Treatment of Hypoglycaemic Emergency

Variability exists between hospitals and jurisdictions over the treatment and management of diabetic and glycaemic emergencies. When treating hypoglycaemia, consideration needs to be given to potential for prolonged susceptibility. While normal glucose levels for those without diabetes are 3.5-7.0mmol/L, Diabetes UK recommends a lower limit and treatment of 4.0mmol/L for those with diabetes.

• Oral carbohydrate – 15-20g of a quick acting carbohydrate (e.g. orange juice) should be followed by a long acting carbohydrate (e.g. toast/banana/two biscuits). With the recent introduction of the sugar tax it is important to check the carbohydrate content if administering a soft drink (e.g Lucozade)
• Buccal Glucose Gel – This is absorbed more quickly than complex carbohydrates and is easily administered. The patient should be able to swallow in order for it to be fully effective.
• Glucagon – Can be administered via IV, IM or SC routes. Useful in situations where behaviour, co-operation or other neuroglycopenic symptoms make oral or IV routes difficult. Repeated doses are not advised. It is important to appreciate the cohort of patients for whom glucagon will be less effective (those with depleted glycogen reserves e.g. sulphonylurea treatment, malnourished, or excessive alcohol consumption)
• Dextrose – using 10% dextrose results in lower post treatment hyperglycaemia. Given the risk of extravasation and phlebitis from 50% dextrose, 10% dextrose is the preferred option. 150-200mls of 10% dextrose is usually sufficient to correct hypoglycaemia for most patients.[17]

When dextrose or glucagon are given recovery is quick, but hypoglycaemia may recur if complex carbohydrates are not also given to provide continued glucose supply. This is particularly important after glucagon as it uses up liver glycogen stores.

Learning Bite

In patients who remain unconscious from another cause or who are unable to eat, frequent monitoring of glucose levels is required and dextrose infusions may be needed.

Learning Bite

Do not omit next insulin dose. Dose modification may be required but the next dose should be given.