From the Guidelines
A sudden drop in glucose levels, known as hypoglycemia, requires immediate attention with the administration of 15 to 20 grams of glucose as the preferred treatment for conscious persons. According to the 2017 American Diabetes Association standards of medical care in diabetes 1, patients with type 1 diabetes should be asked about symptomatic and asymptomatic hypoglycemia at each encounter. Symptoms of hypoglycemia can include shakiness, irritability, confusion, tachycardia, and hunger.
Key Considerations
- If symptoms of hypoglycemia occur, consume 15 to 20 grams of glucose, such as 4 ounces of fruit juice or 3-4 glucose tablets.
- Wait 15 minutes, then recheck blood sugar levels, and repeat treatment if levels remain below 70 mg/dL.
- Once glucose levels stabilize, eat a small meal containing complex carbohydrates and protein to maintain levels.
- For severe hypoglycemia with unconsciousness, bystanders should administer glucagon via injection kit or nasal spray and call emergency services.
Prevention and Management
- Regular monitoring, consistent meal timing, and medication adjustments can help prevent hypoglycemia.
- Patients with repeated episodes of hypoglycemia may develop hypoglycemia unawareness, and insulin-treated patients with hypoglycemia unawareness or an episode of clinically significant hypoglycemia should be advised to raise their glycemic targets to strictly avoid hypoglycemia for at least several weeks 1.
- Glucagon should be prescribed for all patients at increased risk for clinically significant hypoglycemia, and caregivers, school personnel, and family members should know where the glucagon is stored and when and how to administer it 1.
From the FDA Drug Label
5.2 Hypoglycemia in Patients with Insulinoma In patients with insulinoma, administration of glucagon may produce an initial increase in blood glucose; however, Glucagon for Injection administration may directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia If a patient develops symptoms of hypoglycemia after a dose of Glucagon for Injection, give glucose orally or intravenously.
The administration of glucagon may cause a sudden drop in glucose levels in patients with insulinoma due to stimulated insulin release.
- Key points:
- Glucagon may stimulate insulin release from an insulinoma.
- This can cause hypoglycemia after an initial increase in blood glucose.
- Patients who develop symptoms of hypoglycemia should be given glucose orally or intravenously 2.
From the Research
Sudden Drop in Glucose Levels
- A sudden drop in glucose levels is known as hypoglycemia, a common complication in patients with diabetes, particularly those treated with insulin, sulfonylurea, or glinide 3.
- Hypoglycemia can be associated with physical and psychological morbidity, and the fear of hypoglycemia can impede a patient's ability to achieve good glycemic control 3.
- Severe hypoglycemia can lead to altered mental status or physical symptoms that require assistance from another individual to treat, and if left untreated, can be life-threatening 4.
Risk Factors and Prevention
- Impairments in counterregulatory responses and hypoglycemia unawareness are the main risk factors for severe hypoglycemia 3.
- Patient education on risk factors, warning signs, and treatment of hypoglycemia at an early stage is crucial in preventing hypoglycemia, along with setting personalized goals for glycemic control 3.
- Regular review and awareness of the potential dangers of hypoglycemia are essential for optimal diabetes management 5.
Treatment Options
- Treatment for severe hypoglycemia includes glucagon, which is available in various formulations, such as intranasal and subcutaneous autoinjector formulations 4, 5.
- For responsive adults, 15-20 g of oral glucose or sucrose is recommended, repeated after 10-15 minutes, while unresponsive adults may require 10% intravenous dextrose or 1 mg intramuscular glucagon 6.
- Education on symptoms, prevention, and treatment of hypoglycemia is vital for people with diabetes and their caregivers 5.