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

Immediate Treatment for Hypoglycemia

For immediate treatment of hypoglycemia (low blood sugar), administer 15-20g of oral glucose to a conscious patient who can swallow safely. 1

Recognition and Assessment

• Hypoglycemia is defined as blood glucose <70 mg/dL, with clinical significance at <3.0 mmol/L 1
• Common symptoms include confusion, altered behavior, diaphoresis, tremulousness, and cognitive impairment 1, 2
• If the person is unconscious, having seizures, or unable to follow commands or swallow safely, call emergency services immediately 1

Treatment Algorithm for Hypoglycemia

For Conscious Patients Who Can Swallow:

1. First-line treatment: Administer 15-20g of glucose 1

   • Glucose tablets are preferred if available (most rapid response) 1, 3
   • If glucose tablets unavailable, use any carbohydrate-containing food with glucose 1

2. Monitor response:

   • Check blood glucose after 15 minutes 1
   • Initial response should be seen within 10-20 minutes 1
   • Wait at least 10-15 minutes before re-treating with additional oral sugars 1

3. If symptoms persist or blood glucose remains <70 mg/dL:

   • Repeat treatment with another 15-20g of glucose 1
   • Recheck blood glucose after 15 minutes 1

4. Once blood glucose normalizes (>70 mg/dL):

   • If more than one hour until the next meal, provide a starchy or protein-rich food to prevent recurrence 1, 2

For Unconscious Patients or Those Unable to Swallow:

1. Call emergency services immediately 1

2. If trained and medication available:

   • Administer glucagon:
     • Adults and children >25kg: 1mg intramuscularly 4
     • Children <25kg: 0.5mg intramuscularly 4
   • If no response after 15 minutes, a second dose may be administered 4

Evidence Quality and Considerations

• Glucose tablets produce a more rapid clinical response compared to other forms of carbohydrates 1, 3
• Pure glucose raises blood glucose more effectively than equal amounts of carbohydrate from orange juice or milk 1
• 10g of oral glucose can raise blood glucose by approximately 40 mg/dL over 30 minutes 1
• 20g of oral glucose can raise blood glucose by approximately 60 mg/dL over 45 minutes 1

Common Pitfalls and Caveats

• Blood glucose begins to fall again about 60 minutes after glucose ingestion, so monitoring is essential 1, 2
• Adding protein to carbohydrate treatment does not affect glycemic response or prevent subsequent hypoglycemia 1
• Adding fat may delay the acute glycemic response 1
• Fructose (in fruit juice) and galactose (in milk) are less effective than glucose in raising blood glucose levels 1, 3
• Recurrent hypoglycemia can lead to hypoglycemia unawareness, creating a dangerous cycle of repeated episodes 2
• For patients with recurrent hypoglycemia, a 2-3 week period of scrupulous avoidance of hypoglycemia is recommended 2

Special Populations

• For children who may be uncooperative with oral glucose administration, sublingual glucose administration may be considered 1
• For patients with diabetes experiencing illness, insulin should not be omitted, but supplemental carbohydrates may be needed 1