What is the medical management of hypoglycemia (low blood sugar)?

From the Guidelines

The primary medical management of hypoglycemia involves quickly raising blood glucose levels with 15-20 grams of fast-acting carbohydrates orally, such as glucose tablets, fruit juice, or regular soda, as recommended by the most recent guidelines 1. For conscious patients, this initial treatment should be followed by rechecking blood glucose after 15 minutes and repeating treatment if necessary.

Key Considerations

• 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, and caregivers, school personnel, or family members should know where it is and when and how to administer it 1.
• For severe cases or unconscious patients, immediate medical intervention is required, which may include intravenous (IV) glucose or glucagon injection.
• After initial treatment, providing a meal or snack containing complex carbohydrates and protein can help prevent recurrence of hypoglycemia.

Ongoing Management

• Identify and address the underlying cause of hypoglycemia, such as adjusting diabetes medications or treating underlying conditions.
• Educate patients on recognizing symptoms and proper self-management of hypoglycemia.
• Consider prescribing glucagon kits for at-risk patients and their caregivers, as glucagon administration is not limited to healthcare professionals 1.

Important Definitions

• Level 1 hypoglycemia is defined as a measurable glucose concentration <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L) 1.
• Level 2 hypoglycemia is defined as a blood glucose concentration <54 mg/dL (3.0 mmol/L), which requires immediate action to resolve the hypoglycemic event 1.
• Level 3 hypoglycemia is defined as a severe event that requires immediate medical attention. This approach quickly restores blood glucose levels while addressing both immediate and long-term concerns, prioritizing the patient's morbidity, mortality, and quality of life 1.

From the FDA Drug Label

Hypoglycemia is the most common adverse reaction of all insulins, including NOVOLOG. Severe hypoglycemia can cause seizures, may lead to unconsciousness, may be life threatening or cause death. Patients and caregivers must be educated to recognize and manage hypoglycemia. Self-monitoring of blood glucose plays an essential role in the prevention and management of hypoglycemia; increased frequency of blood glucose monitoring is recommended In patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia; increased frequency of blood glucose monitoring is recommended.

The medical management of hypoglycemia (low blood sugar) involves educating patients and caregivers to recognize and manage hypoglycemia, and self-monitoring of blood glucose to prevent and manage hypoglycemia.

• Increased frequency of blood glucose monitoring is recommended in patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia. 2

From the Research

Medical Management of Hypoglycemia

The medical management of hypoglycemia involves various treatments and strategies to raise blood glucose levels. Some key points include:

• Glucagon is an emergency medication that can quickly raise glucose in people who are unconscious or unable to consume glucose due to severe hypoglycemia 3.
• New formulations of glucagon, such as nasal powder glucagon and liquid-stable glucagon, have become available and offer improved ease of use and efficacy compared to traditional glucagon emergency kits 3, 4.
• Intravascular bolus dextrose and intramuscular glucagon are commonly used treatments for hypoglycemia in the emergency department 5.
• The American Diabetes Association recommends that a management protocol for hypoglycemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan 6.
• Continuous glucose monitoring (CGM) should be considered for all individuals with increased risk for hypoglycemia, impaired hypoglycaemia awareness, frequent nocturnal hypoglycaemia, and with history of severe hypoglycaemia 6.

Treatment Options

Some treatment options for hypoglycemia include:

• Intranasal glucagon, which has been shown to be effective and easy to use in patients with diabetes 4.
• Injectable glucagon, which is recommended for patients who are disoriented or unconscious 4.
• Dextrose containing intravenous fluids, which can help raise blood glucose levels 5.
• Medical food bars that provide a sequential release of glucose into the bloodstream, which can help control blood glucose levels 7.

Prevention Strategies

Some prevention strategies for hypoglycemia include:

• Optimizing insulin doses and carbohydrate intake 6.
• Avoiding hypoglycemia during pregnancy by administering rapid-acting insulin analogues rather than human insulin, pre-conception initiation of insulin analogues, and immediate postpartum insulin dose reduction 6.
• Consuming foods with varying glycemic indices to help control hypoglycemia 7.