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Optimal Carbohydrate Dose for Treatment of Nonsevere Hypoglycemia in Insulin-Treated Patients With Diabetes: A Narrative Review

Published:April 06, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.03.011

      Abstract

      Nonsevere hypoglycemia in people with diabetes is usually treated with rapid-acting carbohydrate, of which glucose is the most suitable form. A quantity of 15 g is recommended and repeated after 15 min if hypoglycemia persists. This recommendation has not changed for several years despite the introduction of continuous glucose monitoring, newer and more flexible insulin regimens and improved insulin delivery. The present review has examined published studies that have explored how effectively defined amounts of carbohydrate treat nonsevere hypoglycemia in adults with insulin-treated diabetes. For most nonsevere episodes of hypoglycemia, the optimal treatment is 15 to 20 g of oral glucose. However, this dose may not be appropriate with many current insulins and insulin pump therapy, where doses of glucose may have to be individualized, based on body weight or type of insulin delivery system. Current guidelines on hypoglycemia treatment for newer glucose-lowering therapies may require re-evaluation.

      RÉSUMÉ

      Le traitement de l’hypoglycémie bénigne chez les personnes diabétiques repose généralement sur les glucides à absorption rapide desquels le glucose est la forme la plus appropriée. Une quantité de 15 g est recommandée et répétée après 15 min si l’hypoglycémie persiste. Cette recommandation n’a pas changé depuis plusieurs années en dépit de l’instauration de la surveillance de la glycémie en continu, des schémas posologiques plus récents et plus flexibles et de l’administration améliorée de l’insuline. La présente revue a porté sur les études publiées qui se sont penchées sur la façon dont des quantités bien définies de glucides contribuent au traitement de l’hypoglycémie bénigne chez les adultes diabétiques traités par insuline. Dans la plupart des épisodes d’hypoglycémie bénigne, le traitement optimal est de 15 à 20 g de glucose par voie orale. Toutefois, cette dose ne convient pas aux nombreuses insulines actuelles et au traitement par pompe à insuline dont les doses de glucose peuvent devoir être individualisées, et ajustées en fonction du poids corporel ou du type de système d’administration d’insuline. Les lignes directrices actuelles sur le traitement de l’hypoglycémie par les plus récents traitements hypoglycémiants doivent faire l’objet d’une ré-évaluation.

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      Mots clés

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