Management

1. Monitor carefully with regular bedside estimations. The frequency should be increased in conditions known to precipitate hypoglycaemia, e.g. insulin infusion, liver failure, quinine treatment of malaria.

2. Administer 25 ml 50% glucose solution if the blood glucose is:

• < 4 mmol/l and the patient is symptomatic or

• Within the normal range but the patient is symptomatic (usually long-standing poorly controlled diabetics) Repeat as necessary every few minutes until symptoms abate and the blood glucose level has normalised.

3. If the blood glucose is 3-4 mmol/l and the patient is non-symptomatic, either reduce the rate of insulin infusion (if present), or increase calorie intake (enterally or parenterally). In insulin dependent diabetes mellitus, the insulin should continue with adequate glucose intake.

4. A continuous parenteral infusion of 10%, 20% or 50% glucose solution varying from 10-100 ml/h may be required, depending on the degree of continuing hypoglycaemia and the patient's fluid balance/urine output. 5% glucose solution only contains 20Cal/100 ml and should not be used to prevent or treat hypoglycaemia.

5. In the rare instance of no venous access, hypoglycaemia may be temporarily reversed by glucagon 1 mg given either IM or SC.

6. Continuing hypoglycaemia in the face of adequate treatment and lack of symptoms should be confirmed with a formal laboratory blood sugar estimation to exclude malfunctioning of the bedside testing equipment.

P.439

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