Management of Refractory Hypoglycemia

Initial Management

The European Society of Intensive Care Medicine recommends immediately checking blood glucose levels using arterial blood for more accurate results 1, 2
Administering 10-20g of hypertonic (50%) dextrose IV immediately to correct hypoglycemia is recommended 3
Continuous IV dextrose infusion should be used to maintain blood glucose >70 mg/dL but <180 mg/dL, as recommended by the European Society of Intensive Care Medicine 4, 5
Blood glucose should be monitored every 15-30 minutes initially, then every 1-2 hours until stable, according to the European Society of Intensive Care Medicine 6, 1

The European Society of Intensive Care Medicine recommends implementing a protocolized approach to blood glucose management, targeting an upper blood glucose level ≤180 mg/dL rather than tighter control 4, 6
Arterial blood rather than capillary blood should be used for glucose monitoring if an arterial catheter is available, as recommended by the European Society of Intensive Care Medicine 1
Avoiding tight glucose control (<150 mg/dL) is recommended, as it increases risk of hypoglycemic events in sepsis, according to the European Society of Intensive Care Medicine 5, 2

The European Society of Intensive Care Medicine recommends continuing glucose monitoring every 1-2 hours until glucose values and insulin infusion rates are stable 6
Avoiding reliance on capillary blood glucose measurements alone in critically ill patients, especially those with poor perfusion, is recommended by the European Society of Intensive Care Medicine 6, 1
The European Society of Intensive Care Medicine advises against targeting overly tight glucose control (<150 mg/dL) in septic patients, as this increases mortality risk 4, 5