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

Immediate Treatment of Hypoglycemia

For conscious patients with hypoglycemia (blood glucose ≤70 mg/dL), immediately administer 15-20 grams of oral glucose, recheck blood glucose in 15 minutes, and repeat treatment if hypoglycemia persists. 1

Recognition and Definition

• Hypoglycemia is defined as blood glucose ≤70 mg/dL and requires prompt treatment 1
• Even levels between 60-80 mg/dL may warrant carbohydrate ingestion 1
• Symptoms include sweating, tremor, palpitations, confusion, and in severe cases, altered mental status, seizures, or unconsciousness 2, 3

Treatment Protocol for Conscious Patients

First-line treatment:

• Give 15-20 grams of glucose orally as the initial treatment 1, 4
• Pure glucose (tablets or solution) is the preferred form because glycemic response correlates better with glucose content than total carbohydrate content 1, 2
• Any carbohydrate-containing food with glucose can be used if glucose tablets are unavailable 1, 4

Timing and monitoring:

• Expect initial response within 10-20 minutes after administration 1, 2
• Recheck blood glucose exactly 15 minutes after carbohydrate ingestion 1, 4
• If hypoglycemia persists at 15 minutes, repeat with another 15-20 grams of carbohydrate 1, 4
• Evaluate blood glucose again 60 minutes after initial treatment 1

Follow-up care:

• Once blood glucose normalizes (>70 mg/dL), have the patient consume a meal or snack containing complex carbohydrates and protein to prevent recurrence 2, 4
• This prevents secondary hypoglycemia by restoring liver glycogen 5

Special Considerations for Dosing

• Patients using automated insulin delivery systems may only need 5-10 grams of carbohydrates, unless hypoglycemia occurs with exercise or after significant insulin overestimation 1, 4
• Pediatric patients weighing less than 44 pounds (20 kg) require 0.5 mg glucagon (half the adult dose) if parenteral treatment becomes necessary 5

Treatment Effectiveness by Carbohydrate Type

The evidence shows clear differences in treatment efficacy:

• Glucose tablets and glucose solution are most effective for rapid symptom relief (within 14 minutes) 1, 6
• Sucrose tablets and solutions are equally effective as glucose forms 6
• Orange juice and glucose gel are significantly less effective and take longer to alleviate symptoms 1, 6

What NOT to Do

• Do not use protein to treat hypoglycemia as it may increase insulin secretion without raising blood glucose 1, 2, 4
• Do not add fat to carbohydrate treatment as it slows and prolongs the glycemic response 1
• Never proceed with activities requiring normal cognition (such as swallow evaluations) during active hypoglycemia, as it causes altered mental status that can be mistaken for other conditions 2
• Do not fail to recheck blood glucose after initial treatment, as this leads to recurrent hypoglycemia 4

Treatment for Severe Hypoglycemia (Unconscious Patients)

When the patient cannot take oral carbohydrates:

• Glucagon is the indicated treatment for patients unable or unwilling to consume oral carbohydrates 1, 4
• Newer intranasal and ready-to-inject glucagon preparations are preferred due to ease of administration 1, 7
• Adult dose: 1 mg subcutaneous, intramuscular, or intravenous 5
• Pediatric dose (<44 lb): 0.5 mg or 20-30 mcg/kg 5
• Turn the unconscious patient on their side to prevent choking when they awaken 5
• An unconscious patient typically awakens within 15 minutes of glucagon injection 5
• If no response within 15 minutes, administer another dose of glucagon and seek emergency medical services immediately 5

Alternative hospital treatment:

• Intravenous glucose (0.2-0.5 g/kg bolus followed by continuous infusion) if parenteral access is available 3

Prevention Strategies

• Ensure at-risk patients always carry glucose tablets or glucose-containing foods 1, 4
• Teach recognition of early hypoglycemia symptoms 4
• Avoid targeting overly tight glucose control; maintain blood glucose >70 mg/dL 1
• Implement consistent meal timing with fixed insulin regimens 4
• Consider continuous glucose monitoring for those with recurrent hypoglycemia 4
• All individuals at high risk should be prescribed glucagon, and family members/caregivers must be instructed on its administration 4, 7

Critical Safety Warnings

• Prolonged hypoglycemia can cause permanent neuropsychological dysfunction, particularly in young children, including learning disabilities and EEG abnormalities 3
• Cognitive function can remain impaired for several hours after clinical recovery from hypoglycemia 3
• Untreated severe hypoglycemia can lead to death 5, 7
• Young children and elderly individuals are particularly vulnerable due to reduced ability to recognize symptoms 4