# Hypoglycaemia

- Category: acute
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Egyptian National Drug Formulary - endocrine.pdf, Glucagon monograph (chapter PDF p210) · Mathew P, Thoppil D. Hypoglycemia. [Updated 2022 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK534841. PMID: 30521262.
- Verified date: 2026-08

## Verified against

- Egyptian National Drug Formulary - endocrine.pdf, Glucagon monograph (chapter PDF p210)
- Mathew P, Thoppil D. Hypoglycemia. [Updated 2022 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK534841. PMID: 30521262.

## Treatment metadata

- Glucagon — injection

## Complete treatment card

```text
HYPOGLYCAEMIA
Sources: Egyptian National Drug Formulary - endocrine.pdf, Glucagon monograph (chapter PDF p210) ·
         Mathew P, Thoppil D. Hypoglycemia. [Updated 2022 Dec 26]. In: StatPearls [Internet].
         Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK534841. PMID:
         30521262.
Review status: REVIEWED against 2 sources listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (7)
    - Two families of features: those from the brain being starved of glucose, and those from the
      sympathoadrenal response
    - Brain starvation: altered behaviour, confusion, tiredness, fits, coma, and death if it is not
      corrected at once  [coma · confusion · fatigue · seizures]
    - Adrenergic features are tremor, palpitations and anxiety; cholinergic ones are hunger,
      sweating and tingling  [anxiety · palpitations · sweating · tingling · tremor]
    - Symptoms usually start at a glucose of 50 to 55 mg/dL or lower, but the threshold differs from
      person to person
    - People with diabetes can feel it at higher readings because long-standing high sugar shifts
      the set point, a false hypoglycaemia with a normal glucose
    - Ask about all medicines, alcohol and drug use, psychiatric history, and diabetes or MEN
      syndromes in the patient or family
    - Also ask about unplanned weight change, a change of drug, kidney injury or failure, hormone
      deficiency symptoms, and when the episode fell relative to meals or exercise
  SIGNS - what you find (1)
    - What an observer sees: tremor, sweating, altered behaviour, confusion, a fit or coma  [coma ·
      confusion · seizures · sweating · tremor]
  TESTS (7)
    - No lab number defines it on its own: it needs matching symptoms together with a serum glucose
      under 70 mg/dL
    - It is a clinical picture paired with a lab result, not a chemistry finding by itself
    - Documenting the Whipple triad points to it, and the first labs should confirm the low glucose
    - During a suspected episode measure insulin, proinsulin and C-peptide
    - A low C-peptide alongside high insulin means the insulin came from outside the body
    - Both C-peptide and insulin high points to a sulfonylurea or another drug that drives the
      pancreas to secrete
    - Once injected insulin is excluded, hunt for the body making too much of its own, localised by
      abdominal CT or MRI
  IF NOT THIS - what else fits (1)
    - Once it is confirmed, the cause is chased through adherence to medicines and diet, any change
      of drug, possible kidney injury, and weight change, especially loss
  Source  StatPearls "Hypoglycemia" - disease-level clinical article
  Status  traced to the source above

1. GLUCAGON                                               [1st line]
   Adult    1 mg by intramuscular, subcutaneous, or intravenous injection; may repeat after 15
            minutes if needed.
   Peds     Children weighing less than 20 kg: 0.5 mg IM, SC, or IV; may repeat after 15 minutes if
            needed.
   Source   Egyptian National Drug Formulary - endocrine.pdf, Glucagon monograph (chapter PDF p210)
   Why      Glucagon is the formulary-indicated emergency treatment for severe hypoglycaemia in
            diabetic patients who cannot take oral carbohydrate, a common emergency in Egypt's large
            insulin- and sulfonylurea-treated population.
   Caution  Severe hypoglycaemia with loss of consciousness or seizure is a medical emergency
            requiring urgent glucagon or intravenous glucose and hospital transfer.
            Severe hypoglycaemia with loss of consciousness or seizure is a medical emergency - give
            glucagon or IV glucose immediately and arrange hospital transfer.
            Glucagon is ineffective in patients with depleted glycogen stores (e.g. prolonged
            fasting, alcohol excess, adrenal insufficiency, chronic hypoglycaemia) - give IV glucose
            instead in these patients.
            Give oral carbohydrate as soon as the patient is conscious and able to swallow, to
            prevent recurrence.
   Egypt    GLUCAGEN 1MG/ML VIAL             NOVO NORDISK ...   323.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement.

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