Hypoglycaemia
Treatment of hypoglycaemia
Choice of treatment depends on the clinical situation. See prescribing notes.
Glucose
Glucose 40% oral gel
Initially 10-20g given orally (10g of fast acting glucose for oral administration is the equivalent of 1 x 25g tube of oral gel 400mg/1g).
Glucose tablets
Initially 10-20g given orally (10g of fast acting glucose for oral administration is the equivalent of 3 glucose tablets).
Glucose 10% infusion 500ml bags
Infuse into a large vein at a fast rate until patient regains consciousness, then replace glucose orally.
Glucagon
Glucagon 1mg powder and solvent for solution for injection vials
1mg by subcutaneous or intramuscular injection. If no response within 10 minutes, intravenous glucose must be given.
Prescribing Notes:
- If conscious and able to swallow treat hypoglycaemia (blood glucose concentration less than 4 mmol/litre) with or without symptoms with a fast-acting carbohydrate by mouth.
- Initially 10-20g glucose given orally (10g of fast acting glucose for oral administration is the equivalent of 3 glucose tablets OR 1 x 25g tube of oral gel 400mg/1g). Alternatively, 10-20g of fast acting glucose is the equivalent of a glass or small carton (200ml) of pure fruit juice such as orange juice or 2 teaspoons of sugar dissolved in 10-20ml of water.
- Non-diet soft drinks can be used to treat episodes of hypoglycaemia, check product labels for glucose content and adjust the volume accordingly.
- Hypoglycaemia which does not respond to treatment by mouth should be treated with intramuscular glucagon or glucose 10% intravenous infusion.
- Hypoglycaemia which causes unconsciousness is treated initially with glucagon. If glucagon is not effective after 10mins or is unsuitable glucose 10% intravenous infusion should be given.
- Following administration of glucagon, it is important to give supplementary carbohydrate to restore liver glycogen and prevent secondary hypoglycaemia.
- Although intravenous glucose is the more effective treatment where intravenous access is readily available, intramuscular or subcutaneous glucagon may be more appropriate.
- If there is no response to glucagon injection, arrange immediate transfer to hospital. Patients with hypoglycaemia requiring 3rd party intervention should be considered for admission to hospital for intravenous glucose.
History Notes
08/12/2022
Update to prescribing notes, EWRG Nov 22
16/02/2022
East Region Formulary content agreed.
Treatment of hypoglycaemia in known diabetes
Choice of treatment depends on the clinical situation (oral, infusion or injection).
Glucose
Glucose 40% oral gel
For dose, refer to BNF for Children.
Glucose powder for oral use BP 1980
For dose, refer to BNF for Children.
Glucose tablets
For dose, refer to BNF for Children.
Glucose 10% infusion 1litre bags
For dose, refer to BNF for Children.
Glucagon
Glucagon 1mg powder and solvent for solution for injection vials
For dose, refer to BNF for Children.
Prescribing Notes:
- For further guidance please refer to the NHS Lothian paediatric diabetes handbook section on hypoglycaemia.
- Following administration of glucagon, it is important to give supplementary carbohydrate to restore liver glycogen and prevent secondary hypoglycaemia.
- Glucose 20% or 50% intravenous infusion should not be used to treat hypoglycaemia in children.
- Although intravenous glucose is the more effective treatment where intravenous access is readily available, intramuscular glucagon may be more appropriate.
- Following administration of glucagon, the patient should attend hospital for immediate review.
- If conscious and able to swallow treat hypoglycaemia (blood glucose concentration less than 4 mmol/litre) with or without symptoms with a fast-acting carbohydrate by mouth.
- Initially 10-20g glucose given orally (10g of fast acting glucose for oral administration is the equivalent of 3 glucose tablets OR 1 x 25g tube of oral gel 400mg/1g). Alternatively, 10-20g of fast acting glucose is the equivalent of a glass or small carton (200ml) of pure fruit juice such as orange juice or 2 teaspoons of sugar dissolved in 10-20ml of water.
- Non-diet soft drinks can be used to treat episodes of hypoglycaemia, check product labels for glucose content and adjust the volume accordingly.
- Hypoglycaemia which does not respond to treatment by mouth should be treated with intramuscular glucagon or glucose 10% intravenous infusion.
- Hypoglycaemia which causes unconsciousness is treated initially with glucagon. If glucagon is not effective after 10mins or is unsuitable glucose 10% intravenous infusion should be given.
- Following administration of glucagon, it is important to give supplementary carbohydrate to restore liver glycogen and prevent secondary hypoglycaemia.
- Although intravenous glucose is the more effective treatment where intravenous access is readily available, intramuscular or subcutaneous glucagon may be more appropriate.
- If there is no response to glucagon injection, arrange immediate transfer to hospital. Patients with hypoglycaemia requiring 3rd party intervention should be considered for admission to hospital for intravenous glucose.
History Notes
29/02/2024
East Region Formulary content agreed.
Treatment of persistent hyperinsulinaemic hypoglycaemia of infancy
Diazoxide
Diazoxide 50mg tablets
For dose, refer to BNF for Children.
Diazoxide 250mg/5ml oral solution
For dose, refer to BNF for Children.
Chlorothiazide
Chlorothiazide 250mg tablets
For dose, refer to BNF for Children.
Chlorothiazide 250mg/5ml oral solution
For dose, refer to BNF for Children.
Prescribing Notes:
- Side-effects from diazoxide include fluid retention, hypertrichosis, facial changes, hypotension, rarely leucopenia, thrombocytopenia.
- Haematological and blood pressure monitoring are required during prolonged treatment.
- Chlorothiazide acts synergistically with diazoxide. They should normally be used in combination.
- Patients who fail to respond to the above treatment will be discussed with national specialist centres. Other treatment options include glucagon, octreotide injection or infusion.
History Notes
29/02/2024
East Region Formulary content agreed.