Medication Summary
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 Supplement
Class Summary
Glucose supplements are used to raise the patient's serum glucose.
Dextrose (Glucose-D)
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
Class Summary
Glucose-elevating agents can act in the pancreas or the peripheral tissues to increase blood glucose levels.
Glucagon (GlucaGen, Gvoke)
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 for dextrose administration 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. It is also available as a ready-to-use subcutaneous (SC) solution in prefilled syringes or an autoinjector.
Glucagon intranasal (Baqsimi)
This agent activates hepatic glucagon receptors, which stimulate cyclic adenosine monophosphate (cAMP) synthesis. Hepatic glycogenolysis and gluconeogenesis are thus accelerated, with blood glucose levels consequently increasing. Glucagon requires preexisting hepatic glycogen stores to effectively treat hypoglycemia. Glucagon intranasal is indicated for severe hypoglycemic reactions in adults and children (aged 4 years or older) with diabetes.
Inhibitors of insulin secretion
Class Summary
Agents that inhibit insulin secretion increase glucose levels by reducing peripheral glucose metabolism.
Diazoxide (Proglycem)
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.
Octreotide (Sandostatin)
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
Class Summary
Antineoplastic agents inhibit cell growth and proliferation.
Streptozocin (Zanosar)
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.
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Diagnostic algorithm. A systematic approach is often required to establish the true cause of hypoglycemia, using an algorithmic approach.
