From the Guidelines
The immediate treatment for hypoglycemia is to consume 15-20 grams of fast-acting carbohydrates, such as glucose, 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 8-10 hard candies. After taking these quick-acting carbohydrates, wait about 15 minutes and then recheck blood glucose levels. If the level remains below 70 mg/dL, repeat the treatment. Once blood sugar returns to normal, eat a small snack containing both carbohydrates and protein (like crackers with cheese or a half sandwich) if your next meal is more than an hour away. This two-step approach works because the initial fast-acting carbohydrates quickly raise blood sugar levels to address the immediate danger, while the follow-up snack provides more sustained glucose release to prevent recurrence. For severe hypoglycemia where a person is unconscious or unable to swallow safely, bystanders should not attempt to give oral treatments but instead administer glucagon via injection kit (typically 1 mg for adults) or nasal spray (3 mg) if available, and call emergency services immediately, as supported by recent studies 1.
Some key points to consider:
- Glucose is the preferred treatment for hypoglycemia, although any form of carbohydrate that contains glucose may be used 1.
- Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia, so 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 of the treatment regimen 1.
- Insulin-treated patients with hypoglycemia unawareness, one level 3 hypoglycemic event, or a pattern of unexplained level 2 hypoglycemia should be advised to raise their glycemic targets to strictly avoid hypoglycemia 1.
Overall, the treatment of hypoglycemia should prioritize the immediate administration of fast-acting carbohydrates, followed by a snack with carbohydrates and protein if necessary, and consideration of glucagon administration in severe cases, as recommended by the most recent and highest quality studies 1.
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 typically involves the administration of fast-acting carbohydrates. 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.
- Key findings from the study include:
- Glucose and sucrose in solution or tablets are effective in correcting blood glucose levels and alleviating clinical symptoms of hypoglycemia.
- The glycemic responses were consistently lower with glucose gel or orange juice.
- Clinical symptoms were alleviated in 14.0 +/- 0.8 minutes with sucrose and glucose in solution or tablets.
Recommended Carbohydrate Intake
The recommended carbohydrate intake for treating hypoglycemia varies. A study from 4 suggests that 20 g of carbohydrate as D-glucose corrects hypoglycemia without rebound hyperglycemia. In contrast, 5 recommends a dose of around 15-20 g fast-acting carbohydrates for treating mild or moderate hypoglycemia.
- Factors to consider when treating hypoglycemia include:
- Quantity and quality of carbohydrates consumed
- Glycemic index (GI) and glycemic load of the carbohydrates
- Physical activity and fear of hypoglycemia
- Hypoglycemia awareness
Alternative Treatment Options
In addition to carbohydrate intake, other treatment options are being explored. For example, 6 discusses the potential of intranasal glucagon as a promising approach for the treatment of severe hypoglycemia. This method may offer a more practical and convenient alternative to traditional injection methods.
- Benefits of alternative treatment options include:
- Improved convenience and ease of use
- Reduced risk of hypoglycemia-related complications
- Enhanced patient quality of life
Real-Life Treatment of Hypoglycemia
A study from 5 examined the characteristics of hypoglycemia treatment in adults with type 1 diabetes in real-life conditions. The results showed that many individuals do not manage hypoglycemia according to current guidelines, often overtreating with more than 20 g of carbohydrates.
- Common mistakes in hypoglycemia treatment include:
- Overtreatment with excessive carbohydrate intake
- Choosing foods with low glycemic effect
- Failing to vary the dose of carbohydrates based on physical activity