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

Immediate Treatment for Hypoglycemia

The immediate treatment for hypoglycemia (blood glucose ≤70 mg/dL) is administration of 15-20 grams of oral glucose or carbohydrates for conscious patients, followed by blood glucose monitoring every 15 minutes until levels return to normal (>70 mg/dL). 1

Assessment and Initial Management

For Conscious Patients with Hypoglycemia:

1. Confirm hypoglycemia with blood glucose measurement if possible (though treatment should not be delayed if testing is unavailable) 1
2. Administer 15-20 grams of fast-acting carbohydrates:
   • Pure glucose is preferred (glucose tablets)
   • Alternatives: fruit juice, regular soda, honey, or other glucose-containing foods 1
3. Recheck blood glucose after 15 minutes
4. Repeat treatment if blood glucose remains <70 mg/dL
5. Once blood glucose returns to normal (>70 mg/dL), provide a meal or snack if the next planned meal is more than 1 hour away 1

For Unconscious Patients or Those Unable to Take Oral Carbohydrates:

1. Administer glucagon:
   • Adults and children >25 kg or ≥6 years: 1 mg subcutaneously or intramuscularly
   • Children <25 kg or <6 years: 0.5 mg subcutaneously or intramuscularly 2
2. In medical settings: Administer 20-40 mL of 50% glucose solution intravenously 1
3. Recheck blood glucose after 15 minutes
4. If no response after 15 minutes, a second dose of glucagon may be administered while waiting for emergency assistance 2

Special Considerations

Severe Hypoglycemia

• Defined as hypoglycemia requiring assistance from another person for recovery 1
• May present with altered mental status, confusion, combativeness, seizures, or coma 1
• Requires immediate intervention to prevent serious complications or death
• After recovery, the patient should be evaluated for the cause of hypoglycemia and their diabetes management plan should be reassessed 1

Prevention of Recurrent Hypoglycemia

• After any episode of severe hypoglycemia, the diabetes treatment regimen should be reevaluated 1
• For patients with recurrent hypoglycemia, consider:
  1. Relaxing glycemic targets temporarily
  2. Adjusting medication dosing or timing
  3. Ensuring proper coordination between meals and medication 1
  4. Providing additional education on hypoglycemia recognition and management

Common Pitfalls to Avoid

1. Delayed treatment: Hypoglycemia should be treated immediately upon recognition
2. Inadequate follow-up: Failing to recheck blood glucose 15 minutes after initial treatment
3. Overtreatment: Consuming excessive carbohydrates can lead to rebound hyperglycemia
4. Failure to identify cause: Not investigating the underlying cause of hypoglycemia
5. Neglecting prevention: Not making appropriate adjustments to prevent future episodes

For patients with diabetes, especially those on insulin or insulin secretagogues, carrying a source of fast-acting glucose at all times is essential for prompt self-treatment of hypoglycemia 1. Additionally, family members, caregivers, and close contacts should be educated on recognizing and treating hypoglycemia, including the use of glucagon for severe cases 1.