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

From the Guidelines

Treatment for hypoglycemia should begin with consuming 15-20 grams of fast-acting carbohydrates, such as 4 ounces of fruit juice, 4-6 pieces of hard candy, 1 tablespoon of honey, or glucose tablets as directed on the package, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

Key Recommendations

• For conscious individuals with hypoglycemia, administration of 20 g oral glucose or the equivalent in glucose-containing foods can rapidly restore blood glucose levels 1.
• If blood sugar remains below 70 mg/dL after 15 minutes, the treatment should be repeated, and once blood sugar returns to normal, a small snack containing both carbohydrates and protein should be consumed if the next meal is more than an hour away.
• For severe hypoglycemia where a person is unconscious or unable to swallow safely, bystanders should administer glucagon via injection or nasal spray according to package instructions and call emergency services.

Importance of Quick Treatment

• Hypoglycemia can cause seizures, status epilepticus, permanent brain injury, and death if left untreated, emphasizing the need for prompt treatment 1.
• The brain depends on glucose as its primary energy source, making quick treatment essential to prevent long-term damage.

Prevention and Preparedness

• People with diabetes or recurrent hypoglycemia should carry fast-acting carbohydrates at all times and wear medical identification to ensure prompt treatment in case of an emergency.
• Regular monitoring of blood sugar levels and awareness of hypoglycemia symptoms can help prevent severe hypoglycemic episodes.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION 2. 1 Important Administration Instructions for Using the Glucagon Emergency Kit for Low Blood Sugar to Treat Severe Hypoglycemia

Glucagon for Injection is for subcutaneous, intramuscular, or intravenous injection. Administer intravenously ONLY under medical supervision. Instruct patients and their caregivers on the signs and symptoms of severe hypoglycemia Because severe hypoglycemia requires the help of others to recover, instruct the patient to inform those around them about Glucagon for Injection and its Instructions for Use. Administer Glucagon for Injection as soon as possible when severe hypoglycemia is recognized Instruct the patient or caregiver to read the Instructions for Use at the time they receive a prescription for Glucagon for Injection Emphasize the following instructions to the patient or caregiver: Using the supplied prefilled syringe, carefully insert the needle through the rubber stopper of the vial containing Glucagon for Injection powder and inject all the liquid from the syringe into the vial. Shake the vial gently until the powder is completely dissolved and no particles remain in the fluid The reconstituted solution should be clear and colorless. Inspect visually for particulate matter and discoloration. If the resulting solution is cloudy or contains particulate matter do not use. The reconstituted solution is 1 mg per mL glucagon. Immediately after reconstitution, inject the solution subcutaneously or intramuscularly in the upper arm, thigh, or buttocks In addition, healthcare providers may administer intravenously. Call for emergency assistance immediately after administering the dose. When the patient has responded to the treatment and is able to swallow, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia. Discard any unused portion.

The treatment for hypoglycemia (low blood sugar) is:

• Glucagon for Injection administered subcutaneously, intramuscularly, or intravenously
• The recommended dosage is:
  • 1 mg (1 mL) for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older
  • 0.5 mg (0.5 mL) for pediatric patients weighing less than 25 kg or for pediatric patients with unknown weight less than 6 years of age
• If there has been no response after 15 minutes, an additional dose of Glucagon for Injection may be administered using a new kit while waiting for emergency assistance
• After the patient has responded to the treatment and is able to swallow, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia 2

From the Research

Treatment Options for Hypoglycemia

The treatment for hypoglycemia (low blood sugar) varies depending on the severity of the condition and the patient's level of consciousness.

• For conscious patients, rapid-acting glucose is the preferred treatment, regardless of the setting 3.
• The recommended amount of glucose is typically 15-20 grams, although some studies suggest that the amount should be related to the patient's weight 4.
• For unconscious patients, glucagon is preferred if the patient does not have intravenous (IV) access, while dextrose can be used for patients with IV access 3.
• Intranasal administration of glucagon has been shown to be effective for rapid correction of hypoglycemic episodes where IV access is difficult or unavailable 5.

Factors Affecting Treatment Effectiveness

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

• The severity of the hypoglycemia episode, with more severe episodes requiring longer recovery times 6.
• The patient's total daily insulin dose and the proportion of basal insulin, which can impact the rise in plasma glucose following treatment 6.
• The patient's weight, which may influence the optimal dose of glucose required to treat hypoglycemia 4.

Importance of Patient Education

Patient education is central to recognizing and preventing hypoglycemia, as well as managing its treatment 7.

• Clinicians should make efforts to educate patients on the risks and consequences of hypoglycemia, as well as the importance of prompt treatment.
• Recent developments in glucose monitoring and drug development have provided more approaches to reduce the risk of hypoglycemia in patients with diabetes 7.