*Admit pts with ingestion of a long-acting hypoglycemic agent, recurrent hypoglycemia during observation, and those unable to eat.
Admit to intermediate care.
Blood glucose
Insulin,
Proinsulin,
C-peptide,
Beta-hydroxybutyrate (BHOB),
Screen for oral hypoglycemic agents
TSH
Cortisol level
*Lactate and procalcitonin, if pt is sick
*If pt doesn’t have AMS and can drink and swallow safely (with intact gag reflex), give them something to eat to raise their sugars. E.g, Rapidly-absorbed carbs like: 3 to 4 glucose tablets or a tube of gel with 15 grams, 4 to 6 oz. fruit juice or regular soda (not diet soda), or a teaspoon of honey or table sugar. Measure BS in 10 to 15 mins of eating sth.
*If pt has AMS, can’t swallow, or doesn’t respond to oral glucose within 15 mins, give an IV bolus of 25 to 50ml (12.5 to 25g) of D50. Measure a BS 10 to 15 mins after the IV bolus. Give another IV bolus of 25 to 50ml of D50 as needed to maintain the BS above 80 mg/dL.
*If we can’t give glucose po or IV, then we will give glucagon 1 mg IM or subcutaneously. After that, still find ways to give glucose po or IV.
Give additional maintenance glucose by mouth or IV. IV dextrose infusion should ensure delivery of 6 to 9 mg/kg per minute of glucose.
Will measure a BS 10 to 15 mins after the initial IV bolus and monitor every 30 to 60 minutes thereafter until stable (minimum of four hours).
Will Use a quick POC method like Accucheck to follow BS.
Work up for a hypoglycemic episode in a patient who is otherwise healthy.
-72-hour fast.
Helpful resources
https://academic.oup.com/jcem/article/98/10/39A/2833336