Hypoglycemia

Diagnosis

  1. Symptoms consistent with the diagnosis
  2. Symptoms associated with a low glucose level, usually <50
  3. Symptoms resolve with glucose administration

DDX

  1. Medication-induced
  2. Sepsis
  3. Toxin
  4. Insulinoma
  5. Hepatic failure
  6. Adrenal insufficiency

Treatment

ED or Prehospital

  1. Hypoglycemia from insulin
  2. D50
  3. Oral glucose intake
  4. Glucagon[1]
    1. Efficacy dependent on hepatic glycogen stores
    2. Onset of action slower than IV dextrose (7-10min)
    3. 1mg SC or IM

Hypoglycemia from Sulfonylureas[2][3]

  1. D50 should be given initially
  2. Start a D10 1/2NS drip (5mL/hr)
  3. Octreotide[4]
    • Used 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
  4. Do NOT use a glucagon drip
    • Glucagon also has an insulin-releasing effect and may subsequently cause hypoglycemia

Disposition

Consider admission for obs for sulfonylurea-induced hypoglycemia or long acting insulins

See Also

Sources

  1. 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
  2. Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med Clin N Am 2007; 25:347-356
  3. 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
  4. 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