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

Immediate Treatment of Hypoglycemia

The immediate treatment for hypoglycemia is administration of 15-20g of glucose orally for conscious patients, with pure glucose being the preferred treatment option as it provides the most effective glycemic response. 1

First-Line Treatment for Conscious Patients

• Administer 15-20g of glucose orally for conscious patients experiencing hypoglycemia (blood glucose ≤70 mg/dL) 1, 2
• Pure glucose (in tablet or solution form) is the preferred treatment option as the glycemic response correlates better with glucose content than with total carbohydrate content 1
• Any form of carbohydrate containing glucose can be used as an alternative treatment option if glucose tablets/solution are not available 3, 1
• Initial response to treatment should be seen within 10-20 minutes 1

Follow-up Protocol

• Recheck blood glucose 15 minutes after carbohydrate ingestion 1
• If hypoglycemia persists, repeat the 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
• After successful treatment, consume a meal or snack with complex carbohydrates and protein to prevent recurrence 2

Special Considerations

• For patients using automated insulin delivery systems, a lower dose of 5-10g carbohydrates may be appropriate unless hypoglycemia occurs with exercise 1, 2
• Adding fat to carbohydrate treatment may slow and prolong the acute glycemic response, potentially delaying recovery 3, 1
• Protein should not be used alone to treat hypoglycemia as it may increase insulin secretion without providing sufficient glucose 2
• Orange juice and glucose gel are less effective in quickly alleviating symptoms compared to glucose tablets or solution 1, 4

Treatment for Severe Hypoglycemia (Unconscious Patient)

• For unconscious patients or those unable to consume carbohydrates orally, glucagon is the indicated treatment 1, 2, 5
• The usual adult dose of glucagon is 1mg; for children weighing less than 44 lb (20 kg), give 0.5mg 5
• Newer intranasal and ready-to-inject glucagon preparations are now available and preferred due to ease of administration 1, 6
• After administering glucagon, turn the patient on their side to prevent choking if vomiting occurs upon awakening 5
• Once the patient awakens and can swallow, provide fast-acting carbohydrates (such as juice) followed by longer-acting carbohydrates (such as crackers and cheese) 5
• If the patient does not awaken within 15 minutes, administer another dose of glucagon and seek emergency medical assistance immediately 5

Prevention of Recurrent Hypoglycemia

• Ensure patients at risk always carry a source of fast-acting carbohydrates 2, 5
• Avoid targeting overly tight glucose control; aim to keep blood glucose >70 mg/dL 2
• Implement consistent meal timing when on fixed insulin regimens 2
• Consider continuous glucose monitoring for those with recurrent hypoglycemia 2

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, 5
• Mistaking hypoglycemia for hyperglycemia can lead to inappropriate treatment and potentially fatal outcomes 7