However, given the short duration of glucagon (typically lasting 15-20 minutes), it is extremely doubtful that a single dose could explain her sustained improvement. She did receive one dose of IV glucagon along with the first dose of hydrocortisone. Her recovery was unremarkable, without recurrence of hypoglycemia. Over the next two days, steroid and D10W infusions were gradually weaned off. The D10W infusion was reduced from 200 ml/hr to 100 ml/hr. Immediately after starting steroid, her glucose rose to a safe level. Fortunately, she remained only mildly symptomatic with a glucose in the 20-30 mg/dL range (perhaps due to adequate intracellular glucose).īased on the failure of IV dextrose, 100 mg IV hydrocortisone Q6hr was initiated. However, her glucose remained below 30 mg/dL. Initially she received aggressive IV dextrose (several ampules of D50W plus an infusion of D10W at 200 ml/hr). Before arrival, the patient was conscious and treated with oral carbohydrate. Case #2Ī 60-year-old woman with type-II diabetes was brought to the hospital following a suicide attempt with glargine insulin. IV hydrocortisone) might be preferable to facilitate titration and avoid prolonged hyperglycemia. However, this case suggested that steroid with a shorter half-life (e.g. Hypoglycemia resolved immediately, but the patient subsequently developed moderate hyperglycemia in the 300-400 mg/dL range (without diabetic ketoacidosis). In efforts to avoid recurrent hypoglycemia, 125 mg IV methylprednisolone was given. A patient developed numerous episodes of hypoglycemia requiring large volumes of IV dextrose. The first case of steroid use for refractory hypoglycemia at Genius General occurred several years ago.
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