From the Guidelines
The recommended dosing for glucose gel in treating hypoglycemic events is 15 grams of glucose (typically one tube or packet of commercial glucose gel) as stated in the most recent guidelines 1. After administration, wait 15 minutes and recheck blood glucose levels. If hypoglycemia persists (blood glucose remains below 70 mg/dL or 3.9 mmol/L), repeat the 15-gram dose. This approach is known as the "15-15 rule." For severe hypoglycemia where the person is conscious but unable to swallow safely, glucose gel can be applied between the cheek and gum where it can be absorbed through the oral mucosa. The gel works quickly because it contains dextrose, a simple sugar that requires minimal digestion and rapidly enters the bloodstream to raise blood glucose levels. Some key points to consider when treating hypoglycemia include:
- Commercial glucose gels are preferable to other sugary substances because they're precisely measured, portable, and designed for quick absorption.
- For children, the dose should be adjusted to 0.3 g/kg of body weight.
- Always follow glucose gel treatment with a more substantial snack containing complex carbohydrates and protein once blood glucose begins to normalize to prevent recurrence of hypoglycemia. It's also important to note that the classification of hypoglycemia is crucial in determining the appropriate treatment, with level 1 hypoglycemia defined as a measurable glucose concentration <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L), level 2 hypoglycemia defined as a blood glucose concentration <54 mg/dL (3.0 mmol/L), and level 3 hypoglycemia defined as severe cognitive impairment requiring assistance from another person for recovery, as outlined in the guidelines 1.
From the Research
Dosing for Glucose Gel in Hypoglycemic Events
- The recommended dosing for glucose gel in treating hypoglycemic events is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 6 mentions the use of a dextrose gel as a combined oral and buccal mucosal route, but does not provide specific dosing information.
- Study 5 evaluates the effectiveness of nasal glucagon, but does not discuss glucose gel dosing.
- Studies 2, 3, 4 focus on intravenous glucagon, 20% glucose solution, and intranasal glucagon, respectively, and do not provide information on glucose gel dosing.
- Therefore, there is limited evidence to support a specific dosing recommendation for glucose gel in hypoglycemic events based on the provided studies 2, 3, 4, 5, 6.
Alternative Treatments
- Intravenous glucagon (1 mg) and intravenous dextrose (25 g) are effective in treating hypoglycemia, as shown in study 2.
- 20% glucose solution can effectively treat hypoglycemia in diabetic patients, with a similar curative effect to 50% glucose solution, as demonstrated in study 3.
- Intranasal glucagon is effective in treating moderate and severe hypoglycemia, with a clinically significant improvement in mental status and a corresponding increase in blood glucose levels, as shown in study 4.
- Nasal glucagon (3 mg) is effective in treating moderate, symptomatic, hypoglycemic events in children and adolescents with type 1 diabetes, as demonstrated in study 5.
Administration Routes
- Study 6 compares different routes of glucose administration, including sublingual, buccal, and oral routes, but does not provide information on glucose gel dosing.
- The study suggests that oral glucose administration results in higher blood glucose concentrations after 20 minutes compared to buccal administration of glucose 6.