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 (with pure glucose preferred), and recheck blood glucose after 15 minutes, repeating treatment if hypoglycemia persists. 1

Treatment Algorithm Based on Severity

Level 1-2 Hypoglycemia (Conscious Patient)

1. First-line treatment:

   • Administer 15-20g of fast-acting carbohydrates 1
   • Pure glucose is preferred, but any form of carbohydrate containing glucose will raise blood glucose 2
   • Options include:
     • 4-8 oz (120-240 mL) of juice or regular soda 2
     • Glucose tablets
     • 1 tablespoon of sugar or honey

2. Follow-up steps:

   • Recheck blood glucose after 15 minutes 1
   • If hypoglycemia persists, repeat the 15-20g carbohydrate treatment
   • Initial response should be seen in 10-20 minutes, but blood glucose should be evaluated again in 60 minutes as additional treatment may be necessary 2

3. Once blood glucose normalizes:

   • Consume a meal or snack containing complex carbohydrates to prevent recurrence 1

Level 3 Hypoglycemia (Unconscious/Severe)

1. Emergency treatment:

   • Administer glucagon:
     • Adults and children ≥20kg: 1mg subcutaneously or intramuscularly 1, 3
     • Children <20kg: 0.5mg or 20-30 mcg/kg 1, 3
   • May repeat dose after 15 minutes if no response 1, 3

2. Medical supervision:

   • For intravenous correction, administer 10% dextrose (D10W) in 5g (50mL) aliquots 1
   • Maximum initial dose of 25g total (250mL of D10W) 1
   • Target blood glucose of 100-140 mg/dL to avoid overcorrection 1

3. Post-recovery:

   • Once the patient regains consciousness and can swallow, provide oral carbohydrates 3
   • Call for emergency assistance immediately after administering treatment 3

Physiological Effects and Importance

Hypoglycemia is a serious complication with both immediate and long-term consequences:

• Immediate risks: Neuroglycopenic symptoms (confusion, seizures, coma), injuries, and potentially death 4, 5
• Long-term risks: Recurrent hypoglycemia increases mortality risk 3.4-fold within 5 years 1, impairs counter-regulatory systems leading to hypoglycemia unawareness 5, and increases risk of cardiovascular events 4

10g of oral glucose can raise blood glucose levels by approximately 40 mg/dL over 30 minutes, while 20g can raise levels by about 60 mg/dL over 45 minutes 2. Blood glucose levels typically begin to fall again 60 minutes after treatment 2.

Prevention Strategies

1. Medication adjustments:

   • Consider switching from regular/NPH insulin to insulin analogs 1
   • Adjust balance between basal and bolus insulin 1
   • Reduce excessive correction doses 1

2. Dietary considerations:

   • Correct carbohydrate counting errors 1
   • Ensure consistent meal timing 1
   • Consider bedtime snack if pre-sleep glucose is low 1
   • Moderate alcohol consumption only with food 1

3. Activity management:

   • Adjust insulin for planned exercise 1
   • Carry fast-acting carbohydrates during physical activity 1
   • Monitor glucose before, during, and after exercise 1

4. Education and preparation:

   • Wear medical alert bracelet or necklace 2
   • Always carry a source of sugar 2
   • Educate family members, caregivers and close contacts about hypoglycemia recognition and treatment 2, 1
   • Provide glucagon emergency kit and train family members on administration 1

Hypoglycemia is a significant barrier to achieving optimal glycemic control in diabetes management. Prompt recognition and appropriate treatment are essential to prevent serious complications while maintaining reasonable glycemic targets.