From the Guidelines
The most effective treatment for hypoglycemia is to consume 15-20 grams of fast-acting carbohydrates, such as glucose tablets, and recheck blood glucose levels after 15 minutes, repeating the treatment if levels remain below 70 mg/dL, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment approach for hypoglycemia depends on the severity of the condition. For mild to moderate hypoglycemia, the following steps can be taken:
- Consume 15-20 grams of fast-acting carbohydrates, such as glucose tablets, 4 ounces of fruit juice, 1 tablespoon of honey, or 5-6 pieces of hard candy.
- Wait about 15 minutes and recheck blood glucose levels.
- If levels remain below 70 mg/dL, repeat the treatment.
Severe Hypoglycemia
For severe hypoglycemia, where a person is unconscious or unable to swallow safely, emergency treatment with glucagon is necessary, as stated in the guidelines 1. Glucagon is available as an injection, nasal spray, or auto-injector, with dosing based on age and weight. After administering glucagon, turn the person on their side and call emergency services.
Prevention of Future Episodes
To prevent future episodes of hypoglycemia, it is essential to identify the cause of the hypoglycemia and adjust the treatment plan accordingly, as recommended by the guidelines 1. This may involve adjusting insulin doses, changing meal plans, or using continuous glucose monitoring systems.
Key Considerations
Some key considerations in the treatment of hypoglycemia include:
- Prompt treatment is essential to prevent serious complications like seizures or loss of consciousness.
- The treatment plan should be individualized based on the person's specific needs and medical history.
- Education on hypoglycemia recognition, treatment, and prevention is crucial for people with diabetes and their caregivers, as emphasized in the guidelines 1.
From the FDA Drug Label
2 DOSAGE & ADMINISTRATION 2. 1 Important Administration Instructions for Using the Glucagon Emergency Kit for Low Blood Sugar to Treat Severe Hypoglycemia
Glucagon for Injection is for subcutaneous, intramuscular, or intravenous injection. Administer intravenously ONLY under medical supervision. Instruct patients and their caregivers on the signs and symptoms of severe hypoglycemia Because severe hypoglycemia requires the help of others to recover, instruct the patient to inform those around them about Glucagon for Injection and its Instructions for Use. Administer Glucagon for Injection as soon as possible when severe hypoglycemia is recognized Instruct the patient or caregiver to read the Instructions for Use at the time they receive a prescription for Glucagon for Injection Emphasize the following instructions to the patient or caregiver: Using the supplied prefilled syringe, carefully insert the needle through the rubber stopper of the vial containing Glucagon for Injection powder and inject all the liquid from the syringe into the vial. Shake the vial gently until the powder is completely dissolved and no particles remain in the fluid The reconstituted solution should be clear and colorless. Inspect visually for particulate matter and discoloration. If the resulting solution is cloudy or contains particulate matter do not use. The reconstituted solution is 1 mg per mL glucagon. Immediately after reconstitution, inject the solution subcutaneously or intramuscularly in the upper arm, thigh, or buttocks In addition, healthcare providers may administer intravenously. Call for emergency assistance immediately after administering the dose. When the patient has responded to the treatment and is able to swallow, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia. Discard any unused portion.
The treatment for hypoglycemia is:
- Glucagon for Injection administered subcutaneously, intramuscularly, or intravenously
- Dosage:
- Adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older: 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously
- Pediatric patients weighing less than 25 kg or for pediatric patients with unknown weight less than 6 years of age: 0.5 mg (0.5 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously
- Administration:
- Call for emergency assistance immediately after administering the dose
- When the patient has responded to the treatment and is able to swallow, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia 2
From the Research
Treatment Options for Hypoglycemia
- Intravenous glucagon and dextrose are effective in treating hypoglycemic coma, with glucagon being a useful alternative to dextrose due to its ease of administration and lower risk of complications 3
- Intramuscular glucagon is valuable in treating severe hypoglycemia outside of hospitals, although recovery may be slower and less predictable than with intravenous dextrose 4
- New formulations of glucagon, such as nasal powder and liquid-stable glucagon, have become available and offer improved ease of use, efficacy, and safety 5
Treatment of Mild-to-Moderate Hypoglycemia
- Current recommendations suggest treating mild-to-moderate hypoglycemia with 15g of carbohydrates, but recent studies suggest that this may be insufficient for some patients, particularly those using insulin pump therapy 6
- The optimal dose of carbohydrates for treating hypoglycemia may be related to the patient's weight, rather than a fixed amount 7