Hypoglycemia Therapy for Patients with Diabetic Ketoacidosis

For patients on insulin drip:

• If blood glucose drops between 80 to 99 mg/dL decrease IV insulin to 0.05 units/kg/hour.

• If blood glucose drops to < 80 mg/dL stop IV insulin, follow hypoglycemia protocol located under supportive documents, and contact the primary medical team.

• Consider resuming IV insulin infusion after hypoglycemia is resolved, per discussion with the primary medical team. If insulin infusion was stopped, resume at 0.05 units/kg/hour rather than 0.1 units/kg/hour. Continue until bicarbonate level is ≥ 20 mol/L, anion gap is normalized, or blood ketones are < 0.6 mmol/L.

Hypoglycemia protocol:

• Blood glucose < 80 mg/dL:

  • Stop insulin drip. 

  • Maximize D₁₀ NS with additives IV fluids if not already at 100%. 

  • Recheck glucose in 15 minutes. 

  • If > 80 mg/dL continue current management and contact the primary medical team. 

  • If blood glucose remains < 80 mg/dL, treat with:

    1. Patients who are alert and oriented without nausea/vomiting:

       1. 15 grams of simple carbohydrate to eat/drink: 4 ounces of fruit juice, 5-6 ounces of non-caffeinated regular soda, 6-7 saltine crackers, or 1 package of snack-size crackers.

       2. Recheck blood glucose in 15 minutes.  If blood glucose remains < 80 mg/dL repeat treatment and contact the primary medical team.

    2. Patients who are not alert and oriented, or have nausea/vomiting:

       1.  Administer D₂₅W 1 ml/kg bolus IV and contact the primary medical team.