Hypoglycemia: Difference between revisions
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#Start a D10 1/2NS drip (5mL/hr) | #Start a D10 1/2NS drip (5mL/hr) | ||
#Octreotide<ref>Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406</ref> | #Octreotide<ref>Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406</ref> | ||
#* | #*Theoretical benefit to reduce risk of recurrent hypoglycemia | ||
#*Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release | #*Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release | ||
#*50-100 mcg subcutaneous in adults with repeat dosing Q6hrs | #*50-100 mcg subcutaneous in adults with repeat dosing Q6hrs | ||
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#Do NOT use a glucagon drip | #Do NOT use a glucagon drip | ||
#*Glucagon also has an insulin-releasing effect and may subsequently cause hypoglycemia | #*Glucagon also has an insulin-releasing effect and may subsequently cause hypoglycemia | ||
===Hypoglycemia from Long Acting Insulin=== | |||
*Similar treatment as for Sulfonylureas except no role for Octreotide | |||
*Treatment should include oral PO intake as well as maintenance glucose containing drip either D5 or D10 | |||
==Disposition== | ==Disposition== | ||
Revision as of 15:55, 25 May 2014
Diagnosis
- Symptoms consistent with the diagnosis
- Symptoms associated with a low glucose level, usually <50
- Symptoms resolve with glucose administration
DDX
- Medication-induced
- Sepsis
- Toxin
- Insulinoma
- Hepatic failure
- Adrenal insufficiency
Treatment
ED or Prehospital
- Hypoglycemia from insulin
- D50
- Oral glucose intake
- Glucagon[1]
- Efficacy dependent on hepatic glycogen stores
- Onset of action slower than IV dextrose (7-10min)
- 1mg SC or IM
Hypoglycemia from Sulfonylureas[2][3]
- D50 should be given initially
- Start a D10 1/2NS drip (5mL/hr)
- Octreotide[4]
- Theoretical benefit to reduce risk of recurrent hypoglycemia
- Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release
- 50-100 mcg subcutaneous in adults with repeat dosing Q6hrs
- 2 mcg/kg subcutaneously should be used in children
- Continuous infusion of 50-125 mcg/hr is an alternative in adults
- Do NOT use a glucagon drip
- Glucagon also has an insulin-releasing effect and may subsequently cause hypoglycemia
Hypoglycemia from Long Acting Insulin
- Similar treatment as for Sulfonylureas except no role for Octreotide
- Treatment should include oral PO intake as well as maintenance glucose containing drip either D5 or D10
Disposition
Consider admission for obs for sulfonylurea-induced hypoglycemia or long acting insulins
See Also
Sources
- ↑ Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50
- ↑ Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med Clin N Am 2007; 25:347-356
- ↑ Howland MA. Antidotes in Depth: Octreotide. In: Flomenbaum NE, Goldfrank LR, Hoffman RS et al, eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773
- ↑ Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406