What is the management of hypoglycemia (low blood glucose) with a glucose level of 60 milligrams per deciliter (mg/dL)?

From the Guidelines

Glucose 60 management requires immediate intervention to treat hypoglycemia, and the most recent guidelines recommend administering 15-20 grams of fast-acting carbohydrates at a hypoglycemia alert value of 70 mg/dL or less, as stated in the 2022 standards of medical care in diabetes 1.

Key Recommendations

• Administer 15-20 grams of fast-acting carbohydrates such as 4 ounces of fruit juice, 1 tablespoon of honey, 3-4 glucose tablets, or 8 ounces of milk.
• Wait 15 minutes, then recheck blood glucose.
• If it remains below 70 mg/dL, repeat the treatment.
• Once glucose exceeds 70 mg/dL, consume a small snack containing protein and complex carbohydrates (like cheese and crackers or peanut butter on toast) if the next meal is more than an hour away.

Special Considerations

• For unconscious patients, do not give oral treatments; instead, administer glucagon (1 mg intramuscularly or subcutaneously for adults) or seek emergency medical assistance, as recommended in the 2021 standards of medical care in diabetes 1.
• After recovery, investigate the cause of hypoglycemia, which may include excess insulin/medication, insufficient food intake, increased physical activity, or alcohol consumption.
• Regular monitoring is essential, especially for diabetic patients on insulin or sulfonylureas, and consider consulting a healthcare provider to adjust medication regimens if hypoglycemic episodes occur frequently, as suggested in the 2019 standards of medical care in diabetes 1.

Rationale

The acute glycemic response correlates better with the glucose content of food than with the carbohydrate content of food, and pure glucose is the preferred treatment, but any form of carbohydrate that contains glucose will raise blood glucose, as noted in the 2022 standards of medical care in diabetes 1. Added fat may retard and then prolong the acute glycemic response, and ingested protein may increase insulin response without increasing plasma glucose concentrations in type 2 diabetes, as mentioned in the 2019 standards of medical care in diabetes 1. Therefore, carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia.

Additional Guidance

• The response to treatment of hypoglycemia should be apparent in 10–20 min; however, plasma glucose should be tested again in 60 min, as additional treatment may be necessary, as recommended in the 2008 nutrition recommendations and interventions for diabetes 1.
• Ongoing insulin activity or insulin secretagogues may lead to recurrent hypoglycemia, and hypoglycemia unawareness or one or more episodes of severe hypoglycemia should trigger reevaluation of the treatment regimen, as suggested in the 2018 standards of medical care in diabetes 1.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION 2. 1 Important Administration Instructions for Using the Glucagon Emergency Kit for Low Blood Sugar to Treat Severe Hypoglycemia

Administer Glucagon for Injection as soon as possible when severe hypoglycemia is recognized The reconstituted solution is 1 mg per mL glucagon. Immediately after reconstitution, inject the solution subcutaneously or intramuscularly in the upper arm, thigh, or buttocks When the patient has responded to the treatment and is able to swallow, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia. 2. 2 Dosage in Adults and Pediatric Patients for Using the Glucagon Emergency Kit for Low Blood Sugar to Treat Severe Hypoglycemia Adults and Pediatric Patients Weighing More Than 25 kg or for Pediatric Patients with Unknown Weight 6 Years and Older The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously

The management of hypoglycemia with a glucose level of 60 mg/dL is to administer glucagon for injection as soon as possible. The recommended dosage for adults and pediatric patients weighing more than 25 kg is 1 mg (1 mL) injected subcutaneously or intramuscularly. After the patient has responded to the treatment, give oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia 2.

From the Research

Management of Hypoglycemia

The management of hypoglycemia, particularly with a glucose level of 60 milligrams per deciliter (mg/dL), involves several key considerations:

• Education and regular review are essential between people with diabetes and their caregivers and healthcare professionals about symptoms, prevention, and treatment 3
• Awareness of the potential dangers of hypoglycemia is fundamental to the optimal management of diabetes 3
• The current and potential formulations of glucagon available for treatment of severe hypoglycemia are reviewed 3

Treatment Approaches

Treatment approaches for hypoglycemia include:

• Immediate ingestion of sacharides, preferably glucose, with an optimal dose of 15-20 g, although some studies suggest an amount related to the patient's weight 4
• Use of glucagon preparations that do not require reconstitution vs those that do for managing severe outpatient hypoglycemia for adults and children 5
• Use of real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps in people with type 1 diabetes (T1D) 5
• Initiation of and continuation of CGM for select inpatient populations at high risk for hypoglycemia 5

Prevention Strategies

Prevention strategies for hypoglycemia include:

• Selecting appropriate individualized glycemic goals and providing structured patient education to reduce the incidence of hypoglycemia 6
• Applying the principles of intensive glycemic therapy, including drug selection and selective application of diabetes treatment technologies 6
• Short-term scrupulous avoidance of hypoglycemia, which often will reverse impaired awareness of hypoglycemia 6