrose solution to rapidly increase blood glucose levels.
- Give 50 mL (25 grams) of D50W as an IV push.
- If IV access is not available, administer 1 mg of glucagon intramuscularly or subcutaneously while establishing IV access.
Maintenance and Follow-up
After the initial D50W bolus, start an infusion of D10W or D5W to maintain blood glucose levels, typically at 100-150 mL/hour, and check blood glucose every 15-30 minutes until stable.
- Once the patient is conscious and able to swallow safely, provide oral carbohydrates (juice, glucose tablets, or a small meal) to prevent recurrence.
Importance of Prompt Treatment
This treatment is urgent as severe hypoglycemia (below 40 mg/dL) can rapidly lead to seizures, loss of consciousness, and neurological damage if not corrected quickly, as highlighted in the standards of medical care in diabetes-2022 1.
Key Considerations
- The brain relies almost exclusively on glucose for energy, making prompt correction of hypoglycemia crucial.
- The concentrated dextrose solution provides immediate glucose to the bloodstream, which is essential for brain function.
- Ongoing monitoring and adjustment of treatment are necessary to prevent recurrent hypoglycemia, as recommended in the standards of medical care in diabetes-2020 1.
From the FDA Drug Label
INDICATIONS AND USAGE 50% Dextrose Injection is indicated in the treatment of insulin hypoglycemia (hyperinsulinemia or insulin shock) to restore blood glucose levels. In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate.
The fluid to start if the patient's sugar is down to 10 is 50% Dextrose Injection. The recommended dose is 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose), which should be administered promptly without awaiting pretreatment test results 2, 2.
From the Research
Treatment of Hypoglycemia
- The patient's sugar level is down to 10, indicating hypoglycemia, and requires immediate treatment.
- Studies have compared the effectiveness of 10% dextrose (D10) and 50% dextrose (D50) in treating hypoglycemia 3, 4, 5, 6, 7.
Comparison of D10 and D50
- Research suggests that D10 may be as effective as D50 in resolving symptoms and correcting hypoglycemia, with fewer adverse events 3, 4.
- A study found that the median total dose of dextrose administered was significantly less with D10, and median post-treatment blood sugar levels were also significantly lower 4.
- Another study reported that 100 mL of D10 was effective in treating hypoglycemia, with no reported adverse events or deaths related to D10 administration 5, 6.
Recommendations
- Based on the studies, D10 may be a suitable alternative to D50 for the treatment of hypoglycemia, especially when considering the potential risks associated with D50, such as extravasation injury and hyperglycemia 3, 4, 5, 6, 7.
- However, further study is needed to evaluate the use of D10, the need for dextrose readministration, and its impact on clinical outcomes 7.