Thread by @EmergPharm

Let’s rethink our approach in the management of severe hypoglycemia #ASHP19

Hypoglycemia is the most common and feared complication in those with #diabetes #ASHP19

In addition to short term complications, hypoglycemia accounts for 10% of deaths in patients with type 1 DM and is associated with a 2.7x greater risk of mortality amongst those with type 2 DM #ASHP19

Even though we frequently encounter hypoglycemia in the ED, we also frequently leave it untreated.

12% patients with BG ≤50 mg/dL may not receive treatment while in the ED ncbi.nlm.nih.gov/m/pubmed/27832… #ASHP19

We have room to improve. Median time to treatment after recognizing hypoglycemia was 12 min. #ASHP19

Historically, D50% has been 1st line tx for severe hypoglycemia. There are 3️⃣ major drawbacks with D50:

-⬆️ osmolarity (~2500 mOsm/L)

-More likely to overshoot target BG & cause hyperglycemia

-Rapid excursions in BG may inadvertently lead to rebound HYPOglycemia #ASHP19

Instead of using D50, consider rapid IV bolus of 10-20 grams (100-200 mL) D10 for hypoglycemia #ASHP19

Prehospital RCT of 51 unresponsive adults with hypoglycemia (median initial BG 26 mg/dL) compared D10 vs D50.

No difference in time to achieve full consciousness (8 mins).

D10 group required less total dextrose (10 vs 25 g) #ASHP19

In an observational trial of 871 adults with severe hypoglycemia, 10 g (100 mL) of D10 improved BG from a median of 37 ➡️ 91 mg/dL.

Hypoglycemia resolved 99% of patients after administration of 10-20 g. ncbi.nlm.nih.gov/m/pubmed/27918… #ASHP19

More recent restrospective review evaluating EMS treatment with D10 and D50 from @KyleWeant

ncbi.nlm.nih.gov/m/pubmed/31769… #ASHP19

Ongoing shortages of D50 make this a perfect time to implement change of practice to utilize D10! #ASHP19