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

Immediate Treatment for Hypoglycemia

For conscious patients with hypoglycemia, administer 15-20g of fast-acting carbohydrates, preferably pure glucose, and recheck blood glucose after 15 minutes, repeating treatment if hypoglycemia persists. 1

Treatment Algorithm Based on Patient Status

For Conscious Patients

1. First-line treatment: 15-20g of fast-acting carbohydrates 2, 1

   • Pure glucose is preferred (tablets or solution)
   • 15g of glucose raises blood glucose by approximately 40 mg/dL over 30 minutes
   • 20g of glucose raises blood glucose by approximately 60 mg/dL over 45 minutes

2. Recheck blood glucose after 15 minutes

   • Initial response should be seen within 10-20 minutes 2
   • If hypoglycemia persists, repeat treatment with 15-20g of carbohydrates

3. Follow-up after initial recovery

   • Recheck blood glucose at 60 minutes as additional treatment may be necessary 2
   • Blood glucose begins to fall approximately 60 minutes after glucose ingestion

For Severe Hypoglycemia (Unconscious/Unable to Swallow)

1. Administer glucagon 1, 3, 4

   • Adults and children ≥20kg: 1mg subcutaneously or intramuscularly
   • Children <20kg: 0.5mg or 20-30 mcg/kg
   • Can repeat dose after 15 minutes if no response

2. Position patient on their side to prevent choking if vomiting occurs 3

3. Seek emergency medical assistance immediately 3, 4

4. Once patient awakens and can swallow:

   • Provide fast-acting carbohydrates (juice, soft drink)
   • Follow with long-acting carbohydrates (crackers with cheese, meat sandwich) 3

Carbohydrate Options and Effectiveness

Most Effective Options (in order)

1. Glucose tablets or solution - fastest and most reliable response 1, 5
2. Any form of carbohydrate containing glucose 2
   • Sucrose (table sugar) in solution or tablets
   • Other fast-acting carbohydrates

Less Effective Options

• Glucose gel and orange juice may have slower absorption 6, 5
• Adding fat may delay the glycemic response 2
• Adding protein does not affect the glycemic response or prevent subsequent hypoglycemia 2

Important Considerations

Monitoring

• Blood glucose should be evaluated again 60 minutes after treatment as additional treatment may be necessary 2, 1
• During hypoglycemia, gastric emptying rates are twice as high as during normal blood glucose levels 2

Prevention of Recurrence

• Patients who experience hypoglycemia have a significantly increased mortality risk (3.4-fold increased risk within 5 years following severe hypoglycemia) 1
• For patients with recurrent hypoglycemia, implementing a 2-3 week period of scrupulous avoidance of hypoglycemia by temporarily raising glycemic targets can help restore awareness 1, 7

Patient Education

• Patients should be educated on early recognition of hypoglycemia symptoms 1
• Patients should always carry fast-acting carbohydrates 1, 3
• Family members and caregivers should be trained on glucagon administration for severe episodes 1, 3

Hypoglycemia is a serious condition that requires prompt treatment to prevent progression to severe symptoms, unconsciousness, and potentially death. The evidence clearly supports using glucose as the preferred treatment, with glucagon reserved for severe cases where oral intake is not possible.