What is the immediate treatment for hypoglycemia?

Immediate Treatment for Hypoglycemia

The immediate treatment for hypoglycemia is 15-20g of oral glucose, which should be administered promptly to conscious patients with blood glucose <70 mg/dL, followed by a meal or snack once blood glucose normalizes. 1

First-Line Treatment for Conscious Patients

Preferred Treatment Options (in order):

1. Glucose tablets (15-20g) - most preferred option if available 1
2. Any form of carbohydrate containing glucose (15-20g) 2, 1
   • Pure glucose raises blood glucose by ~60 mg/dL over 45 minutes with a 20g dose 2
   • Initial response should be seen within 10-20 minutes 2, 1

Important Considerations:

• Avoid high-fat foods as they slow glucose absorption 1
• Adding protein does not affect glycemic response 2
• Blood glucose should be re-evaluated after 60 minutes, as additional treatment may be necessary 2, 1
• Follow treatment with a meal or snack to prevent recurrence 1, 3

Treatment for Severe Hypoglycemia (Unconscious Patient)

For patients who are unconscious or unable to swallow safely:

1. Glucagon administration is the treatment of choice 1, 3

   • Adults and children >44 lbs (20 kg): 1 mg subcutaneous, intramuscular, or intravenous injection
   • Children <44 lbs (20 kg): 0.5 mg or 20-30 mcg/kg 3

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

3. Feed the patient as soon as they awaken and can safely swallow 3

   • Give fast-acting sugar source (soft drink, fruit juice)
   • Follow with long-acting carbohydrate (crackers and cheese, meat sandwich)

4. If no response within 15 minutes, administer another dose of glucagon and seek emergency medical assistance immediately 3

Treatment Algorithm

1. Recognize hypoglycemia (symptoms: shakiness, irritability, confusion, tachycardia, hunger)
2. Check blood glucose if possible (hypoglycemia: <70 mg/dL)
3. For conscious patients:
   • Administer 15-20g fast-acting carbohydrate
   • Recheck blood glucose after 15 minutes
   • If still <70 mg/dL, repeat treatment
   • Once blood glucose normalizes, provide a meal or snack
4. For unconscious patients:
   • Administer glucagon per dosing guidelines
   • Position on side to prevent aspiration
   • Seek emergency medical assistance
   • Feed once awake and able to swallow

Common Pitfalls to Avoid

• Delaying treatment - hypoglycemia can rapidly progress to unconsciousness
• Using high-fat foods (e.g., chocolate) as treatment, which slows glucose absorption 1
• Failing to follow with a meal or snack after initial treatment, risking recurrent hypoglycemia 1, 3
• Overtreatment leading to rebound hyperglycemia
• Not having glucagon available for patients on insulin or sulfonylureas 1
• Lack of education for patients/caregivers about proper hypoglycemia recognition and treatment 1

By following these evidence-based guidelines, hypoglycemia can be effectively managed to minimize morbidity and mortality while maintaining quality of life for patients with diabetes.