What is the immediate treatment for hypoglycemia?

From the Guidelines

The immediate treatment for hypoglycemia is to consume 15-20 grams of fast-acting carbohydrates, as recommended by the most recent guidelines 1. This can be achieved by drinking 4 ounces (1/2 cup) of fruit juice or regular soda, eating 4-5 glucose tablets, taking 1 tablespoon of honey or sugar, or consuming 8 ounces of milk. After taking these quick-acting carbohydrates, wait 15 minutes and recheck blood glucose levels. If levels remain below 70 mg/dL, repeat the treatment. Once blood glucose returns to normal, eat a small snack containing both carbohydrates and protein if the next meal is more than an hour away. This approach works because fast-acting carbohydrates are quickly absorbed into the bloodstream, raising blood glucose levels rapidly to prevent serious complications like confusion, seizures, or loss of consciousness. For unconscious individuals or those unable to swallow safely, emergency glucagon should be administered - available as an injection (GlucaGen, Gvoke), nasal spray (Baqsimi), or autoinjector, following package instructions. Severe hypoglycemia requires immediate medical attention.

Some key points to consider when treating hypoglycemia include:

• The preferred treatment is glucose (15–20 g), although any form of carbohydrate that contains glucose may be used 1.
• Fifteen minutes after treatment, if blood glucose monitoring (BGM) shows continued hypoglycemia, the treatment should be repeated 1.
• Once the BGM or glucose pattern is trending up, the individual should consume a meal or snack to prevent recurrence of 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 and reevaluation and adjustment of the treatment plan to decrease hypoglycemia 1.

It's essential to prioritize the most recent and highest-quality study, which in this case is the 2023 standards of care in diabetes 1, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

Administer Glucagon for Injection as soon as possible when severe hypoglycemia is recognized Immediately after reconstitution, inject the solution subcutaneously or intramuscularly in the upper arm, thigh, or buttocks The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously 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 immediate treatment for hypoglycemia is to administer Glucagon for Injection as soon as possible. The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously. After the patient has responded to the treatment, oral carbohydrates should be given to restore liver glycogen and prevent recurrence of hypoglycemia 2.

From the Research

Immediate Treatment for Hypoglycemia

The immediate treatment for hypoglycemia involves the administration of fast-absorbing carbohydrates to quickly raise blood glucose levels.

• According to 3, ingestion of 15 g of carbohydrate in the form of glucose or sucrose tablets or as a solution provides an effective therapy for moderately severe hypoglycemia.
• 4 suggests that treatment of mild episodes of hypoglycemia is intake of fast-absorbing carbohydrates, while severe episodes can be treated with either i.v. dextrose or glucagon injected i.m. or i.v.
• 5 recommends giving 25-50 ml of 50% glucose solution over 2-3 minutes as the treatment of choice in hypoglycemia.

Comparison of Treatment Options

Studies have compared the effectiveness of different treatment options for hypoglycemia, including glucose tablets and dietary sugars.

• 6 found that glucose tablets result in a higher rate of relief of symptomatic hypoglycemia 15 minutes after ingestion compared to dietary sugars.
• However, 3 notes that glucose gel or orange juice may not be recommended due to slower glycemic responses.

Recommendations for Management

It is essential to have a management protocol for hypoglycemia, including a clear prevention and treatment plan.

• 7 recommends that a management protocol for hypoglycemia should be designed and implemented, with a tailored approach to individualize glycemic goals and promote new therapies to improve quality of life.
• Education of diabetic patients and their relatives is necessary to avoid or treat hypoglycemia effectively, as emphasized by 5.