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

Immediate Treatment of Hypoglycemia

The immediate treatment for hypoglycemia is the administration of 15-20g of pure glucose, which is the preferred treatment as it produces the most rapid increase in blood glucose levels. 1

Definition and Recognition of Hypoglycemia

• Hypoglycemia is defined as a blood glucose level ≤70 mg/dL (3.9 mmol/L) and should be treated promptly 1
• Even blood glucose levels of 60-80 mg/dL (3.3-4.4 mmol/L) may require management decisions such as carbohydrate ingestion 1
• Signs and symptoms of hypoglycemia can include neurogenic symptoms (tremor, palpitations, sweating) and neuroglycopenic symptoms (confusion, altered mental status) 2

First-Line Treatment Protocol

• Administer 15-20g of glucose orally for conscious patients with hypoglycemia 1
• Pure glucose is preferred as the glycemic response correlates better with glucose content than with total carbohydrate content 1
• Treatment options in order of effectiveness:
  • Glucose tablets or solution (most effective) 1, 3
  • Sucrose tablets or solution 3
  • Any carbohydrate-containing food that contains glucose 1

Treatment Administration and Follow-up

• Initial response to treatment should be seen within 10-20 minutes 1
• Recheck blood glucose 15 minutes after carbohydrate ingestion 1
• If hypoglycemia persists, repeat the treatment with another 15-20g of carbohydrate 1
• Blood glucose should be evaluated again 60 minutes after initial treatment, as additional treatment may be necessary 1
• When the patient has responded to treatment and is able to swallow, give additional oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia 4

Special Considerations

• For patients using automated insulin delivery systems, a lower dose of 5-10g carbohydrates may be appropriate unless hypoglycemia occurs with exercise or after significant insulin overestimation 1
• Adding fat to carbohydrate treatment may slow and prolong the acute glycemic response 1
• Protein should not be used to treat hypoglycemia as it may increase insulin secretion 1
• Orange juice and glucose gel are less effective in quickly alleviating symptoms compared to glucose tablets or solution 1, 3

Severe Hypoglycemia Treatment (Unconscious Patient)

• For patients unable or unwilling to consume carbohydrates orally, glucagon is indicated 1
• Glucagon can be administered subcutaneously, intramuscularly, or intravenously 4
• Dosage for adults and children weighing >25kg: 1mg 4
• Dosage for children weighing <25kg: 0.5mg 4
• Newer intranasal and ready-to-inject glucagon preparations are now available and preferred due to ease of administration 1, 5
• After glucagon administration, call for emergency assistance immediately 4

Prevention of Recurrent Hypoglycemia

• Identify and address risk factors for hypoglycemia, including insulin dosing, timing of meals, and exercise patterns 2
• For patients with recurrent hypoglycemia or hypoglycemia unawareness, a 2-3 week period of scrupulous avoidance of hypoglycemia is recommended 2
• Ensure patients at risk have access to glucose-containing foods or glucose tablets 6
• Avoid targeting overly tight glucose control; aim to keep blood glucose >70 mg/dL 6

Hypoglycemia is a serious and potentially life-threatening condition that requires prompt recognition and treatment. The evidence strongly supports using pure glucose as the first-line treatment, with careful monitoring and follow-up to prevent recurrence.