Correspondence (letter to the editor): isotonic is better.

The article recommends intravenous injection of a 20% glucose solution for the treatment of severe hypoglycemia and unconsciousness in type 1 diabetes mellitus in children, followed by continuous glucose infusion (1). It must be born in mind that this glucose solution is strongly hypertonic (1110 mosmol/L), so that it would be expected that this should irritate the wall of the vein. After repeated episodes of hypoglycemia and repeated glucose injections, all peripheral veins will be obliterated sooner or later. Rather than using high percentage glucose solutions, it is better to use isotonic 5% glucose solution, as even a slight increase in blood sugar is enough to recover consciousness. An alternative is treatment with IM glucagon (2).