What is the immediate treatment for hypoglycemia (low blood sugar)?

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, consuming 1 tablespoon of honey or sugar, or having 8 ounces of milk. After taking these quick-acting carbohydrates, wait about 15 minutes and then recheck blood glucose levels. If blood sugar remains below 70 mg/dL, repeat the treatment. Once blood sugar returns to normal, eat a small snack containing both carbohydrates and protein if your 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 severe hypoglycemia where a person is unconscious or unable to swallow safely, bystanders should not attempt to give oral treatments but instead administer glucagon if available (via injection or nasal spray) and call emergency services immediately, as supported by the guidelines 1.

Some key points to consider in the treatment of hypoglycemia include:

• The preferred treatment for conscious individuals with blood glucose <70 mg/dL is glucose (approximately 15–20 g) 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 guidelines from Diabetes Care 1, to ensure the best possible outcomes 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

• The immediate treatment for hypoglycemia (low blood sugar) is to administer Glucagon for Injection as soon as possible.
• The recommended dosage for adults and pediatric patients weighing more than 25 kg is 1 mg (1 mL) injected subcutaneously or intramuscularly.
• After administering Glucagon, call for emergency assistance immediately and give oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia when the patient is able to swallow 2

From the Research

Immediate Treatment for Hypoglycemia

The immediate treatment for hypoglycemia (low blood sugar) typically involves administering glucose or glucagon to raise blood glucose levels. The following are some treatment options:

• Intravenous dextrose: Studies have shown that intravenous dextrose is effective in treating hypoglycemia 3, 4. The typical dose is 25g of glucose as 50mL of 50% dextrose solution.
• Glucagon: Glucagon is another treatment option for hypoglycemia, particularly when the patient is unconscious or unable to take glucose orally 5, 4, 6. It can be administered intramuscularly or intranasally.
• Intranasal glucagon: Intranasal glucagon is a promising approach for the treatment of severe hypoglycemia, as it is easier to administer and has a lower risk of complications compared to intramuscular injection 6.

Comparison of Treatment Options

Studies have compared the efficacy of different treatment options for hypoglycemia:

• A study comparing 10%, 25%, and 50% dextrose found that there was no difference in the median time to achieve a Glasgow Coma Scale (GCS) of 15 in all three treatment arms 3.
• A systematic review and meta-analysis found that glucagon was effective in treating hypoglycemia, with a low failure rate, and was not significantly different from dextrose in terms of efficacy 5.
• A study comparing intravenous glucagon and dextrose found that both treatments were effective, but recovery of normal consciousness was slower with glucagon compared to dextrose 4.

Alternative Routes of Administration

Researchers have explored alternative routes of administration for glucagon, including:

• Intranasal administration: Intranasal glucagon has been shown to be effective in raising blood glucose levels and is a promising approach for the treatment of severe hypoglycemia 6.
• Eye drops: A study found that glucagon eye drops were effective in raising blood glucose levels, although this route of administration is not commonly used in clinical practice 7.