eMedicine Specialties > Endocrinology > Diabetes Mellitus

Hypoglycemia: Treatment & Medication

Author: Vasudevan A Raghavan, MBBS, MD, MRCP, Assistant Professor, Department of Internal Medicine, Divisions of Endocrinology, Diabetes and Metabolism and Cardiovascular Sciences, Ohio State University; Co-director of The Ross Heart Hospital Comprehensive Lipid Management Clinic, Ohio State University Medical Center
Coauthor(s): Vellore A R Srinivasan, MSc, PhD, Associate Professor, Department of Biochemistry, Sri Balaji Vidyapeeth University, Mahatma Gandhi Medical College and Research Institute campus, Puducherry, India; Kenneth J Snow, MD, Associate Chief, Adult Diabetes, Joslin Clinic
Contributor Information and Disclosures

Updated: Aug 18, 2009

Treatment

Medical Care

If dietary therapy is inadequate, medical care for patients with fasting hypoglycemia may include intravenous (IV) glucose infusion. However, IV octreotide is effective for suppressing endogenous insulin secretion. Reactive hypoglycemia does not require medical care.

Surgical Care

Definitive treatment for fasting hypoglycemia caused by a tumor is surgical resection. The success rate is good for benign islet-cell adenomas, and the success rate for malignant islet-cell tumors can be as high as 50%.

Diet

  • Dietary therapy may be effective for improving symptoms in patients with fasting hypoglycemia. Frequent meals/snacks are preferred, especially at night, with complex carbohydrates.
  • For patients with reactive hypoglycemia, initiate a carbohydrate restriction. Patients should avoid simple sugars, increase the frequency of their meals, and reduce the size of their meals. Patients may require 6 small meals and 2-3 snacks per day.

Activity

Because exercise burns carbohydrates and increases sensitivity to insulin, patients with fasting hypoglycemia should avoid significant activity. On the other hand, patients with reactive hypoglycemia often find that their symptoms improve after embarking on a routine exercise program.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Inhibitors of insulin secretion

These drugs increase glucose levels by reducing peripheral glucose metabolism.


Diazoxide (Hyperstat)

Can help improve symptoms of hypoglycemia caused by increased insulin secretion in patients awaiting surgery or those with nonresectable disease. Increases blood glucose by inhibiting pancreatic insulin release and, possibly, through an extrapancreatic effect. With normal renal function, hyperglycemic effects start within 1 h and usually last a maximum of 8 h.

Adult

IV: 100-200 mg bid/tid; refractory hypoglycemia may require higher dosages
PO: Usually 300-400 mg/d; may be as high as 800 mg

Pediatric

Infants and newborns: 8-15 mg/kg/d IV q8-12h
Children: Administer as in adults

Highly bound to serum proteins and displaces other substances that also are highly bound (eg, Coumadin), resulting in higher levels; may decrease serum hydantoins, possibly resulting in decreased anticonvulsant effects; thiazide diuretics may potentiate hyperuricemic and antihypertensive effects

Documented hypersensitivity; aortic coarctation, aortic aneurysm, arteriovenous shunts, pheochromocytoma

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Causes salt and water retention; caution in congestive heart failure or decreased cardiac output; causes relaxation of smooth muscle in peripheral arterioles, leading to hypotension; do not administer within 6 h of administering beta-blockers, hydralazine, methyldopa, minoxidil, nitrites, prazosin, reserpine, and papaverinelike compounds; patients with diabetes mellitus may require treatment for hyperglycemia; when given prior to delivery, may produce fetal or neonatal hyperbilirubinemia, thrombocytopenia, altered carbohydrate metabolism, and other adverse reactions


Octreotide (Sandostatin)

Acts primarily on somatostatin receptor subtypes II and V. Inhibits GH secretion and has a multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, VIP peptides, and GI peptides.

Adult

Initial: 50 mcg SC tid; may increase dose to 500 mcg SC tid; doses of 300-600 mcg/d or higher seldom result in additional biochemical benefit

Pediatric

1-10 mcg/kg SC tid

May reduce effects of cyclosporine; patients on insulin, oral hypoglycemics, beta-blockers, and calcium channel blockers may need dosage adjustments

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Biliary tract abnormalities (eg, stones, sludge, biliary duct dilatation) can occur; adverse effects primarily related to altered GI motility include nausea, abdominal pain, diarrhea, increased incidence of gallstones, and biliary sludge; because of alterations in counter-regulatory hormones (eg, insulin, glucagon, GH), hypoglycemia or hyperglycemia may occur; bradycardia, cardiac conduction abnormalities, and arrhythmias have been reported; because of inhibition of TSH secretion, hypothyroidism may occur; caution in renal impairment; cholelithiasis may occur

Antineoplastic agents

These agents inhibit cell growth and proliferation.


Streptozocin (Zanosar)

Has a high affinity for neuroendocrine cells, inhibits cell proliferation, and is cytolytic. Interferes with normal function of DNA by alkylation and protein modification.

Adult

500 mg/m2 IV for 5 d q6wk

Pediatric

Administer as in adults

Aminoglycosides, loop diuretics, and doxorubicin may increase nephrotoxicity; phenytoin may decrease effects

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Severe nausea and vomiting are common; liver dysfunction can occur; renal toxicity is dose-related and cumulative; closely monitor renal, hepatic, and hematologic function

More on Hypoglycemia

Overview: Hypoglycemia
Differential Diagnoses & Workup: Hypoglycemia
Treatment & Medication: Hypoglycemia
Follow-up: Hypoglycemia
Multimedia: Hypoglycemia
References
Further Reading
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References

  1. Hill NR, Thompson B, Bruce J, et al. Glycaemic risk assessment in children and young people with Type 1 diabetes mellitus. Diabet Med. Jul 2009;26(7):740-3. [Medline].

  2. Turnbull FM, Abraira C, Anderson RJ, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. Aug 5 2009;[Medline].

  3. Garza H. Minimizing the risk of hypoglycemia in older adults: a focus on long-term care. Consult Pharm. Jun 2009;24 Suppl B:18-24. [Medline].

  4. Pugh SK, Doherty DA, Magann EF, et al. Does hypoglycemia following a glucose challenge test identify a high risk pregnancy?. Reprod Health. Jul 14 2009;6:10. [Medline].

  5. 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. Aug 2009;63(8):1161-6. [Medline].

  6. Cryer PE, Polonsky KS. Glucose homeostasis and hypoglycemia. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Williams Textbook of Endocrinology. 9th ed. Philadelphia, Pa: WB Saunders; 1998:939-71.

  7. Field JB. Hypoglycemia. Definition, clinical presentations, classification, and laboratory tests. Endocrinol Metab Clin North Am. Mar 1989;18(1):27-43. [Medline].

  8. Ibarra JD Jr. Hypoglycemia. Postgrad Med. Feb 1972;51(2):88-93. [Medline].

  9. Koch B. Selected topics of hypoglycemia care. Can Fam Physician. Apr 2006;52:466-71. [Medline].

  10. Service FJ. Classification of hypoglycemic disorders. Endocrinol Metab Clin North Am. Sep 1999;28(3):501-17, vi. [Medline].

  11. Service FJ. Diagnostic approach to adults with hypoglycemic disorders. Endocrinol Metab Clin North Am. Sep 1999;28(3):519-32, vi. [Medline].

  12. Service FJ. Hypoglycemia. Endocrinol Metab Clin North Am. Dec 1997;26(4):937-55. [Medline].

  13. Service FJ. Hypoglycemic disorders. N Engl J Med. Apr 27 1995;332(17):1144-52. [Medline].

  14. Shamoon H. Hypoglycemia. In: Endocrinology and Metabolism. 3rd ed. New York, NY: McGraw-Hill; 1995:1251-69.

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Further Reading

Related eMedicine topics:
 Diabetes Mellitus, Type 1 [Endocrinology]
Diabetes Mellitus, Type 1 [Pediatrics: General Medicine]
Diabetes Mellitus, Type 1 - A Review
Diabetes Mellitus, Type 2 [Endocrinology]
Diabetes Mellitus, Type 2 [Pediatrics: General Medicine]
Diabetes Mellitus, Type 2 - A Review
Disorders of Carbohydrate Metabolism
Hypoglycemia [Emergency Medicine]
Hypoglycemia [Pediatrics: General Medicine]
Insulinoma
Pediatrics, Hypoglycemia
Pseudohypoglycemia

Clinical guidelines:
 Neonatal hypoglycemia: initial and follow up management.
Barbara Bush Children's Hospital at Maine Medical Center - Private Nonprofit Organization.  2004 Apr.  4 pages.  NGC:004293

Guidelines for glucose monitoring and treatment of hypoglycemia in breastfed neonates.
Academy of Breastfeeding Medicine - Professional Association.  1999 (revised 2006).  7 pages.  NGC:005865

Standards of medical care in diabetes. V. Diabetes care.
American Diabetes Association - Professional Association.  1998 (revised 2008 Jan).  8 pages.  NGC:006281

Clinical trials:
 Insulin Analogues and Severe Hypoglycaemia

Mechanisms Responsible for Hypoglycemia Associated Autonomic Failure (HAAF)

Sulfonylurea Effects on Glucagon Regulation During Hypoglycemia in Type 1 DM

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Keywords

hypoglycemia, blood sugar, blood glucose, low blood sugar, high blood sugar, type 2 diabetes, diabetes mellitus, plasma glucose disorder, glucose disorder, low blood sugar, Whipple triad, decreased glucose, insulin-producing tumor, neuroglycopenic symptoms, reactive hypoglycemia, fasting hypoglycemia, hypoglycemic disorder, hypoglycemic

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Contributor Information and Disclosures

Author

Vasudevan A Raghavan, MBBS, MD, MRCP, Assistant Professor, Department of Internal Medicine, Divisions of Endocrinology, Diabetes and Metabolism and Cardiovascular Sciences, Ohio State University; Co-director of The Ross Heart Hospital Comprehensive Lipid Management Clinic, Ohio State University Medical Center
Vasudevan A Raghavan, MBBS, MD, MRCP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, Endocrine Society, National Lipid Association, and Royal College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Vellore A R Srinivasan, MSc, PhD, Associate Professor, Department of Biochemistry, Sri Balaji Vidyapeeth University, Mahatma Gandhi Medical College and Research Institute campus, Puducherry, India
Disclosure: Sri Balaji Vidyapeeth University, Mahatma Gandhi Medical College and Research Institute campus , Pondicherry ( Puducherry ) , India . P.C. 607 402 Salary Employment

Kenneth J Snow, MD, Associate Chief, Adult Diabetes, Joslin Clinic
Kenneth J Snow, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American Diabetes Association, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

David S Schade, MD, Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center
David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Yoram Shenker, MD, Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison
Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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