From the Guidelines
Hypoglycemia should be treated immediately with 15-20 grams of fast-acting carbohydrates, and if severe, emergency glucagon should be administered. This is based on the most recent and highest quality study available, which emphasizes the importance of prompt treatment to prevent serious complications 1.
Causes and Risk Factors
Hypoglycemia occurs when insulin or other diabetes medications lower blood glucose too much, or when carbohydrate intake is insufficient relative to medication. Other causes include excessive alcohol consumption, certain medications, critical illness, hormone deficiencies, or reactive hypoglycemia after meals.
Symptoms and Classification
Symptoms of hypoglycemia can include shakiness, irritability, confusion, tachycardia, and hunger. The International Hypoglycaemia Study Group has proposed a classification scheme for hypoglycemia, which includes levels of severity based on blood glucose levels and symptoms 1.
Treatment and Prevention
For conscious individuals with hypoglycemia, treatment with 15-20 grams of fast-acting carbohydrates is recommended, with rechecking of blood sugar levels after 15 minutes and repetition of treatment if necessary 1. For severe hypoglycemia with unconsciousness or inability to swallow, emergency glucagon should be administered. Prevention is critical and can be achieved through regular monitoring, consistent meal timing, and medication adjustment.
Education and Emergency Response
People at risk for hypoglycemia should wear medical identification and educate family members on emergency response, including the use of glucagon kits 1. 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.
Key Recommendations
- Treat hypoglycemia immediately with 15-20 grams of fast-acting carbohydrates
- Use emergency glucagon for severe hypoglycemia with unconsciousness or inability to swallow
- Educate people at risk and their family members on emergency response
- Regular monitoring, consistent meal timing, and medication adjustment can help prevent episodes 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. The risk of hypoglycemia after an injection is related to the duration of action of the insulin and, in general, is highest when the glucose lowering effect of the insulin is maximal Other factors which may increase the risk of hypoglycemia include changes in meal pattern (e.g., macronutrient content or timing of meals), changes in level of physical activity, or changes to concomitantly administered medication Patients with renal or hepatic impairment may be at higher risk of hypoglycemia
Hypoglycemia Risk Factors:
- Changes in meal pattern
- Changes in level of physical activity
- Changes to concomitantly administered medication
- Renal or hepatic impairment Key Considerations:
- Hypoglycemia can happen suddenly
- Symptoms may differ in each individual and change over time
- Self-monitoring of blood glucose plays an essential role in the prevention and management of hypoglycemia 2
From the Research
Definition and Causes of Hypoglycemia
- Hypoglycemia is a side effect of therapy primarily with insulin, sulphonylurea derivatives, and glinides 3.
- It is an acute complication of insulin and sulfonylurea therapy in diabetes management, which can cause behavioral and cognitive disturbance, seizure, coma, and even death 4.
- The risk of hypoglycemia is higher in people with type 1 diabetes, but those with insulin-treated type 2 diabetes are also at risk 5.
Symptoms and Treatment of Hypoglycemia
- Symptoms of hypoglycemia occur at higher blood glucose concentrations in sulphonylurea-treated patients than in insulin-treated patients 6.
- The therapy for hypoglycemia is based on the immediate ingestion of sacharides, preferably glucose, with an optimal dose of 15-20 g, although some studies suggest an amount related to the patient's weight 3.
- Severe hypoglycemia can be treated with glucagon injection in non-professional settings or intravenous administration of glucose in professional settings 3.
Prevention of Hypoglycemia
- Education and regular review are essential between people with diabetes and their caregivers and healthcare professionals about symptoms, prevention, and treatment of hypoglycemia 5.
- Awareness of the potential dangers of hypoglycemia is fundamental to the optimal management of diabetes 5.
- Insulin-responsive glucagon delivery methods, such as a microneedle-array patch, can prevent hypoglycemia following high-dose insulin injection 4.
- Reducing or discontinuing insulin or sulfonylurea when initiating a glucagon-like peptide-1 agonist can promote positive patient outcomes, such as preventing hypoglycemia and minimizing weight gain 7.