What are the treatment steps for hypoglycemia (low blood sugar)?

Treatment of Hypoglycemia

For hypoglycemia treatment, administer 15-20g of fast-acting carbohydrates to conscious patients who can swallow, and use glucagon for unconscious patients or those unable to swallow. 1

Classification of Hypoglycemia

The American Diabetes Association classifies hypoglycemia into three levels:

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 with altered mental/physical status requiring assistance	Glucagon injection

Treatment Algorithm for Hypoglycemia

For Conscious Patients (Level 1-2 Hypoglycemia)

1. Administer 15-20g of fast-acting carbohydrates 2, 1

   • Pure glucose is preferred (glucose tablets)
   • Any form of carbohydrate containing glucose will work
   • Avoid carbohydrates high in protein as they may increase insulin response without raising glucose 2

2. Recheck blood glucose after 15 minutes 2, 1

   • If hypoglycemia persists, repeat treatment with 15-20g carbohydrates

3. Once blood glucose normalizes, provide a meal or snack 2

   • This prevents recurrence of hypoglycemia
   • Include both fast-acting and long-acting carbohydrates (e.g., crackers and cheese or a meat sandwich) 3

For Unconscious Patients or Those Unable to Swallow (Level 3 Hypoglycemia)

1. Administer glucagon 2, 1, 3

   • For adults and children >44 lbs (20 kg): 1mg dose
   • For children <44 lbs (20 kg): 0.5mg dose (or 20-30 mcg/kg)
   • Available forms:
     • Traditional injectable glucagon (requires reconstitution)
     • Ready-to-use injectable solutions
     • Intranasal glucagon 4, 5

2. Position patient on their side to prevent aspiration 1, 3

3. If no response within 15 minutes, administer second dose of glucagon and seek emergency medical assistance 3

4. Once patient regains consciousness and can swallow, provide oral carbohydrates 1, 3

Post-Hypoglycemia Management

1. Monitor blood glucose every 1-2 hours until stable 1

2. Identify and address the cause of hypoglycemia 1

   • Insulin dosing errors
   • Missed/delayed meals
   • Unexpected physical activity
   • Alcohol consumption
   • Medication interactions
   • Reduced oral intake or vomiting

3. Notify healthcare provider 3

   • All severe hypoglycemic events should be reported to the patient's doctor

Prevention Strategies

1. For patients with recurrent hypoglycemia:

   • Raise glycemic targets temporarily to reverse hypoglycemia unawareness 2, 1
   • Review and potentially reduce insulin or insulin secretagogue doses 1
   • Consider transitioning from intermediate-acting insulin to long-acting insulins 1

2. Practical preventive measures:

   • Carry fast-acting carbohydrates at all times 1, 3
   • Consider medical alert identification 1
   • Consume a bedtime snack if blood glucose is low before sleep 1
   • Always consume food with alcohol 1
   • Monitor blood glucose before, during, and after exercise 1

3. Glucagon prescription:

   • Prescribe glucagon for all individuals at significant risk of severe hypoglycemia 2, 1
   • Train family members, caregivers, school personnel, and others in close contact with the patient on glucagon administration 2, 1

Common Pitfalls to Avoid

1. Treatment errors:

   • Using carbohydrates high in protein or fat, which may delay glucose absorption 2
   • Using insufficient amounts of carbohydrates for treatment 6
   • Failing to provide follow-up meal/snack after initial treatment 2

2. Glucagon-related errors:

   • Not having glucagon readily available for high-risk patients 1
   • Family members/caregivers not trained in glucagon administration 1
   • Using expired glucagon 3

3. Management errors:

   • Not identifying and addressing the underlying cause of hypoglycemia 1
   • Not adjusting treatment regimens after hypoglycemic events 2, 1
   • Not raising glycemic targets temporarily after severe hypoglycemia 2

By following this structured approach to hypoglycemia management, healthcare providers can effectively treat hypoglycemic episodes while minimizing complications and preventing recurrence.