Intravenous glucose
If intravenous glucose is needed to increase blood glucose concentrations for adult patients, ideally, give the glucose through a securely positioned cannula into an antecubital vein. Injection into veins in the hand may cause superficial thrombophlebitis, especially at higher glucose concentrations.
For a child or adolescent with diabetes and severe hypoglycaemia use an intravenous glucose infusion to increase blood glucose concentration. Give initially:
glucose 10% 1 to 2 mL/kg (100 to 200 mg/kg) by intravenous infusion over 20 minutes, until blood glucose concentration is more than 4 mmol/L. hypoglycaemia, severe (child with diabetes)
When the blood glucose concentration is more than 4 mmol/L, start an intravenous infusion of sodium chloride 0.45% with glucose 5% at a maintenance rate to prevent further hypoglycaemia. If required, increase the concentration of glucose in the sodium chloride 0.45% infusion to maintain the blood glucose concentration at more than 4 mmol/L.
Do not give glucose 50% to children because it can cause hyperosmolality and subsequent death.
Further management of children and adolescents should be directed by the multidisciplinary diabetes team.
For an adult with diabetes and severe hypoglycaemia use an intravenous glucose infusion to increase blood glucose concentration, give:
1 glucose 10% 150 to 200 mL (15 to 20 g) by intravenous infusion over 15 minutes hypoglycaemia, severe (adult)
OR
1 glucose 20% 75 to 100 mL (15 to 20 g) by intravenous infusion over 15 minutes. hypoglycaemia, severe (adult)
An alternative would be to give glucose 50% by slow intravenous injection. Glucose 50% must be used with extreme caution because extravasation can cause potentially serious necrosis.
Adult patients usually regain consciousness within minutes of being given intravenous glucose. Measure the patient’s blood glucose concentration 10 to 15 minutes after the infusion and repeat the dose if the blood glucose concentration remains less than 4 mmol/L.
If the adult is conscious and able to swallow, give a longer-acting carbohydrate (eg sandwich, dried fruit, yoghurt) to prevent the recurrence of hypoglycaemia.
For an adult patient with severe hypoglycaemia who has responded well to the glucose infusion, measure their blood glucose concentration every 1 to 2 hours for the first 4 hours, and then resume the usual self-monitoring regimen for patients with type 1 diabetes. For patients with type 2 diabetes, continue checking blood glucose concentrations more frequently depending on the patient’s antihyperglycaemic treatment (see Self-monitoring blood glucose concentrations in adults with type 2 diabetes). The period of monitoring may need to be extended if the cause of severe hypoglycaemia is not immediately reversible.
If hypoglycaemia is prolonged or extremely severe and/or associated with a seizure, recovery of full consciousness and cognition may take several hours, despite restoring the blood glucose concentration to normal. Managing these patients includes:
- management of the hypoglycaemia
- supportive treatment while waiting for improvement in consciousness
- thorough investigation for other causes of the decreased consciousness. Consider the possibility of inadvertent insulin overdose.
Warn patients that they are at risk of another severe hypoglycaemic episode within 24 to 48 hours, so they must continue to monitor their blood glucose concentration and must not drive.