D10 vs. D50 for the Treatment of Hypoglycemia in the Emergency Department.
The Journal of emergency medicine · 2026-08-20 · Observational study
Abstract
BACKGROUND: Studies in the prehospital setting comparing D10 and D50 for the treatment of hypoglycemia have demonstrated equivalent efficacy and fewer adverse effects with D10. Despite these results, D50 is commonly used first-line in the emergency department (ED). OBJECTIVE: The purpose of this study is to compare the efficacy and safety of D10 and D50 for the treatment of hypoglycemia in the ED. METHODS: This was a single-center retrospective cohort study of adult patients with a blood glucose (BG) <70 mg/dL and administered D10 or D50 in the ED. The primary outcome was time to achieve euglycemia. Safety outcomes included incidence of hyperglycemia (BG > 180 mg/dL) and rebound hypoglycemia (BG < 70 mg/dL) within 6 h. A subgroup of patients with severe hypoglycemia (BG < 40 mg/dL) was evaluated separately. RESULTS: Three hundred seventy-five patients were included, with 246 receiving D10 and 129 receiving D50. Patients were predominantly African American (61.3%) and had a history of diabetes (56%). D50 administration resulted in a nonsignificant decrease in time to euglycemia compared to D10 (38.0 vs. 51.0 min, p = 0.053). More patients in the D50 group experienced rebound hypoglycemia (43.4% vs. 27.2%, p = 0.002). Time to euglycemia was not different between groups when only evaluating severe hypoglycemia (34.5 vs. 34.5 min; p = 0.655). CONCLUSION: D50 was associated with a clinically, although not statistically, significant decrease in time to achieve euglycemia and significantly higher rate of rebound hypoglycemia. Larger studies are warranted to confirm findings and compare D10 and D50 in patients with severe hypoglycemia.