From the Guidelines
Hypoglycemia is a condition where blood glucose levels fall below 70 mg/dL (3.9 mmol/L), requiring immediate treatment with fast-acting carbohydrates, as recommended by the most recent guidelines 1. The diagnosis of hypoglycemia involves measuring blood glucose levels and assessing symptoms such as shakiness, sweating, confusion, or dizziness.
Treatment Options
- For conscious individuals, the preferred treatment is glucose (approximately 15–20 g), although any form of carbohydrate that contains glucose may be used 1.
- Fifteen minutes after treatment, if blood glucose monitoring shows continued hypoglycemia, the treatment should be repeated.
- Once blood glucose levels normalize, the individual should consume a meal or snack to prevent recurrence of hypoglycemia.
Severe Hypoglycemia
- For severe hypoglycemia with unconsciousness or inability to swallow, bystanders should administer glucagon via injection (GlucaGen 1 mg) or nasal spray (Baqsimi 3 mg), and call emergency services.
- Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia, and caregivers or family members should be instructed on its administration 1.
Prevention
- Prevention involves regular meals, monitoring blood glucose, adjusting medications as needed, and carrying fast-acting carbohydrates at all times.
- Hypoglycemia occurs when insulin or certain diabetes medications lower blood glucose excessively, or when carbohydrate intake is insufficient relative to medication dosage, exercise, or alcohol consumption.
- Recurrent episodes warrant medical consultation to adjust treatment regimens, as hypoglycemia unawareness or one or more episodes of level 3 hypoglycemia should trigger reevaluation and adjustment of the treatment plan to decrease hypoglycemia 1.
From the FDA Drug Label
Instruct patients and their caregivers on the signs and symptoms of severe hypoglycemia Administer Glucagon for Injection as soon as possible when severe hypoglycemia is recognized 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. 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.
The diagnosis of hypoglycemia is based on signs and symptoms, and the treatment for severe hypoglycemia is administration of glucagon via subcutaneous, intramuscular, or intravenous injection, with a recommended dosage of 1 mg for adults and pediatric patients weighing more than 25 kg. If there is no response after 15 minutes, an additional dose may be administered. After the patient responds to treatment, oral carbohydrates should be given to restore liver glycogen and prevent recurrence of hypoglycemia 2. For mild episodes of hypoglycemia, treatment may include oral glucose and adjustments in drug dosage, meal patterns, or exercise 3.
From the Research
Diagnosis of Hypoglycemia
- Hypoglycemia is defined as a blood glucose level under 70 mg/dL (3.9 mmol/L) 4
- Symptoms may occur at higher blood glucose levels in individuals with poor glycaemic control 4
- Severe hypoglycemia is defined as an episode requiring the assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions to assure neurologic recovery 4
Treatment of Hypoglycemia
- The American Diabetes Association recommends oral glucose as the first-line treatment option for all conscious patients with hypoglycemia 5
- The second line of treatment (or first line in unconscious patients) is the use of glucagon 5
- Novel formulations of glucagon include the nasal form, the Gvoke HypoPen which is a ready-to-deliver auto-injector packaged formulation and finally a glucagon analogue, Dasiglucagon 5
- Intravenous glucagon and dextrose are effective in the treatment of hypoglycemic coma 6, 7
- 20% glucose solution can effectively treat hypoglycemia in diabetic patients, with the same curative effect as 50% glucose solution and is much safer 8
Management of Hypoglycemia
- A management protocol for hypoglycemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan 4
- A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycaemic goals and promote new therapies to improve quality of life of patients 4
- Continuous glucose monitoring (CGM) should be considered for all individuals with increased risk for hypoglycaemia, impaired hypoglycaemia awareness, frequent nocturnal hypoglycaemia and with history of severe hypoglycaemia 4
- Optimizing insulin doses and carbohydrate intake, in addition to a short warm up before or after the physical activity sessions may help avoiding hypoglycaemia 4