What treatment is indicated for hypoglycemia (low blood glucose) with a glucose level of 43 mg/dL?

From the Guidelines

For a glucose level of 43 mg/dL, immediate treatment with fast-acting carbohydrates is necessary as this represents severe hypoglycemia. Give 15-20 grams of glucose, which can be administered as 4 ounces (120 mL) of fruit juice or regular soda, 1 tablespoon of honey or sugar dissolved in water, 3-4 glucose tablets, or glucose gel. If the patient is unconscious or unable to swallow safely, administer glucagon injection (1 mg for adults and children weighing over 25 kg, or 0.5 mg for children under 25 kg) intramuscularly or subcutaneously, or give IV dextrose (D50W, 25-50 mL for adults) if available and you have appropriate training. After treatment, recheck glucose in 15 minutes and repeat treatment if levels remain below 70 mg/dL. Once the glucose level stabilizes above 70 mg/dL, provide a more substantial snack containing protein and complex carbohydrates. This rapid intervention is critical because hypoglycemia at this level can lead to seizures, loss of consciousness, and if prolonged, brain damage or death 1.

Some key points to consider in the treatment of hypoglycemia include:

• The preferred treatment for conscious individuals with blood glucose <70 mg/dL is glucose (approximately 15–20 g) 1
• Any form of carbohydrate that contains glucose may be used to treat hypoglycemia 1
• Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia so that it is available should it be needed 1
• Hypoglycemia unawareness or one or more episodes of level 3 hypoglycemia should trigger hypoglycemia avoidance education 1

It is essential to note that the treatment of hypoglycemia should be individualized based on the patient's specific needs and circumstances. The patient's blood glucose level should be monitored closely after treatment to ensure that it returns to a safe range. If the patient experiences recurrent hypoglycemia, their treatment regimen may need to be adjusted to prevent future episodes. In addition, patients with hypoglycemia unawareness or a history of severe hypoglycemia may require more intensive education and monitoring to prevent future episodes 1.

In terms of specific treatment options, the following may be considered:

• Fast-acting carbohydrates such as glucose tablets, glucose gel, or fruit juice
• Glucagon injection for patients who are unconscious or unable to swallow safely
• IV dextrose for patients who require more rapid treatment and have access to medical facilities It is crucial to choose the most appropriate treatment option based on the patient's specific needs and circumstances, and to monitor their blood glucose level closely after treatment to ensure that it returns to a safe range 1.

From the FDA Drug Label

The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously If there has been no response after 15 minutes, an additional 1 mg dose (1 mL) of Glucagon for Injection may be administered using a new kit while waiting for emergency assistance. For a glucose level of 43, glucagon should be administered. The dose is 1 mg (1 mL) for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older, injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously 2.

• 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.

From the Research

Treatment for Hypoglycemia

• For a glucose level of 43, treatment is necessary to raise blood glucose levels.
• According to 3, the recommended treatment for nonsevere hypoglycemia is 15 to 20 g of oral glucose, which can be repeated after 15 minutes if hypoglycemia persists.

Alternative Treatments

• In cases where oral glucose is not possible, glucagon can be used as an emergency medication to raise glucose levels 4.
• Intravenous dextrose (25g) or intramuscular glucagon (1mg) can also be used to treat hypoglycemic coma 5, 6.
• A study comparing intravenous glucose and intramuscular glucagon found that recovery time was significantly faster with glucose, but glucagon was a safe and reliable alternative 7.

Important Considerations

• The choice of treatment may depend on the severity of the hypoglycemia, the patient's medical history, and the availability of medical personnel.
• It is essential to follow established guidelines and consult with a healthcare professional for proper treatment and management of hypoglycemia 3, 4, 5, 6, 7.