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

Treatment of Hypoglycemia

For hypoglycemia treatment, administer 15-20g of oral glucose for mild to moderate hypoglycemia in conscious patients, or glucagon injection for severe hypoglycemia with altered mental status. 1

Classification and First-Line Treatments

Hypoglycemia is classified into three levels with specific treatments:

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

For Conscious Patients (Mild to Moderate Hypoglycemia)

• Administer 15-20g of rapid-acting carbohydrates orally
• Options include:
  • Glucose tablets (preferred for consistent dosing)
  • Glucose solution
  • Sucrose tablets or solution
  • Note: Glucose gel and orange juice are less effective for quick blood glucose elevation 2
• Recheck blood glucose after 15 minutes
• If hypoglycemia persists, repeat treatment with another 15-20g of carbohydrates
• Once blood glucose normalizes, provide a meal or snack containing complex carbohydrates to prevent recurrence 1, 3

For Unconscious Patients (Severe Hypoglycemia)

1. Without IV access:

   • Administer glucagon:
     • Adults and children >25kg or ≥6 years: 1mg subcutaneously or intramuscularly
     • Children <25kg or <6 years: 0.5mg subcutaneously or intramuscularly
   • If no response after 15 minutes, administer a second dose while awaiting emergency assistance 4

2. With IV access:

   • Administer 10% dextrose (D10W) in 5g (50mL) aliquots
   • Maximum initial dose: 25g total (250mL of D10W)
   • Target blood glucose: 100-140 mg/dL to avoid overcorrection above 150 mg/dL
   • For children: 2-5 mL/kg of D10W 1

Monitoring and Follow-up

• Check blood glucose 15 minutes after treatment
• Continue monitoring hourly until stable
• Median time to recovery of normal consciousness with D10W: approximately 8 minutes
• Monitor for resolution of autonomic and neuroglycopenic symptoms 1
• Once the patient is conscious and able to swallow, provide oral carbohydrates to restore liver glycogen and prevent recurrence 4

Prevention Strategies

• Teach recognition of early hypoglycemia symptoms
• Advise carrying a source of rapid-acting sugar at all times
• Recommend medical alert identification
• For patients at risk of severe hypoglycemia, provide a glucagon emergency kit and train family members on administration
• Recommend bedtime snack if blood glucose is low before sleep
• Advise moderate alcohol consumption to always be accompanied by food
• Recommend carrying fast-acting carbohydrates during physical activity 1

Special Considerations

• Hypoglycemia unawareness: More vigilant monitoring is required for patients with repeated episodes of hypoglycemia, which may result in hypoglycemia unawareness 1, 5
• Elderly patients: Focus on preventing hypoglycemia rather than achieving tight glycemic control 1
• Children: Severe hypoglycemia may be associated with cognitive deficits; caregivers must be aware of age-dependent hypoglycemia signs 1
• Critical illness: Maintain blood glucose levels <180 mg/dL to reduce mortality while avoiding hypoglycemia 1

Common Pitfalls to Avoid

• Undertreatment: Insufficient carbohydrate administration may lead to prolonged hypoglycemia
• Overtreatment: Excessive carbohydrate administration may cause hyperglycemia
• Delayed recognition: Symptoms are nonspecific and relatively insensitive; many episodes go unrecognized 5
• Failure to identify causes: Not addressing the underlying cause may lead to recurrent episodes
• Inappropriate glucagon use: Glucagon may be less effective in patients with depleted glycogen stores (alcoholics, malnourished)

The 15-20g carbohydrate rule has been shown to be highly effective, with one study demonstrating a 97.6% effectiveness rate in restoring normal glucose levels in hospitalized patients 6.