Neuroglycopenia or recurrent low glucose requiring immediate glucose restoration, recurrence prevention and rapid investigation of drug, organ-failure, endocrine and nutritional causes.
Confirm a low bedside glucose when this does not delay therapy, but treat immediately when severe neuroglycopenic symptoms, seizure or coma are present. Recheck a laboratory glucose when the bedside result is discordant with the clinical picture.
If the patient can swallow safely, give rapid oral carbohydrate. In severe symptoms or unsafe swallowing, give IV dextrose using the local concentrated/infusion protocol; if IV access is unavailable, glucagon can provide temporary rescue while access is obtained. Thiamine may be appropriate in malnutrition/alcohol-use risk but must not delay dextrose in symptomatic hypoglycemia.
Recheck glucose frequently after treatment and provide longer-acting carbohydrate/continuous dextrose when recurrent hypoglycemia is likely. In sulfonylurea-associated recurrent hypoglycemia, consider octreotide with toxicology/endocrine guidance rather than repeatedly treating insulin release with dextrose alone.
Caution
Never delay glucose for thiamine, diagnostic blood sampling or an attempt to identify the cause in a symptomatic patient. Rescue first; investigate recurrence in parallel.
Evidence status
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