Hypoglycemia Management Page 1 of 4

This practice algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson,
including the following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. Moreover, this algorithm is not
intended to replace the independent medical or professional judgment of physicians or other health care providers. This algorithm should not be used to treat pregnant women.

PRESENTATION NOTE: Call CODE at any time if patient in apparent physical distress

Yes
● Implement
Patient on hypoglycemic Hypoglycemia order set1,2 Able
medications1 or clinical suspicion of ● Call attending or to eat/drink by
hypoglycemia based on signs and responsible provider mouth?
Yes
symptoms below: Perform the following STAT: Glucose involved No
● Diaphoresis ● Vital signs and oxygen saturation less than
● Shakiness ● Fingerstick or serum glucose level 70 mg/dL?2
● Mental health changes
No See Page 2
● Headache Call MERIT and follow
● Hunger orders per physician

See Page 2 Yes

Has patient
received 2 oral treatments for
Repeat treatment until glucose hypoglycemia?
No
greater than or equal to 70mg/dL

Yes
Eat/drink 15-20 grams carbohydrates,
choose one of the following: Wait 15 minutes
Glucose
● 1/2 cup fruit juice after treatment and
less than Once fingerstick glucose ● Document hypoglycemic
● 3/4 cup non-diet soda recheck fingerstick
70 mg/dL? is greater than 70 mg/dL event and interventions
● 1 cup milk glucose No and symptoms resolved, in bedside glucose record
● 1 tube glucose gel
recheck fingerstick ● Disposition per
glucose in one hour healthcare provider
1
If patient is using a subcutaneous insulin pump, pause pump until instructed by provider to restart.
2
If patient has an insulin pump and fingerstick glucose is less than 70 mg/dL, ask patient to stop insulin infusion from the pump until glucose values are above 70 mg/dL.
Department of Clinical Effectiveness V4
Copyright 2017 The University of Texas MD Anderson Cancer Center Approved by the Executive Committee of the Medical Staff on 11/29/2016
 Hypoglycemia Management Page 2 of 4
This practice algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson,
including the following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. Moreover, this algorithm is not
intended to replace the independent medical or professional judgment of physicians or other health care providers. This algorithm should not be used to treat pregnant women.

NOTE: Call CODE at any time if patient in apparent physical distress

Continue treatment: administer dextrose 50%, 50 mL
Patient unable to eat or (25 grams) by slow IV push, followed by normal saline flush.
drink by mouth or Administer dextrose 50%, 25 mL (For patients 5kg - 25kg1 D50% 1 mL/kg by slow IV push
hypoglycemia despite (12.5 grams) by slow IV push, Yes followed by normal saline flush. If patient weighs less than
2 oral treatments Wait 15 minutes
followed by normal saline flush. 5kg, give D10% 5mL/kg by slow IV push)
after treatment Glucose
(For patients 5kg - 25kg1
and recheck less than
D50% 1 mL/kg by slow IV push
fingerstick 70 mg/dL?
followed by normal saline flush. If
glucose No
Yes patient weighs less than 5kg, give
D10% 5mL/kg by slow IV push)
Able
to obtain IV Healthcare ● Document hypoglycemic
Once fingerstick glucose
access? provider to event and interventions in
is greater than 70 mg/dL
determine bedside glucose record and
and symptoms resolved,
No further MAR
recheck fingerstick
Administer glucagon2 1 mg subcutaneously treatment and ● Disposition per healthcare
glucose in one hour
(0.5 mg subcutaneously if patient less than 25 kg1) disposition provider

Healthcare provider to Once fingerstick glucose is If glucose does ● Document hypoglycemic event
Wait 15 minutes after and interventions in bedside
determine further greater than 70 mg/dL and not improve, call
treatment and recheck glucose record and MAR
treatment and symptoms resolved, recheck MERIT, MD or
fingerstick glucose ● Disposition per
disposition fingerstick glucose in one hour APP
healthcare provider
1
If patient weighs less than 25 kg then notify physician for additional IV Fluid orders.
2
NOTES: If glucagon is contraindicated, MD will provide an alternate treatment plan.
In emergency, satellite pharmacy will dispense glucagon without printed order.

Department of Clinical Effectiveness V4

Copyright 2017 The University of Texas MD Anderson Cancer Center Approved by the Executive Committee of the Medical Staff on 11/29/2016
 Hypoglycemia Management Page 3 of 4
This practice algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson,
including the following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. Moreover, this algorithm is not
intended to replace the independent medical or professional judgment of physicians or other health care providers. This algorithm should not be used to treat pregnant women.

SUGGESTED READINGS

American Diabetes Association. (January 2011). Standards of Medical Care in Diabetes – 2011. Diabetes Care. 34(1):11-61
Cryer, Philip E., Axelrod, Lloyd, Grossman, Ashley B., et. Al.; (March 2009). Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical
Practice Guideline. J Clin Endocrinol Metab. 94(3):709-728.
McEuen, Judy A., Gardner, K. Paige, Barachea, Dawn F., et Al.; (July 2010). An Evidence-Based Protocol for Managing Hypoglycemia. AJN. 110(7):40-45.
Society of Hospital Medicine Glycemic Control Task Force. (2007). Workbook for Improvement: Improving Glycemic Control, Preventing Hypoglycemia, and Optimizing
Care of the Inpatient with Hyperglycemia and Diabetes. Retrieved electronically on September 2, 2011 from http://www.hospitalmedicine.org.
Tomky, Donna. (2005). Detection, Prevention, and Treatment of Hypoglycemia in the Hospital. Diabetes Spectrum. 18(1)39-44.

Department of Clinical Effectiveness V4

Copyright 2017 The University of Texas MD Anderson Cancer Center Approved by the Executive Committee of the Medical Staff on 11/29/2016
 Hypoglycemia Management Page 4 of 4
This practice algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson,
including the following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. Moreover, this algorithm is not
intended to replace the independent medical or professional judgment of physicians or other health care providers. This algorithm should not be used to treat pregnant women.

DEVELOPMENT CREDITS

This practice consensus algorithm is based on majority expert opinion of Hypoglycemia work group at the University of Texas MD Anderson Cancer
Center. It was developed using a multidisciplinary approach that included input from the following:

Veronica J. Brady, BC, FNP, RN

Maria-Claudia Campagna, MD
Tennille Campbell, RN
Katherine Cain, PharmD, RPh
Karen Chen, MD
Yoliette Goodman, MBA♦
Firoze Jameel, MSN, RN, OCN♦
Patty Johnston, DNP, RN, OCN
Judy M. Keaveny, RN, MS, CNS M-S, CDE
Victor R. Lavis, MDŦ
Rodrigo Mejia, MDŦ
Cindy Murphy, MS, RN-BC, OCN
Goley B. Richardson, RN, BSN, OCN
Sonali Thosani, MDŦ
Steven Waguespack, MD
Laura Worth, MD, PhD
Anita Kuo Ying, MDŦ

Ŧ
Physician Leads
♦
Clinical Effectiveness Development Team

Department of Clinical Effectiveness V4

Copyright 2017 The University of Texas MD Anderson Cancer Center Approved by the Executive Committee of the Medical Staff on 11/29/2016