- Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more...
The mainstay of therapy for hypoglycemia is glucose. Other medications may be administered based on the underlying cause or the accompanying symptoms; however, these medications are not addressed in this article.
Glucose supplements are used to raise the patient's serum glucose.
Dextrose is a monosaccharide absorbed from intestine and distributed, stored, and used by tissues. Parenterally injected, dextrose is used in patients unable to obtain adequate oral (PO) intake. Direct oral absorption results in rapid increase of blood glucose concentrations.
Dextrose is effective in small doses, and there is no evidence that it may cause toxicity. Concentrated dextrose infusions provide higher amounts of glucose and increased caloric intake with minimum fluid volume. The long-term management of hypoglycemia is dictated by its cause (eg, insulinoma).
Glucose-elevating agents can act in the pancreas or the peripheral tissues to increase blood glucose levels.
Pancreatic alpha cells of islets of Langerhans produce glucagon, a polypeptide hormone. This agent exerts effects opposite of insulin on blood glucose and elevates blood glucose levels by inhibiting glycogen synthesis and enhancing formation of glucose from noncarbohydrate sources, such as proteins and fats (gluconeogenesis).
Glucagon also increases hydrolysis of glycogen to glucose (glycogenolysis) in the liver. This agent accelerates hepatic glycogenolysis and lipolysis in adipose tissue by stimulating cyclic AMP (cAMP) synthesis via adenylyl cyclase and enhancing phosphorylase kinase activity.
Glucagon may be useful when intravenous (IV) access is problematic. This agent may be administered as part of emergency medical services (EMS) protocol in patients with altered mental status and no IV access.
Inhibitors of insulin secretion
Agents that inhibit insulin secretion increase glucose levels by reducing peripheral glucose metabolism.
Diazoxide is a direct inhibitor of insulin secretion. This agent increases hepatic glucose output by inhibiting pancreatic insulin release and, possibly, through an extrapancreatic effect, as well as decreases cellular glucose uptake. Although, diazoxide has a very limited role in treating hypoglycemia, it can help improve symptoms of hypoglycemia caused by increased insulin secretion in patients awaiting surgery or those with nonresectable disease and may be indicated in some cases of insulinoma or overdosage with oral (PO) hypoglycemic agents.
Hyperglycemic effect starts within 1 hour, lasting a maximum of 8 hours if the patient's renal function normal. Patients with refractory hypoglycemia may require high dosages.
This agent Inhibits insulin secretion. Octreotide acts primarily on somatostatin receptor subtypes II and V. It also inhibits growth hormone secretion and has a multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, vasoactive intestinal peptides (VIP), and gastrointestinal peptides.
Antineoplastic agents inhibit cell growth and proliferation.
Streptozocin has a high affinity for neuroendocrine cells, inhibits cell proliferation, and is cytolytic. This agent interferes with normal DNA function by alkylation and protein modification.
Pugh SK, Doherty DA, Magann EF, et al. Does hypoglycemia following a glucose challenge test identify a high risk pregnancy?. Reprod Health. 2009 Jul 14. 6:10. [Medline]. [Full Text].
Hughes S. Pain Med Linked to Hypoglycemia. Medscape Medical News. Dec 11 2014. [Full Text].
Fournier JP, Azoulay L, Yin H, et al. Tramadol Use and the Risk of Hospitalization for Hypoglycemia in Patients With Noncancer Pain. JAMA Intern Med. 2014 Dec 8. [Medline].
Eriksson JW, Bodegard J, Nathanson D, Thuresson M, Nystrom T, Norhammar A. Sulphonylurea compared to DPP-4 inhibitors in combination with metformin carries increased risk of severe hypoglycemia, cardiovascular events, and all-cause mortality. Diabetes Res Clin Pract. 2016 Jul. 117:39-47. [Medline].
Gautier JF, Monguillon P, Verier-Mine O, et al. Which oral antidiabetic drug to combine with metformin to minimize the risk of hypoglycemia when initiating basal insulin?: A randomized controlled trial of a DPP4 inhibitor versus insulin secretagogues. Diabetes Res Clin Pract. 2016 Jun. 116:26-8. [Medline].
Hill NR, Thompson B, Bruce J, et al. Glycaemic risk assessment in children and young people with Type 1 diabetes mellitus. Diabet Med. 2009 Jul. 26(7):740-3. [Medline].
Turnbull FM, Abraira C, Anderson RJ, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009 Aug 5. [Medline].
Prolonged Nocturnal Hypoglycemia Is Common During 12 Months Of Continuous Glucose Monitoring In Children And Adults With Type 1 Diabetes. Diabetes Care. 2010 Mar 3. [Medline]. [Full Text].
Swinnen SG, Dain MP, Aronson R, et al. A 24-week, randomized, treat-to-target trial comparing initiation of insulin glargine once-daily with insulin detemir twice-daily in patients with type 2 diabetes inadequately controlled on oral glucose-lowering drugs. Diabetes Care. 2010 Mar 3. [Medline].
Ito T, Otsuki M, Igarashi H, et al. Epidemiological Study of Pancreatic Diabetes in Japan in 2005: A Nationwide Study. Pancreas. 2010 Feb 22. [Medline].
Chen L. A literature review of intensive insulin therapy and mortality in critically ill patients. Clin Nurse Spec. 2010 Mar-Apr. 24(2):80-6. [Medline].
Garza H. Minimizing the risk of hypoglycemia in older adults: a focus on long-term care. Consult Pharm. 2009 Jun. 24 Suppl B:18-24. [Medline].
Boucai L, Southern WN, Zonszein J. Hypoglycemia-associated Mortality Is Not Drug-associated but Linked to Comorbidities. Am J Med. 2011 Nov. 124(11):1028-35. [Medline]. [Full Text].
Feil DG, Rajan M, Soroka O, et al. Risk of hypoglycemia in older veterans with dementia and cognitive impairment: implications for practice and policy. J Am Geriatr Soc. 2011 Dec. 59(12):2263-72. [Medline].
Lin YY, Hsu CW, Sheu WH, Chu SJ, Wu CP, Tsai SH. Use of therapeutic responses to glucose replacement to predict glucose patterns in diabetic patients presenting with severe hypoglycaemia. Int J Clin Pract. 2009 Aug. 63(8):1161-6. [Medline].
Egi M, Bellomo R, Stachowski E, et al. Hypoglycemia and outcome in critically ill patients. Mayo Clin Proc. 2010 Mar. 85(3):217-24. [Medline]. [Full Text].
New Guidelines Stress Hypoglycemia Affects All Diabetics. Medscape Medical News. Available at http://www.medscape.com/viewarticle/802949?nlid=30763_1621. Accessed: May 2, 2013.
Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the american diabetes association and the endocrine society. Diabetes Care. 2013 May. 36(5):1384-95. [Medline]. [Full Text].
Goh HK, Chew DE, Miranda IG, Tan L, Lim GH. 24-Hour observational ward management of diabetic patients presenting with hypoglycaemia: a prospective observational study. Emerg Med J. 2009 Oct. 26(10):719-23. [Medline].
Goto A, Arah OA, Goto M, Terauchi Y, Noda M. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013 Jul 29. 347:f4533. [Medline].
Lowry F. Severe Hypoglycemia Boosts CVD Risk in Type 2 Diabetes. Medscape Medical News. Available at http://www.medscape.com/viewarticle/808863. Accessed: August 12, 2013.
McMahon MM, Nystrom E, Braunschweig C, Miles J, Compher C. A.S.P.E.N. clinical guidelines: nutrition support of adult patients with hyperglycemia. JPEN J Parenter Enteral Nutr. 2013 Jan. 37(1):23-36. [Medline].
Sinert R, Su M, Secko M, Zehtabchi S. The utility of routine laboratory testing in hypoglycaemic emergency department patients. Emerg Med J. 2009 Jan. 26(1):28-31. [Medline].
Kong AP, Chan JC. Hypoglycemia and Comorbidities in Type 2 Diabetes. Curr Diab Rep. 2015 Oct. 15 (10):646. [Medline].