From the Guidelines
If you've been diagnosed with hypoglycemia, immediate treatment involves consuming 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, as recommended by the 2015 Diabetes Care study 1.
Key Considerations
- Wait 15 minutes, then recheck your blood glucose, and if it remains low, repeat the treatment, as suggested by the same study 1.
- Once your blood sugar normalizes, eat a small meal or snack containing protein and complex carbohydrates to prevent recurrence.
- For long-term management, follow a consistent meal schedule with small, frequent meals containing a balance of carbohydrates, proteins, and fats, and avoid skipping meals, limit alcohol consumption, and exercise regularly but with caution.
Prevention and Education
- Patients should be educated about times when they may be at increased risk for hypoglycemia, such as while fasting for tests, with delayed meals, during or after exercise, and during sleep, as highlighted in the 2017 Annals of Internal Medicine study 1.
- Self-monitoring of blood glucose and, for some patients, continuous glucose monitoring (CGM) are important tools to monitor glucose levels and prevent hypoglycemia.
Severe Hypoglycemia
- Glucagon is indicated for the treatment of hypoglycemia in patients unable or unwilling to consume carbohydrates by mouth, and those in close contact with a patient who has type 1 diabetes should be instructed on the safe use of glucagon kits in case of an emergency, as recommended by the 2017 Annals of Internal Medicine study 1.
- Severe hypoglycemia can progress to loss of consciousness, seizure, coma, or death, and prevention is critical for type 1 diabetes management.
From the FDA Drug Label
5.1 Hypoglycemia All sulfonylureas, including glimepiride, can cause severe hypoglycemia [see ADVERSE REACTIONS (6. 1)]. 5.1 Hypoglycemia All glinides, including repaglinide tablets, can cause hypoglycemia [see Adverse Reactions (6. 1)] . The patients diagnosed with hypoglycemia should be educated to recognize and manage hypoglycemia.
- Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important (e.g., driving or operating other machinery).
- Factors which may increase the risk of hypoglycemia include changes in meal pattern (e.g., macronutrient content), changes in level of physical activity, changes to co-administered medication, and concomitant use with other antidiabetic agents.
- Patients with renal or hepatic impairment may be at higher risk of hypoglycemia 2, 3.
- In patients who experience hypoglycemia, the dose of the medication should be reduced 3.
From the Research
Diagnosed Hypoglycemia
- Hypoglycemia is a serious problem in insulin-treated diabetic patients, and its treatment is crucial to prevent further complications 4.
- The efficacy of intravenous glucagon and dextrose in treating hypoglycemia has been compared, with both being effective in treating hypoglycemic coma, although recovery of normal consciousness was slower with glucagon 4.
- A systematic review and meta-analysis compared the effectiveness of glucagon with dextrose and different glucagon formulations, finding that ineffectiveness of glucagon is unfrequent and not different from dextrose 5.
Treatment Options
- Intranasal glucagon has been approved for use in the acute treatment of severe hypoglycemia in patients with diabetes, offering an alternative to injectable glucagon 6.
- Studies have shown that intranasal glucagon is effective in increasing blood glucose levels within 15-30 minutes, with a mean time to treatment success of 10-20 minutes 6.
- The efficacy and usability of intranasal glucagon have been evaluated, with results showing that it is a useful option for the management of hypoglycemia in patients with diabetes 6.
Prevention and Management
- Hypoglycemia is a common complication in patients with diabetes, and its prevention and management are crucial to prevent physical and psychological morbidity 7.
- Patient education regarding risk factors, warning signs, and treatment of hypoglycemia is essential to prevent hypoglycemia and improve glycemic control 7.
- Current and new formulations of glucagon are available for the treatment of severe hypoglycemia, and education and regular review are essential for optimal management of diabetes 8.