Hypoglycemia Management

Preventing and Treating Hypoglycemia in Hyperglycemic Crisis

Patients with hyperglycemia crisis are at risk for developing hypoglycemia during treatment due to the following reasons:

• Insulin therapy lowers blood glucose levels as ketone levels are reduced
• High glucose levels on presentation may obscure the degree of insulin deficiency
• Depletion of glucose and glycogen stores during the development of DKA

Patients on a insulin infusion have their intravenous fluids changed to contain dextrose at blood sugar of 250 mg/dL until the resolution of other components of DKA or HHS. This is the primary method to prevent hypoglycemia in these patients. However, if that fails, and the blood sugar falls below

Definitions of Hypoglycemia

• Level 1 (glucose <70 mg/dL): Take action such as ingest carbs, recheck glucose, avoid critical tasks
• Level 2 (glucose <54 mg/dL): Serious hypoglycemia requiring immediate treatment with fast-acting carbs
• Level 3: Severe hypoglycemia requiring assistance of another person and glucagon or IV glucose

Treating Hypoglycemia

• Level 1: 15-20 g fast-acting carbs (glucose tabs, juice); recheck in 15 min; adjust meds.
• Level 2: 15-20 g fast-acting carbs; recheck in 15 min; give meal/snack after Or administered 12.5 g of dextrose as (Dextrose 50%  in sterile water or Dextrose (D50W) 10% in sterile water (D10W)
• Level 3 with IV: 25 g IV dextrose as (Dextrose 50 gram in sterile water or Dextrose (D50W) 10% in sterile water (D10W)
  • Level 3 without IV: 1 mg glucagon SC/IM; stable liquid forms preferred
• Post-treatment: Give carbs/food once awake; may need glucose infusion
• Monitor to ensure recovery and avoid recurrence

The key is to recognize levels of hypoglycemia and initiate prompt treatment with fast-acting carbohydrates or glucagon as appropriate. Ongoing monitoring and carbohydrate intake are important after treating hypoglycemia episodes.