What is the treatment for severe hypoglycemia with a blood glucose level of approximately 1.8 mmol/L?

From the Guidelines

Severe hypoglycemia with a blood glucose level of approximately 1.8 mmol/L (32 mg/dL) requires immediate treatment with intravenous dextrose, and for an unconscious or severely impaired patient, administer 25g of 50% dextrose (D50W) intravenously as a bolus dose, as recommended by the most recent guidelines 1. For patients who are conscious, glucose (approximately 15–20 g) is the preferred treatment, although any form of carbohydrate that contains glucose may be used, and if blood glucose monitoring shows continued hypoglycemia 15 minutes after treatment, the treatment should be repeated 1. If IV access is unavailable, 1 mg of glucagon can be given intramuscularly or subcutaneously, and for emergency responders or family members of patients at risk, glucagon nasal powder (Baqsimi) 3 mg in one nostril is an alternative 1. Once the patient regains consciousness, oral carbohydrates should be provided, such as 15-20g of fast-acting carbohydrates (juice, glucose tablets) followed by a more substantial snack containing protein and complex carbohydrates to prevent recurrence. Blood glucose should be monitored every 15 minutes until stable above 4.0 mmol/L (72 mg/dL), and hypoglycemia unawareness or one or more episodes of level 3 hypoglycemia should trigger reevaluation and adjustment of the treatment plan to decrease hypoglycemia 1. Key considerations in managing severe hypoglycemia include:

• Prompt recognition and treatment to prevent neurological damage or death
• Use of glucagon for patients at increased risk of level 2 or 3 hypoglycemia
• Ongoing assessment of cognitive function with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if impaired or declining cognition is found 1. It is essential to prioritize the patient's safety and well-being, and to take a proactive approach to managing severe hypoglycemia to minimize the risk of morbidity, mortality, and long-term complications.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION

1. 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 treatment for severe hypoglycemia with a blood glucose level of approximately 1.8 mmol/L is Glucagon for Injection. The recommended dosage is:

• 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older.
• 0.5 mg (0.5 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously for pediatric patients weighing less than 25 kg or for pediatric patients with unknown weight less than 6 years of age. After administering Glucagon for Injection, call for emergency assistance immediately and give oral carbohydrates when the patient has responded to the treatment and is able to swallow to restore the liver glycogen and prevent recurrence of hypoglycemia 2.

From the Research

Severe Hypoglycemia Treatment

• Severe hypoglycemia is a dangerous condition that requires immediate treatment, especially when blood glucose levels are approximately 1.8 mmol/L (≈32 mg/dL) 3, 4, 5.
• The treatment for severe hypoglycemia typically involves administering glucose or glucagon to raise blood glucose levels quickly 6, 7.
• In some cases, hospitalization may be necessary, especially if the patient experiences confusion, loss of consciousness, or other severe symptoms 4, 5.

Risk Factors and Prevention

• Certain risk factors, such as advanced age, black race, and use of multiple medications, can increase the likelihood of severe hypoglycemia 6.
• Recent hospital discharge is also a strong predictor of subsequent hypoglycemia in older persons with diabetes 6.
• Preventing hypoglycemia is crucial, and methods such as insulin-responsive glucagon delivery are being developed to prevent hypoglycemia 7.
• Patient education and close monitoring can also help reduce the incidence of hypoglycemia, especially in high-risk individuals 3, 4.

Symptoms and Consequences

• Severe hypoglycemia can cause a range of symptoms, including weakness, fatigue, sweating, confusion, and loss of consciousness 4, 5.
• If left untreated, severe hypoglycemia can lead to serious consequences, such as coma, seizure, and even death 4, 5.
• The frequency and severity of hypoglycemic episodes can be reduced by adjusting insulin doses and improving patient awareness and response to warning signs 3, 4.