From the Guidelines
Glucose is the most effective and recommended option for treating hypoglycemia, due to its rapid absorption and direct entry into the bloodstream, as supported by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When blood sugar drops below 70 mg/dL, the standard treatment is 15-20 grams of fast-acting carbohydrates, ideally in the form of glucose tablets, glucose gel, or dextrose. 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 with dietary sugars such as sucrose, fructose, orange juice, jellybeans, candy tablets, and milk 1.
- Untreated hypoglycemia can cause seizures, status epilepticus, permanent brain injury, and death, making prompt treatment crucial 1.
- Glucose is preferred because it's rapidly absorbed and directly enters the bloodstream without requiring additional processing by the liver.
- Sucrose (table sugar), which is a combination of glucose and fructose, is also effective but works slightly slower since only half of it is immediately available as glucose.
- Fructose is not recommended for hypoglycemia treatment because it must be converted to glucose by the liver first, making it too slow to quickly raise blood sugar levels in an emergency situation. For practical application, keep glucose tablets or gel readily available, consume 15-20 grams when symptoms occur, wait 15 minutes, then recheck blood sugar and repeat treatment if levels remain below 70 mg/dL. Follow with a small snack containing protein and complex carbohydrates once blood sugar normalizes to prevent recurrence. It's also important to note that initial response to treatment for hypoglycemia should be seen in 10 –20 min; however, blood glucose should be evaluated again in 60 min, as additional treatment may be necessary, as stated in the evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications 1.
From the Research
Comparison of Glucose, Fructose, and Sucrose in Hypoglycemia Treatment
- Glucose is often recommended for the treatment of hypoglycemia due to its rapid absorption and effect on blood glucose levels 2, 3, 4
- Fructose, on the other hand, has been shown to have a slower and more gradual effect on blood glucose levels, making it potentially less effective for rapid treatment of hypoglycemia 5, 4
- Sucrose, a disaccharide composed of glucose and fructose, has been found to be effective in treating hypoglycemia, with some studies suggesting it is as effective as glucose 2, 3, 4
Efficacy of Different Sugars in Hypoglycemia Treatment
- A study comparing glucose, sucrose, and fructose in children with type 1 diabetes found that glucose and sucrose were equally effective, while fructose was significantly less effective 4
- Another study found that dietary sugars, including sucrose and fructose, were less effective than glucose tablets in relieving symptomatic hypoglycemia 3
- A study on subjects with reactive hypoglycemia found that fructose given as a drink resulted in relatively flat serum glucose and insulin responses and did not cause a hypoglycemic reaction in any of the subjects, while glucose caused a hypoglycemic reaction in some subjects 5
Treatment Guidelines and Recommendations
- Current treatment guidelines for hypoglycemia recommend 15-20 g of oral glucose or sucrose, repeated after 10-15 min, for treatment of responsive adults 2
- For unresponsive adults, guidelines recommend 10% intravenous dextrose or 1 mg intramuscular glucagon 2, 6
- There is limited high-quality evidence to support specific treatment recommendations, and further studies are needed to inform optimal management of hypoglycemia 2, 3