Administration of Glucose for Hypoglycemia
Glucose is administered to rapidly treat hypoglycemia in conscious patients who are able to swallow, as it provides the fastest way to increase blood glucose levels and resolve potentially life-threatening low blood sugar. 1
Indications for Glucose Administration
- Glucose should be administered to patients with symptomatic hypoglycemia (blood glucose <70 mg/dL or 3.9 mmol/L) who are conscious and able to swallow 1
- Symptoms of hypoglycemia include confusion, altered behavior, diaphoresis, tremulousness, dizziness, fatigue, shakiness, tachycardia, and slurred speech 1, 2
- Untreated hypoglycemia can progress to unconsciousness, seizures, permanent brain injury, and death 2, 3
Recommended Administration Methods
First-Line Treatment
- Oral/swallowed glucose is strongly recommended as the first-line treatment for conscious patients able to swallow 1
- The recommended dose is 15-20g of glucose for adults and children with suspected hypoglycemia 1
- Glucose tablets, if available, should be used as they provide more rapid clinical relief compared to other dietary sugars 1
Alternative Options (if glucose tablets unavailable)
- Various forms of dietary sugars can be used as alternatives to glucose tablets, including: 1
- Skittles
- Mentos
- Sugar cubes
- Jelly beans
- Orange juice
Special Administration Routes
- For children who are conscious but uncooperative with oral glucose administration, sublingual glucose administration may be used 1
- If oral glucose tablets are not immediately available, a combined oral and buccal glucose (e.g., glucose gel) administration is suggested 1
- Buccal glucose administration alone is less effective than oral/swallowed glucose 1
Post-Administration Monitoring and Follow-up
- After administering glucose, wait 15 minutes before re-checking blood glucose levels 1
- If hypoglycemia persists after 15 minutes, repeat the treatment 1, 4
- Once blood glucose returns to normal (≥70 mg/dL), the patient should consume a meal or snack to prevent recurrence of hypoglycemia 1, 4
Severe Hypoglycemia Management
- For patients who are unconscious, having seizures, or unable to swallow safely, oral glucose is contraindicated due to aspiration risk 1, 2
- In these cases, emergency medical services should be called immediately 1, 4
- For patients unable to take oral glucose, parenteral options include: 2, 4, 5
- Intramuscular glucagon (0.5-1.0 mg)
- Intravenous dextrose (for healthcare providers)
- Intranasal glucagon (newer option with easier administration)
Important Considerations and Pitfalls
- Blood glucose levels typically do not improve substantially until 10-15 minutes after treatment with dietary sugars 1, 6
- Providing more sugar than needed can lead to "over-shooting" of blood glucose goals, which may be harmful if repeated over time 1, 7
- Never attempt oral administration of glucose in patients who are unconscious or unable to swallow due to significant aspiration risk 2, 4
- Recurrent episodes of hypoglycemia may indicate a need to reevaluate the treatment regimen and potentially relax glycemic targets 1, 3