How is acute hypoglycemia treated in the emergency department (ED)?

Updated: Dec 16, 2016
  • Author: Frank C Smeeks, III, MD; Chief Editor: Erik D Schraga, MD  more...
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The initial approach in the ED should include the following:

  • ABCs (A irway, Breathing, C irculation)

  • Intravenous (IV) access

  • Oxygen

  • Monitoring

  • Accucheck

Administration of glucose as part of the initial evaluation of altered mental status often corrects hypoglycemia. As was the case in the field, treatment should not be withheld while one is waiting for a laboratory glucose value. Because the brain uses glucose as its primary energy source, neuronal damage may occur if treatment of hypoglycemia is delayed.

A hyperglycemic patient with an altered mental status may receive a bolus of glucose. This procedure is unlikely to harm the patient with high glucose; however, the delay in giving glucose to the hypoglycemic patient may be detrimental.

If an Accucheck can be performed immediately, it is reasonable to await the results (which are typically available within 1 minute) before deciding whether to administer glucose.

Once the diagnosis of hypoglycemia is made, search carefully for the cause in the previously healthy patient. In the diabetic patient, potential causes of the hypoglycemic episode include medication changes, dietary changes, new metabolic changes, recent illness, and occult infection.

A study by Akirov et al found that spontaneous or insulin-related hypoglycemia is associated with increased mortality in hospitalized patients in both the short- and long-term. The cohort included 33,675 patients who were classified into 6 groups: non-insulin treated (NITC) and insulin-treated controls (ITC), insulin-related hypoglycemia (IH) or severe hypoglycemia (ISH), and non-insulin-related hypoglycemia (NIH) and severe hypoglycemia (NISH). Hypoglycemia was defined as blood glucose < 70mg/dl. The mortality risk more than doubled in patients who had non-insulin related hypoglycemia (NIH) and insulin-related hypoglycemia (IH [2.2, 2.5]) and approximately quadrupled in patients with non-insulin related severe hypoglycemia (NISH) and insulin-related hypoglycemia (ISH [4.2, 3.8]). [11, 12]

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