How do I manage hypoglycemia?

Management of Hypoglycemia

The most effective approach to manage hypoglycemia is to immediately administer 15-20g of fast-acting carbohydrates for conscious patients, followed by a meal or snack once blood glucose normalizes, and to use glucagon for severe cases when the patient cannot safely consume oral carbohydrates. 1

Immediate Management of Hypoglycemia

For Conscious Patients (Blood Glucose <70 mg/dL)

1. Administer 15-20g of fast-acting carbohydrates such as:

   • 4-8 oz (120-240 mL) of fruit juice or regular soda
   • Glucose tablets (follow package instructions for 15-20g equivalent)
   • 1 tablespoon of sugar or honey 1

2. Recheck blood glucose after 15 minutes

   • If hypoglycemia persists, repeat the treatment 2
   • Continue this cycle until blood glucose normalizes

3. Once blood glucose returns to normal, provide a meal or snack containing complex carbohydrates to prevent recurrence 2, 1

For Severe Hypoglycemia (Patient Unable to Self-Treat)

1. Administer glucagon via one of these routes:

   • Subcutaneous or intramuscular injection:
     • Adults and children ≥20kg: 1mg
     • Children <20kg: 0.5mg (or 20-30 mcg/kg) 3
   • Intravenous administration (medical professionals only):
     • Same dosing as above 3

2. Position patient on their side to prevent aspiration if vomiting occurs when they regain consciousness 1

3. Call emergency services immediately after administering glucagon 1, 3

4. Monitor blood glucose every 15 minutes until emergency help arrives 1

5. Provide oral carbohydrates once the patient regains consciousness and can safely swallow 3

Prevention Strategies

Medication Adjustments

• Review insulin and secretagogue dosing to minimize risk
• For patients on once-daily steroids, consider NPH insulin administration at the same time as steroids 1
• For recurrent hypoglycemia, temporarily raise glycemic targets to 100-180 mg/dL 1

Patient Education

1. Teach proper hypoglycemia recognition and treatment:

   • Symptoms: sweating, shakiness, confusion, irritability
   • Proper carbohydrate amounts for treatment
   • Importance of not overtreating (common pitfall) 4

2. Prescribe glucagon emergency kits for all patients at significant risk of severe hypoglycemia 2

   • Train family members/caregivers on administration
   • Ensure unexpired kits are available

3. Advise carrying fast-acting carbohydrates at all times 1

4. Recommend wearing medical alert identification 1

Special Considerations

For Patients with Hypoglycemia Unawareness

• Implement a 2-3 week period of strict hypoglycemia avoidance 1
• Consider raising glycemic targets to prevent recurrent episodes 2

For Exercise-Related Hypoglycemia

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

Common Pitfalls to Avoid

1. Overtreating hypoglycemia - Studies show that 50.3% of patients consume >20g of carbohydrates and 22.3% consume >30g, which can lead to rebound hyperglycemia 4

2. Using inappropriate foods - Low glycemic index foods like milk or cookies are less effective for rapid correction 4

3. Failing to follow up with a meal or snack after initial treatment, which can lead to recurrent hypoglycemia 2

4. Not adjusting treatment regimens after severe hypoglycemic episodes 2

5. Ignoring hypoglycemia unawareness - This condition significantly increases risk of severe episodes and requires temporary elevation of glycemic targets 2, 1

By following this structured approach to hypoglycemia management, you can effectively treat acute episodes while implementing strategies to prevent future occurrences, ultimately reducing the significant morbidity and mortality associated with this common complication 5.