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

Treatment of Hypoglycemia

For hypoglycemia, administer 15-20g of oral glucose as first-line treatment for conscious patients, followed by a meal or snack once blood glucose normalizes; for severe hypoglycemia with altered mental status, administer glucagon injection. 1

Immediate Treatment Algorithm for Hypoglycemia

For Conscious Patients (Levels 1-2: Blood Glucose <70 mg/dL)

1. Administer 15-20g of oral glucose

   • Glucose tablets are preferred if available 1
   • Alternative carbohydrate sources containing glucose can be used 2
   • Avoid high-fat foods as they slow glucose absorption 1

2. Recheck blood glucose after 15 minutes

   • If hypoglycemia persists, repeat treatment with another 15-20g of glucose 2
   • Symptoms should begin resolving within 10-20 minutes 1

3. Once blood glucose normalizes

   • Patient should consume a meal or snack to prevent recurrence 2, 1
   • Protein added to carbohydrate has no benefit in preventing subsequent hypoglycemia 2

For Severe Hypoglycemia (Level 3: Any Blood Glucose with Altered Mental Status)

1. Administer glucagon

   • For adults and children >25kg or ≥6 years with unknown weight: 1mg subcutaneously or intramuscularly 3
   • For children <25kg or <6 years with unknown weight: 0.5mg subcutaneously or intramuscularly 3
   • If no response after 15 minutes, administer a second dose while awaiting emergency assistance 3

2. Call for emergency assistance immediately after administration 3

3. When patient regains consciousness

   • Provide oral carbohydrates to restore liver glycogen and prevent recurrence 3

Prevention and Follow-up

1. Prescribe glucagon for at-risk patients

   • All individuals at significant risk of severe hypoglycemia should have glucagon prescribed 2, 1
   • Train family members/caregivers on glucagon administration 1

2. For patients with hypoglycemia unawareness or recurrent severe hypoglycemia

   • Implement 2-3 weeks of strict hypoglycemia avoidance 1
   • Raise glycemic targets temporarily to reverse hypoglycemia unawareness 2
   • Reassess medication regimen 1

3. Patient education

   • Teach recognition of hypoglycemic symptoms (shakiness, irritability, confusion, tachycardia, hunger) 1
   • Emphasize carrying fast-acting carbohydrates at all times 1
   • Stress importance of following treatment with a meal/snack 1

Special Considerations

• Comparative effectiveness: Glucose tablets result in higher rates of symptom resolution at 15 minutes compared to dietary sugars and should be considered first when available 4

• Hospital management: For hospitalized patients, implement standardized nurse-initiated hypoglycemia treatment protocols for blood glucose <70 mg/dL 1

• Elderly patients: Focus on preventing hypoglycemia rather than achieving tight glycemic control 1

• Hypoglycemia unawareness: Short-term avoidance of hypoglycemia (2-3 weeks) can reverse hypoglycemia unawareness in most affected patients 5

• Common pitfall: Ongoing activity of insulin or insulin secretagogues may lead to recurrence of hypoglycemia unless further food is ingested after initial recovery 2

By following this structured approach to hypoglycemia management, clinicians can effectively treat acute episodes while implementing strategies to prevent recurrence and reduce the associated morbidity and mortality.