Treatment of Insulin-induced Hypoglycaemia

In the conscious and cooperative patient hypoglycaemia

is treated by eating a readily absorbable form of

carbohydrate, such as sugar lumps or a glucose-based

drink; all diabetics should always carry a suitable sugar

source by way of precaution.

If the patient is drowsy or unconscious, then glucose

must be given parenterally. Doses of 50 mL of a 20%

solution of glucose or 25 to 50 mL of glucose 50% can

be given intravenously; the higher concentration is

more viscous and irritant to the veins. Lower concentrations

are equally effective, and carry less risk of irritant

effects, but larger volumes are required, e.g. up to

500 mL of glucose 5%, or 250 mL of 10%, titrated to

patient response. Smaller quantities (e.g. 5 to 10 mL/kg

of a 10% solution) are required in children. Bolus doses

may need to be repeated, or a maintenance infusion

started, to prevent persistent hypoglycaemia. If the patient

has not regained consciousness within a few minutes

after a bolus dose of glucose, the possibility of cerebral

oedema should be considered.

In situations where giving intravenous glucose is

impractical or not feasible, glucagon 1 mg for adults

and children above 25 kg or 0.5 mg for children below

25 kg by subcutaneous, intramuscular, or intravenous

injection may arouse the patient sufficiently to allow

oral glucose to be given. If the patient fails to respond

to glucagon within about 10 to 15 minutes, then glucose

has to be given intravenously despite any impracticalities.

After a return to consciousness, oral carbohydrates

may need to be given until the action of insulin has

ceased, which for preparations with a relatively long

duration of action such as isophane insulin, some insulin

zinc suspensions, and protamine zinc insulin, may

be several hours.

Precaution

Dosage requirements of insulin may be altered by

many factors. Increased doses are usually necessary

during infection, emotional stress, accidental or surgical

trauma, puberty, and the latter two trimesters of

pregnancy. Decreased doses are usually necessary in

patients with impaired renal or hepatic function or during

the first trimester of pregnancy. On first stabilising

therapy in newly diagnosed diabetic patients, a temporary

decrease in requirements may also occur (the socalled

honeymoon period).

Because of the possibility of differing responses to insulins

from different species, inadvertent change from

insulin of one species to another should be avoided.

Reduction in insulin dosage may be required on transfer

from animal (especially bovine) to human insulin.

Hypoglycaemic problems associated with a change to

human insulin are discussed under Adverse Effects,

above. Care is also necessary during excessive exercise;

hypoglycaemia caused by metabolic effects and

increased insulin absorption is the usual response, but

hyperglycaemia may sometimes occur.

The use of insulin requires monitoring of therapy, such

as testing blood or urine for glucose concentrations and

the urine for ketones, by the patient.

Drugs which have an effect on blood-glucose concentrations

may alter glycaemic control with consequent

need for a change in insulin dose (see Interactions, below)