Adult Medical Emergency Handbook - Scottish Intensive Care Society

i
• If patient not known to have diabetes, or deliberate overdose of
insulin/sulphonylurea suspected, take blood for assay of insulin
and c-peptide concentrations.
Mild or severe
but conscious
• 2-4 dextrose tablets or
• small glass of carbonated
sugar-containing drink
• If no improvement within 5-10
mins, repeat
• If next meal not imminent,
longer acting carbohydrate
should be administered, e.g.
biscuit, sandwich, fruit
Hypoglycaemia Severe and
unconscious
• IV dextrose
125mls 20% dextrose, 250mls
10% dextrose or 500mls 5%
dextrose*
OR
• Glucagon 1 mg IM (not if liver
disease/alcoholism)
• Glucagon is effective almost as quickly as dextrose but may not work
in alcohol related hypoglycaemia, in liver disease or in prolonged
hypoglycaemia. Occasionally causes vomiting, abdominal pain,
diarrhoea. Dextrose infusion 10-20% IV may be needed especially
when a long acting insulin or oral hypoglycaemic agent is responsible.
Give oral starchy carbohydrate within 10-30 mins of glucagon to
replenish liver glycogen stores and prevent recurrent
hypoglycaemia.
• In the situation of a massive insulin overdose with a long acting
preparation the injection site can (occasionally) be surgically
removed.
Recovery from hypoglycaemia may be delayed if:
• hypoglycaemia has been prolonged or severe.
• an alternative cause for impairment of consciousness co-exists,
e.g. stroke or drug overdose.
• patient is post-ictal (convulsion caused by hypoglycaemia).
Follow up
• Think of the causes of hypoglycaemia.
• Why has it occurred?
• If patient recovers quickly then admission is rarely indicated
(unless sulphonylurea induced hypoglycaemia) but ensure that
adequate follow up is arranged through the diabetes team.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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