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Will Bassett


  • Definition: BG <70 mg/dL in a patient on insulin or an oral hypoglycemic; <55 mg/dL for other patients

    • Generally worse outcomes than hyperglycemia
  • Causes: infection, liver failure, iatrogenic (e.g. insulin not adjusted for AKI or being NPO)

  • Symptoms vary from tremor, palpitations, delirium, dizziness, AMS, coma


  • Give PO carbohydrate load (15-20g oral glucose) if pt is alert and tolerates PO

  • Give IV D50 if severe (<50), or cannot take PO

  • Repeat measurements after 15 minutes and treat again as needed

    • As a rule of thumb, 15g of carbs should raise BG within 15 minutes
  • Give glucagon 0.5-1mg SQ/IM if no IV access and impaired consciousness

    • Effect is transient and IV access should be obtained ASAP for glucose infusion
  • Do NOT hold basal insulin for T1DM: treat the low, then reduce dose if needed

Last update: 2022-06-20 02:12:46