From the Guidelines
The NHS guideline for treating hypoglycemia recommends administering 15-20g of fast-acting oral glucose for conscious patients with blood glucose below 4 mmol/L, as supported by the most recent evidence from the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Recommendations
- Administer 20g oral glucose or the equivalent in glucose-containing foods to rapidly restore blood glucose levels, as oral glucose is available in different forms and can be given through different routes in the first aid setting 1.
- For conscious patients, provide 15-20g of fast-acting oral glucose, which can be given as 4-5 glucose tablets (4g each), 150-200ml of pure fruit juice, 5-6 pieces of candy, or 3-4 teaspoons of sugar dissolved in water.
- After administration, wait 10-15 minutes and recheck blood glucose, and if levels remain below 4 mmol/L, repeat the treatment once, as suggested by the 2023 Diabetes Care guidelines 1.
- Once blood glucose exceeds 4 mmol/L, provide a longer-acting carbohydrate snack such as a sandwich, piece of fruit, or the next meal if due, to prevent recurrence, especially for patients on insulin or sulfonylureas.
Important Considerations
- Untreated hypoglycemia can cause seizures, status epilepticus, permanent brain injury, and death, emphasizing the importance of prompt treatment 1.
- For patients with hypoglycemia who are unable to swallow, intravenous dextrose can be lifesaving, and glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia 1.
- Hypoglycemia unawareness or one or more episodes of level 3 hypoglycemia should trigger hypoglycemia avoidance education and reevaluation and adjustment of the treatment plan to decrease hypoglycemia 1.
From the Research
Treatment of Hypoglycemia
- The provided studies do not specifically mention the National Health Service (NHS) guidelines for treating hypoglycemia with oral glucose 2, 3, 4, 5, 6.
- However, the studies discuss the importance of prompt treatment of hypoglycemia, including the use of glucagon and oral glucose, to prevent medical sequelae of severe hypoglycemic emergencies 4, 6.
- The American Diabetes Association Standards of Medical Care recommends that a management protocol for hypoglycemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan 4.
- The Endocrine Society Clinical Practice Guideline recommends evaluation and management of hypoglycemia only in patients in whom Whipple's triad is documented, and suggests a strategy for pursuing clinical clues to potential hypoglycemic etiologies 5.
Management of Hypoglycemia
- The studies emphasize the importance of education and regular review between people with diabetes and their caregivers and healthcare professionals about symptoms, prevention, and treatment of hypoglycemia 2, 3, 4.
- Continuous glucose monitoring (CGM) should be considered for all individuals with increased risk for hypoglycemia, impaired hypoglycemia awareness, frequent nocturnal hypoglycemia, and with history of severe hypoglycemia 4.
- Optimizing insulin doses and carbohydrate intake, in addition to a short warm-up before or after physical activity sessions, may help avoid hypoglycemia 4.
Treatment Options
- Glucagon is an effective treatment for severe hypoglycemia, and a ready-to-use liquid glucagon injection administered by autoinjector is a viable alternative to traditional glucagon emergency kits 6.
- The use of GLP-1 receptor agonists or SGLT2 inhibitors may be considered for vulnerable patients with type 2 diabetes at dual risk of severe hypoglycemia and cardiovascular outcomes 4.