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6.1 Drugs used in Diabetes: Hypoglycaemia, painful diabetic peripheral neuropathy

6.1.4 Treatment of Hypoglycaemia

Glucose gel ("Hypostop")
Glucose 20% injection
Glucagon injection
Glucose 50% should not be given peripherally due to its hypertonicity, which causes thrombophlebitis
Diazoxide tablets - see note

Note:

The following procedures should be followed for treatment of hypoglycaemia:

Conscious patients who are able to swallow should have oral glucose in the form of glucose tablets (e.g. Dextrosol) or liquid (Lucozade), if they are available. If not, any sugary drink, or chocolate, should be used. For patients who are unable to swallow, a gel containing a high concentration of glucose (Hypostop) is available. It should be squeezed into the buccal cavity and the cheek gently massaged, to facilitate absorption from the buccal mucosa. Hypostop should be issued to relatives of patients with a history of serious hypoglycaemia or who have hypoglycaemia unawareness. It is prescribable on FP10.

Unconscious patients:

1mg of Glucagon/Glucagen should be given SC, IM (or IV). Pre-filled syringes are available for ease of use by patients' carers.

This should be repeated if there is no response after 5 minutes.

Glucagon is ineffective in chronic hypoglycaemia, starvation andadrenal insuficiency. In these instances 50ml glucose 20% should be given by slow IV bolus via a large vein.

When sufficiently recovered, patients should be given oral carbohydrate (e.g. orange drink with 2 spoonfuls of sugar or glucose powder).

Diazoxide are available for patients with chronic, intractable, symptomatic hypoglycaemia (due to excess insulin secretion e.g. islet cell tumours, or extra-pancreatic neoplasms etc), who are unsuitable for surgery. This is classed as a RED drug in the local Traffic Light Classification.

 

6.1.5 Treatment of painful diabetic peripheral neuropathy

Duloxetine capsules - third-line for painful diabetic neuropathy (after tricyclic antidepressants and gabapentin)

Note:

This is a distressing condition that may be difficult to treat and referral to the Neuropathy Clinic in the Diabetes Unit is advised.

Non pharmaceutical treatments can be tried first such as applying an occlusive dressing (e.g. Cutifilm, Op-site or Tegaderm) to the most painful areas. Relief begins within 24-48 hr if successful.

Standard analgesics are usually ineffective. amitryptyline or other tricyclics given at night can be very useful - start with low doses (10mg) and gradually build up to maximum tolerated levels. Carbamazepine may be a useful alternative. Gabapentin should remain a specialise use only medicine.

Other treatments exist but usually involve non-licensed indications so referral is advised.

 

6.1.6 Diagnostic and monitoring agents for diabetes mellitus

Note:

Choice of reagent strips is normally determined by patients' purchase of blood glucose meters. Details of compatibility are published in a table in MIMS, as are details of finger-pricking devices and compatible lancets.

Prescribers will be informed of any agent which is significantly more expensive through the Prescribing Newsletter.

 

For link to BNF sections: 6.1.4 Treatment of hypoglycaemia; Diabetic neuropathy