Hypoglycemia Therapy

For patients on insulin drip:

• If blood glucose drops between 80 to 99 mg/dL decrease IV insulin to 0.05units/kg/hour and contact the Supervising Physician.

• If blood glucose drops < 80 mg/dL stop IV insulin, follow hypoglycemia protocol located under supportive documents, and contact Supervising Physician

• Consider resuming IV insulin infusion after hypoglycemia is resolved, per discussion with Supervising Physician. If insulin infusion was stopped, resume at 0.05 units/kg/hour rather than 0.1 units/kg/hour. Continue until bicarbonate level is ≥ 20 mol/L, anion gap is normalized, or blood ketones are < 0.6 mmol/L.

For patients receiving rapid acting subcutaneous insulin:

• If blood glucose drops between 80 to 99 mg/dL decrease IV insulin to 0.05 units/kg/hour and contact the Supervising Physician.

• If blood glucose drops < 80 mg/dL stop IV insulin, follow hypoglycemia protocol located under supportive documents, and contact Supervising Physician.

• Consider resuming IV insulin infusion after hypoglycemia is resolved, per discussion with Supervising Physician. If insulin infusion was stopped, resume at 0.05 units/kg/hour rather than 0.1 units/kg/hour. Continue until bicarbonate level is ≥ 20 mol/L, anion gap is normalized, or blood ketones are < 0.6 mmol/L.

Hypoglycemia protocol

1. Patients currently in DKA on IV insulin drip:

   • Blood glucose < 80 mg/dL

     • Stop insulin drip. 

     • Maximize D₁₀ NS with additives IV fluids if not already at 100%. 

     • Recheck glucose in 15 minutes. 

     • If > 80 mg/dL continue current management and contact Supervising Physician. 

     • If blood glucose remains < 80 mg/dL treat with:

       1. If patient is alert and oriented without nausea/vomiting treat the patient with:

          1. 15 grams of simple carbohydrate to eat/drink: 4 ounces of fruit juice, 5-6 ounces of non-caffeinated regular soda, 6-7 saltine crackers, or 1 package of snack size crackers.

          2. Recheck blood glucose in 15 minutes.  If blood glucose remains < 80 mg/dL repeat treatment and contact Supervising Physician.

       2. If the patient is not alert and oriented or has nausea/vomiting administer D₂₅W 1 ml/kg bolus IV and contact Supervising Physician.

2. Patients on subcutaneous insulin:

   • Blood glucose <80 mg/dL

     • Mild hypoglycemia: 

1. 1. 1. 1. Signs/symptoms (shaky, weak, tired, hungry, irritable, or difficulty focusing), but alert enough to safely take oral fluids/solids.
         2. Administer 15 grams of simple carbohydrate to eat/drink:  4 ounces of fruit juice, 5-6 ounces of non-caffeinated regular soda, 6-7 saltine crackers, or 1 package of snack size crackers. Recheck blood glucose in 15 minutes and repeat above steps if still hypoglycemic. If blood glucose does not increase to > 80 mg/dL within 30 minutes contact Supervising Physician.

• • • Moderate to severe hypoglycemia:

1. 1. 1. 1. Signs/symptoms (pale, sweaty, confused, distant, poor coordination, slurred speech, difficulty cooperating, altered mental status, semi-conscious, unconscious, or seizing).
         2. If patient is able to cooperate, follow directions, and swallow safely administer 15 grams of simple carbohydrate to eat/drink:  4 ounces of fruit juice, 5-6 ounces of non-caffeinated regular soda, 6-7 saltine crackers, or 1 package of snack size crackers.  Recheck blood glucose in 15 minutes and repeat above steps if patient remains hypoglycemic. If blood glucose does not increase to > 80 mg/dL within 30 minutes contact Supervising Physician.
         3. If patient is not able to cooperate and swallow safely and has IV access administer either D₁₀W 5 ml/kg bolus IV OR D₂₅W 1 ml/kg bolus IV.
         4. If patient does not have IV access give glucagon IM injection.
            1. 0.5 mg IM for <6 y/o.
            2. 1 mg IM for 6 y/o and older.