Management of Hypoglycemia Episodes
For episodes of hypoglycemia, administer 15-20g of glucose or fast-acting carbohydrates, recheck blood glucose after 15 minutes, and repeat treatment if hypoglycemia persists. 1
Classification of Hypoglycemia
Hypoglycemia is classified into three levels according to the American Diabetes Association:
| Level | Blood Glucose | Description | Treatment |
|---|---|---|---|
| 1 | <70 mg/dL and ≥54 mg/dL | Mild hypoglycemia | 15-20g oral glucose |
| 2 | <54 mg/dL | Moderate hypoglycemia | 15-20g oral glucose |
| 3 | Any level | Severe event requiring assistance | Glucagon injection |
Immediate Management of Hypoglycemia
For Conscious Patients (Level 1 and 2)
- Administer 15-20g of glucose or fast-acting carbohydrates 2
- Preferred options:
- Glucose tablets (most effective and recommended)
- 4-8 oz of fruit juice or regular soda
- Hard candy
- For patients on α-glucosidase inhibitors, use glucose tablets specifically as these drugs prevent digestion of polysaccharides 2
- When blood glucose is 50-60 mg/dL, 15g of glucose can raise levels by approximately 50 mg/dL 2
- Recheck blood glucose after 15 minutes 2
- If hypoglycemia persists, repeat treatment with another 15-20g of carbohydrates 2
- After blood glucose normalizes, consume a meal or snack containing protein and complex carbohydrates to prevent recurrence 2, 1
For Severe Hypoglycemia (Level 3)
- For unconscious patients or those unable to swallow safely, administer glucagon 3:
- Adults and children >25kg: 1mg subcutaneously or intramuscularly
- Children <25kg: 0.5mg subcutaneously or intramuscularly
- May repeat dose after 15 minutes if no response while waiting for emergency assistance 3
- Call for emergency assistance immediately after administering glucagon 3
- After the patient regains consciousness, provide oral carbohydrates to restore liver glycogen and prevent recurrence 3, 4
Prevention Strategies
Medication Management
- Match mealtime insulin to carbohydrate intake 2
- Consider reducing mealtime insulin if physical activity is planned within 1-2 hours of injection 2
- For patients on fixed insulin regimens:
Lifestyle Considerations
- Always carry a source of quick-acting carbohydrates 2
- Increase frequency of blood glucose monitoring during illness, exercise, or changes in routine 1
- Limit alcohol consumption as it inhibits the liver from releasing glucose, exacerbating hypoglycemia 2
- Manage stress levels, as stress can affect recognition of hypoglycemia symptoms 2
For Recurrent Hypoglycemia
- For patients with hypoglycemia unawareness or recurrent level 3 hypoglycemia, temporarily raise glycemic targets to restore awareness 2
- Consider continuous glucose monitoring for patients with frequent hypoglycemia 1
- Evaluate and adjust treatment plan after any severe hypoglycemic event 2
Patient Education
- Educate patients, family members, and caregivers on recognizing and treating hypoglycemia 1
- Prescribe glucagon for all individuals at risk of level 2 or 3 hypoglycemia 2
- Ensure caregivers know where glucagon is stored and how to administer it 2
- Recommend wearing a medical alert bracelet or necklace 2
Special Considerations
- For patients on insulin pumps or multiple daily injections, monitor closely during physical activity 2
- After apparent clinical recovery from hypoglycemia, continued observation and additional carbohydrate intake may be necessary to avoid recurrence 4
- For patients with sulfonylurea-induced hypoglycemia, extended monitoring is required due to longer duration of action 1
By following this structured approach to hypoglycemia management, patients can effectively treat episodes when they occur and implement strategies to reduce their frequency and severity.