What is the treatment for fasting hypoglycemia?

Treatment of Fasting Hypoglycemia

The treatment for fasting hypoglycemia should begin with immediate ingestion of 15-20g of glucose, which is the preferred treatment due to its rapid effect on blood glucose levels, followed by a meal or snack to prevent recurrence once glucose normalizes. 1

Immediate Management

• For conscious patients with hypoglycemia (blood glucose ≤70 mg/dL or 3.9 mmol/L), administer 15-20g of fast-acting carbohydrates, preferably pure glucose 1
• Recheck blood glucose after 15 minutes; if hypoglycemia persists, repeat the treatment 1
• Once blood glucose normalizes, the patient should consume a meal or snack containing carbohydrates to prevent recurrence 1
• For patients using automated insulin delivery systems, a smaller amount (5-10g) of carbohydrates may be appropriate unless hypoglycemia is associated with exercise or significant meal bolus overestimation 1

Severe Hypoglycemia Management

• For severe hypoglycemia (altered mental status, unconsciousness, or inability to consume oral carbohydrates), glucagon administration is indicated 1, 2
• Glucagon should be prescribed for all individuals at risk of severe hypoglycemia 1
• Family members, caregivers, and others in close contact should be trained on glucagon administration 1, 2
• Newer formulations of glucagon (intranasal and ready-to-inject) are preferred due to ease of administration and faster correction of hypoglycemia 1
• After glucagon administration and patient recovery, oral carbohydrates should be given to restore liver glycogen and prevent recurrence 2

Choice of Carbohydrate Source

• Pure glucose is the preferred treatment as it raises blood glucose more effectively than equivalent amounts of other carbohydrates 1
• Any form of carbohydrate containing glucose will raise blood glucose, but the glycemic response correlates better with glucose content than total carbohydrate content 1
• Carbohydrate sources high in protein should be avoided as they may increase insulin secretion without adequately raising glucose 1
• Added fat may slow and then prolong the acute glycemic response, potentially delaying recovery 1

Prevention Strategies

• Identify and address risk factors for hypoglycemia through regular assessment 1
• Provide structured education on hypoglycemia prevention, recognition, and treatment 1
• For patients with recurrent hypoglycemia or hypoglycemia unawareness, consider temporarily raising glycemic targets 1
• During acute illness, patients should continue insulin (if applicable), monitor blood glucose frequently, maintain adequate fluid intake, and consume 150-200g of carbohydrate daily to prevent starvation ketosis 1
• For patients fasting for laboratory tests, implement a prevention program including blood glucose monitoring and adjustment of antidiabetic medications 3

Special Considerations

• For patients with impaired hypoglycemia awareness, more vigilant monitoring and preventive strategies are essential 1
• Glucagon should be readily available and not expired; newer formulations have improved stability but still require proper storage and replacement when expired 1
• After severe hypoglycemia, evaluate the need for medication adjustments to prevent future episodes 1