What is the protocol for managing hypoglycemia (low blood sugar)?

From the Guidelines

The protocol for managing hypoglycemia involves immediate treatment with 15-20 grams of glucose for conscious individuals with blood glucose <70 mg/dL (3.9 mmol/L), with repeated treatment if hypoglycemia persists after 15 minutes, as recommended by the 2023 standards of care in diabetes 1. The treatment should be repeated every 15 minutes until blood glucose levels return to normal, and a meal or snack should be consumed to prevent recurrence of hypoglycemia. Some key points to consider in managing hypoglycemia include:

• Glucagon should be prescribed for individuals at increased risk of level 2 or 3 hypoglycemia, and caregivers or family members should know how to administer it 1.
• Hypoglycemia unawareness or severe hypoglycemic events should trigger hypoglycemia avoidance education and reevaluation of the treatment plan to decrease hypoglycemia risk 1.
• Insulin-treated patients with hypoglycemia unawareness or a history of severe hypoglycemic events should consider raising their glycemic targets to strictly avoid hypoglycemia for at least several weeks to partially reverse hypoglycemia unawareness and reduce the risk of future episodes 1. It is essential to note that hypoglycemia is a major limiting factor in the glycemic management of type 1 and type 2 diabetes, and ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia if impaired or declining cognition is found 1.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION 2. 1 Important Administration Instructions for Using the Glucagon Emergency Kit for Low Blood Sugar to Treat Severe Hypoglycemia

Glucagon for Injection is for subcutaneous, intramuscular, or intravenous injection. Administer intravenously ONLY under medical supervision. Instruct patients and their caregivers on the signs and symptoms of severe hypoglycemia Because severe hypoglycemia requires the help of others to recover, instruct the patient to inform those around them about Glucagon for Injection and its Instructions for Use. Administer Glucagon for Injection as soon as possible when severe hypoglycemia is recognized Instruct the patient or caregiver to read the Instructions for Use at the time they receive a prescription for Glucagon for Injection Emphasize the following instructions to the patient or caregiver: Using the supplied prefilled syringe, carefully insert the needle through the rubber stopper of the vial containing Glucagon for Injection powder and inject all the liquid from the syringe into the vial. Shake the vial gently until the powder is completely dissolved and no particles remain in the fluid The reconstituted solution should be clear and colorless. Inspect visually for particulate matter and discoloration. If the resulting solution is cloudy or contains particulate matter do not use. The reconstituted solution is 1 mg per mL glucagon. Immediately after reconstitution, inject the solution subcutaneously or intramuscularly in the upper arm, thigh, or buttocks In addition, healthcare providers may administer intravenously. 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. Discard any unused portion.

The protocol for managing hypoglycemia (low blood sugar) involves:

• Administering Glucagon for Injection as soon as possible when severe hypoglycemia is recognized
• Reconstituting the solution by injecting the liquid from the prefilled syringe into the vial and shaking gently until the powder is completely dissolved
• Inspecting the solution for particulate matter and discoloration before use
• Injecting the solution subcutaneously or intramuscularly in the upper arm, thigh, or buttocks, or intravenously by a healthcare provider
• Calling for emergency assistance immediately after administering the dose
• Giving oral carbohydrates to the patient when they have responded to the treatment and are able to swallow, to restore liver glycogen and prevent recurrence of hypoglycemia 2

From the Research

Protocol for Managing Hypoglycemia

The protocol for managing hypoglycemia involves several steps to ensure prompt and effective treatment. The following are key aspects of the protocol:

• Recognition of Hypoglycemia: Identifying the symptoms of hypoglycemia, such as decreased level of consciousness, syncope, or seizure, is crucial for prompt treatment 3.
• Treatment Options: Treatment of hypoglycemia is based on the administration of glucose (oral or parenteral depending on the level of consciousness) or glucagon injected intramuscularly or subcutaneously 4, 5.
• Intranasal Glucagon: Intranasal glucagon is a new and effective way to treat severe hypoglycemia, especially in patients with diabetes who are treated with insulin 4, 5.
• Prevention: Preventing hypoglycemic events is also an essential part of the protocol, which can be achieved by individualizing glycemic goals, particularly in elderly individuals or patients with complicated or advanced type 2 diabetes 6.
• Systems-Based Approach: A systems-based approach to recognition, treatment, and prevention of hypoglycemia is critical in hospitalized patients with diabetes, involving a multidisciplinary team to develop strategies to prevent hypoglycemic events 7.

Key Considerations

Some key considerations in the protocol for managing hypoglycemia include:

• Prompt Treatment: Prompt treatment of hypoglycemia is essential to prevent life-threatening disorders 4, 3.
• Education and Communication: Education and communication among healthcare providers, patients, and families are crucial for effective management of hypoglycemia 6, 7.
• Individualized Care: Individualized care and attention to the specific needs of each patient are essential for preventing and treating hypoglycemia 6, 7.