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

Immediate Treatment for Hypoglycemia

For conscious patients with hypoglycemia, administer 15-20g of oral glucose (such as glucose tablets) as first-line treatment, followed by a meal or snack once blood glucose normalizes. 1, 2

Treatment Algorithm Based on Patient Status

For Conscious Patients Able to Swallow:

• First-line treatment: 15-20g of oral glucose 2, 1
  • Glucose tablets are preferred if available 2
  • If glucose tablets unavailable, use any carbohydrate containing glucose:
    • 4 oz (120 mL) of fruit juice or regular soda
    • 1 tablespoon of honey or sugar dissolved in water
    • Hard candies, jelly beans, or other sugar-containing foods
• Wait 15 minutes and recheck blood glucose 1
• If hypoglycemia persists, repeat 15-20g of glucose 1
• Once blood glucose normalizes, provide a meal or snack containing protein and complex carbohydrates to prevent recurrence 1, 2

For Unconscious Patients or Those Unable to Swallow:

• Position patient safely to prevent aspiration 1
• Administer glucagon 1, 3:
  • Adults and children >25kg: 1mg intramuscularly or subcutaneously
  • Children <25kg: 0.5mg intramuscularly or subcutaneously
• Call for emergency medical assistance immediately after administering glucagon 3
• If no response after 15 minutes, administer a second dose while waiting for emergency help 3
• Once the patient regains consciousness and can swallow safely, provide oral carbohydrates 3

Important Clinical Considerations

• Adding protein to carbohydrate treatment does not affect glycemic response or prevent subsequent hypoglycemia 2
• Adding fat may delay the glycemic response and should be avoided for immediate treatment 2
• During hypoglycemia, gastric emptying rates are twice as fast as during normal blood glucose levels, allowing for rapid absorption of oral treatments 2
• Symptoms should begin to resolve within 10-20 minutes after glucose administration 2, 1

Special Populations

• Children: May be uncooperative with oral glucose administration; sublingual glucose can be considered as an alternative route 2
• Patients with recurrent hypoglycemia: Consider reviewing medication regimen, evaluating timing of insulin administration relative to meals, and assessing for hypoglycemia unawareness 1
• Hospital setting: For suspected hypoglycemia-related emergencies with IV access, administer intravenous glucose (D10W in 50mL aliquots) as first-line treatment 1

Prevention of Future Episodes

• Prescribe glucagon to all patients on insulin regimens and consider for patients taking sulfonylureas 1
• Train family members/caregivers on glucagon administration 1
• For patients with hypoglycemia unawareness or recurrent severe hypoglycemia, implement a 2-3 week period of strict hypoglycemia avoidance 1, 4

Remember that untreated severe hypoglycemia can lead to seizures, coma, and death, making prompt recognition and appropriate treatment essential 5.