What is the treatment for a patient with hypoglycemia (low blood glucose)?

Management of Hypoglycemia with Blood Glucose of 55 mg/dL

For a patient with hypoglycemia and blood glucose of 55 mg/dL, administer 15-20g of oral glucose immediately if the patient is conscious, or use glucagon if the patient is unconscious or unable to safely consume oral carbohydrates. 1, 2

Initial Assessment and Treatment

For Conscious Patients:

• Administer 15-20g of glucose orally (preferred treatment) or any carbohydrate containing glucose 1, 2
• Pure glucose (glucose tablets or solution) is the most effective treatment as glycemic response correlates better with glucose content than with total carbohydrate content 2
• Recheck blood glucose 15 minutes after treatment 3, 1
• If hypoglycemia persists, repeat treatment with another 15-20g of carbohydrate 3, 2
• Once blood glucose normalizes (>70 mg/dL), provide a meal or snack to prevent recurrence 3, 1

For Unconscious Patients or Those Unable to Take Oral Glucose:

• Administer glucagon via subcutaneous, intramuscular, or intravenous route 4
• For adults and children weighing >25kg or ≥6 years with unknown weight: 1mg glucagon 4
• For children weighing <25kg or <6 years with unknown weight: 0.5mg glucagon 4
• If no response after 15 minutes, an additional dose may be administered while waiting for emergency assistance 4
• Newer intranasal and ready-to-inject glucagon preparations are available and preferred due to ease of administration 2, 5

Follow-up Care

• Once the patient has responded to treatment and is able to swallow, give oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia 4
• Monitor blood glucose for at least 60 minutes after initial treatment 2
• Call for emergency assistance if the patient doesn't respond to treatment 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 2
• Adding fat to carbohydrate treatment may slow and prolong the acute glycemic response 3, 2
• Protein should not be used to treat hypoglycemia as it may increase insulin secretion without raising blood glucose 3, 2

Prevention of Recurrent Hypoglycemia

• After a hypoglycemic episode, investigate the cause and adjust medications as needed 6
• For patients with hypoglycemia unawareness or recurrent severe episodes, raise glycemic targets for at least several weeks to reverse unawareness 3
• Educate patients about situations that increase hypoglycemia risk, such as fasting, delayed meals, exercise, sleep, and alcohol consumption 3, 1

Comparing Treatment Options

• Intravenous dextrose works faster than glucagon (recovery of consciousness in 4.0 vs 6.5 minutes) but glucagon is easier to administer and has fewer vascular complications 7
• Intranasal glucagon has been shown to be effective in prehospital settings, with 62% of patients showing substantial or slight improvement in mental status 8
• Most caregivers and non-caregivers can administer intranasal glucagon within 1 minute compared to 1.3-5 minutes for intramuscular glucagon 5

Remember that hypoglycemia is a medical emergency, and prompt treatment is essential to prevent serious complications including seizures, coma, or death 9.