Neonatal Drug Therapy Manual

Dextrose 40% Oral Gel

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Insta-Glucose, Sweet Cheeks
Treatment for hypoglycemia
Original Date: 
February 2024
  • Treatment of hypoglycemia 
  • Buccal: Dry buccal mucosa with a sterile cotton tipped applicator or dry 2x2 sterile gauze. Apply ½ of the ordered dose onto a gloved finger and massage into the buccal mucosa of one cheek. Repeat with the remaining dose inside the other cheek. For large gel volumes, the dose may be divided into 4 equal amounts and given alternating between cheeks. The gel should be provided with a feed.
  • GA ≥35 weeks, Post-natal Age ≤48 hours: 0.2 g/kg/dose (0.5 mL/kg of 40% dextrose gel) buccally; if still hypoglycemic after 30 minutes or if hypoglycemia recurs later, repeat dose; may repeat up to 6 doses over 48 hours  
Side Effects: 
  • Usually well tolerated; no significant adverse effects have been reported in studies
Parameters to Monitor: 
  • Blood glucose 
Reconstitution and Stability: 

For Insta-Glucose®: 

  • Store the tube at room temperature until opened. 
  • Suggested methods for dose measurement: 
    • #1: Using a 3 mL oral syringe, remove the plunger and squeeze gel into the syringe. Gently reinsert the plunger and push out any air and extra volume. 
    • #2: Squeeze the gel into a medicine cup. Draw up the ordered gel dose (slowly and on an angle) into a 1 mL OIT syringe. 
  • The same tube may be used for the same patient if further doses are required. Once a tube is opened, the remaining gel can be kept in the fridge for 3 days, providing the tube is well-sealed, by returning it to the clear plastic container with the white lid after use (the tube cannot be  “recapped”).
  • If tube cannot be stored as above, then treat as single use only and discard remainder. 
  • Lexi-Comp Database, accessed August 2023 
  • The Hospital for Sick Children e-formulary, accessed April 2023. 
  • Harris DL, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet. 2013 Dec 21;382(9910):2077-83. 
  • Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose. Paediatr Child Health. 2019 Dec;24(8):536-554. 
  • Edwards T, Liu G, Battin M, HarrisDL, Hegarty JE, Weston PJ, Harding JE. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database of Systematic Reviews 2022, Issue 3. Art. No.: CD011027. DOI: 10.1002/14651858.CD011027.pub3.

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