Guidelines for the management of hypoglycaemia for adults

• For South Devon Healthcare information - see Torbay Hospital Intranet
• Please refer to the BNF for paediatric management

Conscious patient

• Initially 10-20g glucose by mouth (if necessary repeated at 10-15 minutes)
  • Glucose tablets = 3 tablets
  • Granulated sugar = 2 teaspoons
  • Sugar lumps = 3 lumps
  • Glucose drink = 50-55ml
  • Cola drink (not diet) = 90ml
• Use only glucose/dextrose if patient taking acarbose

GlucaGen Hypokit

(Glucagon)

• 1mg powder and solvent for solution for injection (£11.52)

Indications and dose

• Severe hypoglycaemia
  • Paediatric population (1 month to 8 years)
    • Weight less than 25kg: 500micrograms administered by subcutaneous injection, or by intramuscular injection
    • Weight 25kg or over: 1mg administered by subcutaneous injection, or by intramuscular injection
  • Adolescents (≥9 years)
  • 1mg to be administered by subcutaneous injection, or by intramuscular injection
  • Adults over 18 years
  • 1mg to be administered by subcutaneous injection, or by intramuscular injection

Notes

1. Prescribe by brand. User familiarity with one brand is important; instructions for use vary between preparations and user training is required.
2. Patients, relatives and carers should be taught how to reconstitute and administer GlucaGen Hypokit, and when to seek medical assistance.
3. The GlucaGen HypoKit should be stored at a temperature of 2-8°C. The user can store GlucaGen HypoKit at a temperature not exceeding 25°C for 18 months provided that the expiry date is not exceeded (as per the SmPC).

Ogluo

(Glucagon)

• 1mg/0.2ml solution for injection pre-filled pen (£73.00 = 1 pen)
• 500micrograms/0.1ml solution for injection pre-filled pen (£73.00 = 1 pen)

Indications and dose

• Severe hypoglycaemia
  • Paediatric population (≥2 to <6 years)
  • Weight less than 25kg: 500micrograms administered by subcutaneous injection
  • Weight 25kg or over: 1mg administered by subcutaneous injection
  • Adolescents (≥6 years)
  • 1mg to be administered by subcutaneous injection
  • Adults over 18 years (see note 3)
  • 1mg to be administered by subcutaneous injection

Notes

1. Prescribe by brand. User familiarity with one brand is important; instructions for use vary between preparations and user training is required.
2. Patients, relatives and carers should be taught how to handle and administer an Ogluo pen, and when to seek medical assistance. Ensure they understand that the Ogluo device is a single dose device which can only be used once.
   1. Patients up to 18 years: the paediatric diabetes specialist teams will provide training on the use of Ogluo.
3. Adults 18 years and older: Ogluo is significantly more expensive than GlucaGen Hypokit (above). Ogluo should be prescribed only if GlucaGen Hypokit is not available or if GlucaGen Hypokit is unsuitable for the patient’s circumstances.
4. The manufacturer has produced a video on how to use the Ogluo pre-filled pen, which is available here: Tetris Pharma Ogluo - patients
5. Ogluo pre-filled pens should be stored at a temperature between 15°C and 25°C. Ogluo can be stored at this temperature for up to 30 months provided the expiry date is not exceeded.

GlucoGel

(Glucose)

• Oral gel, 3x25g tubes (10g glucose per tube) (£7.16)

Indications

• Hypoglycaemia

Notes

1. GlucoGel is only appropriate if a patient is conscious and able to swallow.

Chronic hypoglycaemia

Diazoxide

• Tablets 50mg (£108.61 = 100 tablets)
• Injection 15mg/1ml, 20ml amp

Notes

1. Diazoxide, administered by mouth, is useful in the management of patients with chronic hypoglycaemia from excess endogenous insulin secretion, either from an islet cell tumour or islet cell hyperplasia. It has no place in the management of acute hypoglycaemia.