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

Treatment of Hypoglycemia

For hypoglycemia treatment, administer 15-20g of glucose orally for conscious patients, recheck blood glucose after 15 minutes, and repeat treatment if hypoglycemia persists. 1, 2

Classification of Hypoglycemia

Hypoglycemia is classified into three levels according to the American Diabetes Association 1:

Level	Definition
Level 1	Glucose <70 mg/dL (3.9 mmol/L) and ≥54 mg/dL (3.0 mmol/L)
Level 2	Glucose <54 mg/dL (3.0 mmol/L)
Level 3	A severe event characterized by altered mental and/or physical status requiring assistance for treatment

Treatment Algorithm

For Conscious Patients (Level 1 or 2 Hypoglycemia)

1. Immediate treatment: Administer 15-20g of glucose orally 1

   • Pure glucose is preferred as it produces a greater rise in plasma glucose 2
   • Alternatives include any carbohydrate-containing food with glucose 1
   • Avoid protein-rich carbohydrate sources as they may increase insulin response without raising glucose 1

2. Recheck blood glucose after 15 minutes 1

3. If hypoglycemia persists (glucose still <70 mg/dL):

   • Repeat treatment with another 15-20g of glucose 1

4. Once blood glucose normalizes:

   • Provide a meal or snack to prevent recurrence of hypoglycemia 1, 2

For Unconscious Patients or Those Unable to Take Oral Glucose (Level 3 Hypoglycemia)

1. Administer glucagon 1, 3:

   • For adults and children >25kg or ≥6 years with unknown weight: 1mg subcutaneously or intramuscularly 3
   • For children <25kg or <6 years with unknown weight: 0.5mg subcutaneously or intramuscularly 3
   • Intranasal glucagon is an alternative that may be easier to administer by non-medical personnel 4, 5

2. Call for emergency assistance immediately after administering glucagon 3

3. If no response after 15 minutes, administer a second dose of glucagon using a new kit while waiting for emergency assistance 3

4. Once the patient regains consciousness and can swallow, give oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia 3

Special Considerations

• Hypoglycemia unawareness: For patients with hypoglycemia unawareness or recurrent severe hypoglycemia, temporarily raise glycemic targets to strictly avoid hypoglycemia for at least 2-3 weeks to help reverse the unawareness 1, 2, 6

• Prevention: Identify and address the cause of hypoglycemia by reviewing medication dosing, recent food intake patterns, physical activity levels, and potential medication interactions 2, 6

• Elderly patients: Be aware that hypoglycemia symptoms may be atypical or less pronounced in elderly patients 2

• Prescribe glucagon: Ensure glucagon is prescribed and available for all patients at significant risk of severe hypoglycemia 1, 2

Common Pitfalls and Caveats

• Delayed treatment: Failure to promptly treat hypoglycemia can lead to progression to severe hypoglycemia with altered mental status 6

• Inadequate follow-up intake: Not consuming a meal or snack after initial treatment can lead to recurrent hypoglycemia due to ongoing insulin activity 1

• Overtreatment: Excessive treatment of hypoglycemia can lead to rebound hyperglycemia 7

• Failure to recognize symptoms: Hypoglycemia symptoms vary among individuals and many events remain undiagnosed 8

• Ignoring recurrent episodes: Recurrent hypoglycemia requires adjustment of the diabetes treatment regimen to prevent future episodes 1, 6

The burden of hypoglycemia extends beyond immediate physical effects to include anxiety, reduced quality of life, and economic impacts through increased healthcare utilization and reduced workplace productivity 8, 7. Therefore, prompt and appropriate treatment of hypoglycemia is essential for both short-term safety and long-term health outcomes.