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

Immediate Treatment of Hypoglycemia

For conscious patients with hypoglycemia (blood glucose ≤70 mg/dL), administer 15-20g of oral glucose as the first-line treatment. 1

First-Line Treatment for Conscious Patients

• Pure glucose (in tablet or solution form) is the preferred treatment as it provides the most reliable glycemic response 1, 2
• 15-20g of glucose can raise blood glucose levels by approximately 40-60 mg/dL within 30-45 minutes 3
• Any carbohydrate-containing food with glucose can be used if glucose tablets/solution are unavailable 1, 2
• Initial response to treatment should be seen within 10-20 minutes 1

Treatment Protocol

1. Initial Treatment:

   • Administer 15-20g of glucose orally 1, 2
   • For patients using automated insulin delivery systems, a lower dose of 5-10g carbohydrates may be sufficient (except with exercise-induced hypoglycemia) 1, 2

2. Follow-up Assessment:

   • Recheck blood glucose 15 minutes after carbohydrate ingestion 1
   • If hypoglycemia persists, repeat treatment with another 15-20g of carbohydrate 1, 2
   • Blood glucose should be evaluated again 60 minutes after initial treatment, as additional treatment may be necessary 3, 1

3. Post-Treatment:

   • After successful treatment, provide a meal or snack with complex carbohydrates and protein to prevent recurrence 2
   • This helps restore liver glycogen and prevents subsequent hypoglycemia 4

Treatment for Severe Hypoglycemia (Unconscious Patient)

• For patients unable to consume carbohydrates orally (unconscious or unable to swallow), glucagon is indicated 1, 2
• Glucagon administration options:
  • Adults and children >25kg or ≥6 years: 1mg subcutaneously or intramuscularly 5, 4
  • Children <25kg or <6 years: 0.5mg subcutaneously or intramuscularly 5, 4
  • If no response after 15 minutes, an additional dose may be administered while waiting for emergency assistance 5, 4
• Newer intranasal and ready-to-inject glucagon preparations are available and preferred due to ease of administration 1
• After the patient regains consciousness, oral carbohydrates should be given 5, 4

Important Considerations

• Adding fat to carbohydrate treatment may slow and prolong the acute glycemic response 1
• Protein should not be used alone to treat hypoglycemia as it may increase insulin secretion without providing adequate glucose 1, 2
• Orange juice and glucose gel are less effective in quickly alleviating symptoms compared to glucose tablets or solution 1, 6
• During hypoglycemia, gastric emptying rates are twice as high as during normal blood glucose levels 3

Common Pitfalls to Avoid

• Failing to recheck blood glucose after initial treatment can lead to recurrent hypoglycemia 2
• Treating hypoglycemia with foods high in protein without adequate glucose content can worsen the condition 2
• Not carrying fast-acting glucose sources for emergency treatment increases the risk of severe hypoglycemia 2
• Misdiagnosing hypoglycemia as hyperglycemia can lead to inappropriate treatment and potentially fatal outcomes 7

By following this structured approach to hypoglycemia treatment, prompt recognition and appropriate intervention can effectively resolve hypoglycemic episodes and prevent serious complications.