If awake and able to tolerate POs
Oral glucose
If altered mental status or otherwise unable to tolerate POs
Dextrose 50% 50mL bolus IV (equals "one amp")
Contains 25g glucose
Glucagon 1mg SC or IM (if unable to achieve IV access)
Onset of action slower than IV dextrose (7-10min)
Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)
Oral glucose
Dextrose 50% 50mL bolus IV (equals "one amp")
Contains 25g glucose
Glucagon 1mg SC or IM (if unable to achieve IV access)
Onset of action slower than IV dextrose (7-10min)
Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)
Contains 25g glucose
Onset of action slower than IV dextrose (7-10min)
Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)
Administer activated charcoal, preferably within 1 hr of ingestion
Multiple doses may be beneficial, especially for glipizide
Initial therapy regardless of known cause
50mL D50W bolus
Start a D10 1/2NS drip  (100mL/hr)
1mL/kg of D50W OR
2mL/kg D25W OR 5-10mL/kg D10W
Neonate: 5-10 mL/kg D10W
Theoretical benefit to reduce risk of recurrent<unk> 
Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release
50-100 mcg subcutaneous in adults with repeat dosing Q6hrs
2 mcg/kg (max 150mcg) subcutaneously Q6hrs should be used in children
Continuous infusion of 50-125 mcg/hr is an alternative in adults
Administer octreotide for 24 hours, then after discontinuing, monitor for<unk>  for another 24 hours
Glucagon 5mg IM may be used as temporizing measure, e.g. while obtaining IV access
Dependent on glycogen stores which may be depleted in prolonged<unk> 
Also short duration of action
Caution in using glucagon drip
Glucagon also has an insulin-releasing effect
May subsequently cause initial paradoxical<unk> 
Dependent on glycogen stores which may be depleted in prolonged<unk> 
Also short duration of action
Caution in using glucagon drip
Glucagon also has an insulin-releasing effect
May subsequently cause initial paradoxical<unk> 
Glucagon also has an insulin-releasing effect
May subsequently cause initial paradoxical<unk> 
Similar treatment as for Sulfonylureas except no role for Octreotide
Treatment should include oral intake as well as maintenance glucose containing drip either D5 or D10
Symptomatic management as above
Short acting octreotide, start at 50 μg SC TID, max 1500 μg per day
SSTR2 and SSTR5 receptors at various levels on insulinomas, producing different response levels
Octreotide can inhibit growth hormone and glucagon secretion, thereby worsening<unk>  in some pts
Long term medical management prior to surgery
Diazoxide, start at 50 mg TID, max 400 mg per day, effective in ~50% of pts
Long acting octreotide, 30 mg IM q28 days
SSTR2 and SSTR5 receptors at various levels on insulinomas, producing different response levels
Octreotide can inhibit growth hormone and glucagon secretion, thereby worsening<unk>  in some pts
Diazoxide, start at 50 mg TID, max 400 mg per day, effective in ~50% of pts
Long acting octreotide, 30 mg IM q28 days
Hypoglycemia
Anti-hyperglycemic
Nonketotic hyperglycemia
Insulin
Ketonemia
Oral secretagogue
Hyperammonemia
Sulfonylurea toxicity