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

Immediate Treatment for Hypoglycemia

The preferred immediate treatment for hypoglycemia is 15-20 grams of glucose for a conscious individual with blood glucose <70 mg/dL (3.9 mmol/L). If blood glucose remains low after 15 minutes, repeat the treatment. Once blood glucose is trending up, the person should consume a meal or snack to prevent recurrence of hypoglycemia. 1

Recognizing Hypoglycemia

Hypoglycemia is classified into three levels:

• Level 1: Blood glucose <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L)
• Level 2: Blood glucose <54 mg/dL (3.0 mmol/L)
• Level 3: Severe event characterized by altered mental and/or physical status requiring assistance 1

Common symptoms include:

• Shakiness
• Irritability
• Confusion
• Tachycardia
• Hunger 1

Step-by-Step Treatment Algorithm

For Conscious Patients:

1. Administer 15-20g of glucose

   • Pure glucose is the preferred treatment as it raises blood glucose more effectively than other carbohydrates 1
   • Acceptable alternatives include any carbohydrate containing glucose:
     • Glucose tablets
     • Glucose solution
     • Sucrose tablets or solution
     • Fruit juice (though less effective) 2

2. Wait 15 minutes and recheck blood glucose

   • If hypoglycemia persists, repeat the 15-20g glucose treatment 1

3. Once blood glucose is trending upward

   • Consume a meal or snack containing carbohydrates, protein, and fat to prevent recurrence 1

For Unconscious Patients:

1. Administer glucagon

   • For adults and children >25kg or ≥6 years: 1mg subcutaneously or intramuscularly
   • For children <25kg or <6 years: 0.5mg subcutaneously or intramuscularly 3
   • If no response after 15 minutes, a second dose may be administered while waiting for emergency assistance 3

2. Call for emergency assistance immediately 3

3. When patient regains consciousness and can swallow

   • Provide oral carbohydrates to restore liver glycogen and prevent recurrence 3

Important Considerations

• Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia 1
• Caregivers, family members, and school personnel should know where glucagon is stored and how to administer it 1
• Hypoglycemia unawareness (lack of warning symptoms) increases risk for severe episodes and requires special attention 4
• After severe hypoglycemia, patients should temporarily raise their glycemic targets for several weeks to help reverse hypoglycemia unawareness 1

Common Pitfalls to Avoid

1. Delayed treatment - Treat promptly when blood glucose is <70 mg/dL even if symptoms are mild 1

2. Overtreatment - Using excessive amounts of carbohydrates can cause rebound hyperglycemia

3. Inadequate follow-up - Failing to consume a meal or snack after initial treatment often leads to recurrent hypoglycemia 1

4. Using ineffective treatments - Some forms of carbohydrate (like glucose gel or orange juice) may be less effective for rapid correction 2

5. Ignoring patterns of hypoglycemia - Recurrent episodes should trigger reevaluation of the treatment regimen 1

By following this evidence-based approach to treating hypoglycemia, patients can effectively manage this common and potentially dangerous complication of diabetes treatment.