What is the management of a hypoglycemic (low blood sugar) emergency?

Management of Hypoglycemic Emergencies

For hypoglycemic emergencies, immediately administer oral glucose (15-20g) for conscious patients who can swallow, or glucagon injection for unconscious patients, followed by calling emergency services for severe cases. 1, 2, 3

Assessment and Initial Management

Conscious Patient with Mild-Moderate Hypoglycemia

• If patient is conscious, able to follow commands and swallow safely:
  • Administer 15-20g of fast-acting oral glucose 1, 2
  • Preferred options (in order):
    1. Glucose tablets (most effective) 1
    2. 4 oz (120 mL) of fruit juice or regular soda
    3. 1 tablespoon of honey or sugar dissolved in water
  • Recheck blood glucose after 15 minutes 1, 2
  • If blood glucose remains <70 mg/dL, repeat treatment with another 15-20g of glucose 1, 2
  • Wait at least 10-15 minutes before calling EMS or re-treating with additional oral sugars 1
  • Once blood glucose normalizes, provide a meal or snack with protein and complex carbohydrates to prevent recurrence 2

Unconscious Patient or Severe Hypoglycemia

• If patient is unconscious, having seizures, or unable to swallow safely:
  • Call EMS immediately 1
  • Administer glucagon via injection 3:
    • Adults and children >25kg or ≥6 years: 1mg subcutaneously or intramuscularly into upper arm, thigh, or buttocks
    • Children <25kg or <6 years: 0.5mg subcutaneously or intramuscularly
    • May repeat dose after 15 minutes if no response while waiting for emergency assistance 3
  • Position patient on their side to prevent aspiration
  • Monitor vital signs until EMS arrives
  • Once patient regains consciousness and can swallow safely, provide oral carbohydrates to restore liver glycogen and prevent recurrence 3

Special Considerations

Hospital Setting

• Implement standardized hypoglycemia protocol 2:
  • Nurse-initiated treatment protocol for blood glucose <70 mg/dL
  • Documentation of hypoglycemic episodes
  • Review of treatment regimens to prevent further episodes

Pediatric Patients

• Children may be uncooperative with oral glucose administration
• Consider sublingual glucose administration for uncooperative children 1
• Children are particularly vulnerable due to reduced ability to recognize symptoms 2

Elderly Patients

• More vulnerable to hypoglycemia due to reduced symptom recognition 2
• May require closer monitoring and more conservative glucose targets

Follow-up Care

• After successful treatment of hypoglycemia:
  • Identify and address the cause (medication dosing, missed meals, exercise)
  • Consider temporarily raising glycemic targets to avoid recurrence 2
  • Educate patient and family members about recognition and treatment of hypoglycemia
  • Ensure patient has glucagon emergency kit and family members know how to use it 2, 3
  • Recommend wearing medical alert identification 2

Common Pitfalls to Avoid

1. Delayed treatment: Hypoglycemia is an emergency; treat immediately when recognized 3
2. Inadequate monitoring: Always recheck glucose 15 minutes after treatment 1, 2
3. Premature discharge: Ensure blood glucose has stabilized and patient has consumed a meal before leaving 4
4. Overlooking the cause: Identify and address the underlying cause to prevent recurrence
5. Insufficient follow-up: Less than 8% of patients treated for hypoglycemia and left at home need secondary treatment within 72 hours, but follow-up is still important 4

By following this algorithmic approach to hypoglycemia management, healthcare providers can effectively treat this common but potentially dangerous condition while minimizing complications and preventing recurrence.