Hypoglycemia

Will Bassett

Background

  • Definition: BG <70mg/dL
    • Generally worse outcomes than hyperglycemia.
  • Causes: infection, liver failure, renal failure, iatrogenic (e.g. insulin not adjusted for AKI or being NPO), hyperinsulinemic process.
  • Symptoms vary from tremor, palpitations, delirium, dizziness, AMS, coma (can mimic stroke).

Management

  • Give PO carbohydrate load (15-20g oral glucose) if pt is alert and tolerates PO.
  • Give IV D50 if severe (<50), or cannot take PO.
  • Repeat measurements every 15 minutes in the first hour and treat again as needed.
  • Give glucagon 0.5-1mg SQ/IM if no IV access and impaired consciousness
    • Effect is transient and IV access should be obtained ASAP for glucose infusion.
  • Do NOT hold basal insulin for T1DM: treat the low, then reduce dose if needed.
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