What is the recommended dose of glucose for treating hypoglycemia?

From the Guidelines

The recommended dose of glucose for treating hypoglycemia is 20 g oral glucose or the equivalent in glucose-containing foods. This dose can rapidly restore blood glucose levels, and oral glucose is available in different forms and can be given through different routes in the first aid setting 1. According to the 2024 American Heart Association and American Red Cross guidelines for first aid, administration of 20 g oral glucose is the preferred treatment for hypoglycemia 1.

When treating hypoglycemia, it is essential to consider the severity of the condition and the individual's ability to swallow. For people with hypoglycemia who are unable to swallow, intravenous dextrose can be lifesaving 1. Additionally, oral glucose tablets have been shown to demonstrate better resolution of symptoms 15 minutes after treatment compared with dietary sugars such as sucrose, fructose, orange juice, jellybeans, candy tablets, and milk 1.

It is also important to note that untreated hypoglycemia can cause seizures, status epilepticus, permanent brain injury, and death 1. Therefore, prompt treatment with the recommended dose of glucose is crucial to prevent these complications. After taking the initial dose, it is recommended to wait approximately 15 minutes and then recheck blood glucose levels. If blood glucose remains below 70 mg/dL (3.9 mmol/L), repeat the treatment with another 15-20 grams of carbohydrates.

In severe cases of hypoglycemia where the person is unconscious or unable to swallow safely, bystanders should not attempt oral glucose administration but instead call emergency services, and healthcare professionals may administer glucagon via injection or nasal spray 1. The "rule of 15" approach, which involves administering 15-20 grams of fast-acting carbohydrates and rechecking blood glucose levels after 15 minutes, can be an effective way to manage hypoglycemia 1. However, the most recent and highest quality study recommends a dose of 20 g oral glucose 1.

Key points to consider when treating hypoglycemia include:

• Administering 20 g oral glucose or the equivalent in glucose-containing foods
• Considering the severity of the condition and the individual's ability to swallow
• Using oral glucose tablets, which have been shown to be effective in resolving symptoms
• Promptly treating hypoglycemia to prevent complications such as seizures and permanent brain injury
• Rechecking blood glucose levels after 15 minutes and repeating treatment as needed
• Calling emergency services in severe cases where the person is unconscious or unable to swallow safely.

From the FDA Drug Label

In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. The recommended dose of glucose for treating hypoglycemia is 10 to 25 grams of dextrose, which is equivalent to 20 to 50 mL of 50% dextrose 2.

• The dose may be repeated as needed in severe cases.
• Supportive treatment may also be required in severe cases.

From the Research

Recommended Dose of Glucose for Treating Hypoglycemia

The recommended dose of glucose for treating hypoglycemia varies depending on the severity of the condition and the individual's response to treatment.

• For mild-to-moderate hypoglycemia, a dose of 15-16 grams of carbohydrates is often recommended 3, 4.
• In more severe cases, such as hypoglycemic coma, intravenous dextrose may be administered, with a typical dose of 25 grams of dextrose 5, 6, 7.
• The use of 10% dextrose has been shown to be effective in treating hypoglycemia, with a lower risk of adverse events compared to 50% dextrose 6, 7.

Factors Affecting Treatment Effectiveness

Several factors can affect the effectiveness of glucose treatment for hypoglycemia, including:

• The severity of the hypoglycemia, with more severe cases requiring more aggressive treatment 5, 4.
• The individual's insulin regimen and glucose metabolism, with those using insulin pumps or having impaired glucose regulation potentially requiring adjusted treatment 4.
• The type and dose of glucose administered, with different concentrations and doses of dextrose having varying effects on blood glucose levels 6, 7.

Administration of Glucose

Glucose can be administered in various forms, including:

• Oral carbohydrates, such as glucose tablets or gel 3.
• Intravenous dextrose, which can be administered in different concentrations, such as 10%, 25%, or 50% 5, 6, 7.
• Intramuscular glucagon, which can be used in emergency situations where intravenous access is not available 5.