From the Guidelines
For immediate treatment of hypoglycemia, administration of 20 g oral glucose or the equivalent in glucose-containing foods is recommended to rapidly restore blood glucose levels. This is based on the most recent guidelines from the American Heart Association and American Red Cross, as stated in the 2024 guidelines 1. The guidelines emphasize the importance of promptly treating hypoglycemia to prevent severe complications such as seizures, status epilepticus, permanent brain injury, and death.
Some key points to consider when treating hypoglycemia include:
- Oral glucose tablets have been shown to demonstrate better resolution of symptoms 15 minutes after treatment compared to dietary sugars such as sucrose, fructose, orange juice, jellybeans, candy tablets, and milk 1
- Glucose products that are swallowed, such as tablets or gels, result in higher blood glucose levels than buccally applied glucose (spray or gel) 1
- For people with hypoglycemia who are unable to swallow, intravenous dextrose can be lifesaving 1
It's essential to identify and address the underlying cause of hypoglycemia, as treatment varies based on whether it's reactive hypoglycemia, diabetes-related, or caused by other medical conditions. Always carrying fast-acting carbohydrates and maintaining regular eating patterns can help prevent hypoglycemic episodes. The 15-15 rule can be followed: consume 15 grams of fast-acting carbohydrates, wait 15 minutes, then recheck blood sugar, and repeat the process if still low.
From the Research
Oral Medication for Hypoglycemia
- The standard treatment for hypoglycemia is oral carbohydrate, typically 15-20g of glucose or sucrose, repeated after 10-15 minutes if necessary 2.
- However, some studies suggest that this may not be sufficient to treat all episodes of hypoglycemia, particularly in patients with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) 3.
- Alternative treatments, such as mini-dose glucagon, have been shown to be effective in treating mild hypoglycemia and may be a useful alternative to oral carbohydrate 4.
- Glucagon has been found to be similarly effective to dextrose in treating hypoglycemia, and intranasal glucagon may be a convenient and effective option 5.
Factors Affecting Treatment Effectiveness
- The effectiveness of treatment for hypoglycemia can be influenced by various factors, including the severity of the hypoglycemia, the type of diabetes, and the individual's insulin regimen 3, 4.
- For example, patients with type 1 diabetes using CSII may require more aggressive treatment for hypoglycemia due to the rapid onset of action of insulin analogs 3.
- Additionally, the proportion of total daily insulin from basal doses can affect the post-treatment plasma glucose rise, with a higher proportion of basal insulin associated with a slower rise in glucose levels 3.
Treatment Guidelines and Evidence
- Current treatment guidelines for hypoglycemia are based on limited evidence, and high-quality studies are needed to inform the optimum management of this condition 2.
- The evidence search for emergency treatment of hypoglycemia returned 2649 articles, but only 17 were found to be relevant and of sufficient quality to inform treatment recommendations 2.
- Further research is needed to evaluate the effectiveness of different treatments for hypoglycemia and to develop evidence-based guidelines for management 2.