Immediate Management of Hypoglycemia
For conscious patients with hypoglycemia, immediately administer 15-20 grams of oral glucose (preferred) or any glucose-containing carbohydrate, then recheck blood glucose in 15 minutes and repeat treatment if needed. 1, 2, 3
Initial Assessment and Action
Confirm hypoglycemia with blood glucose measurement immediately when suspected (blood glucose ≤70 mg/dL or ≤3.9 mmol/L), but if testing is unavailable, begin treatment immediately without delay 2, 3
Call EMS immediately if the patient is unconscious, seizing, or unable to follow simple commands or swallow safely 1
Treatment Algorithm for Conscious Patients
First-Line Treatment
Administer 15-20 grams of oral glucose - this is the preferred treatment because glycemic response correlates better with glucose content than total carbohydrate content 1, 3
Glucose tablets or glucose solution are most effective and should be used when available 3
Alternative carbohydrate sources (juice, regular soda, candy) may be used if glucose tablets are unavailable, though they are less effective 1, 3
Monitoring and Repeat Treatment
Recheck blood glucose 15 minutes after initial treatment 1, 2, 3
If blood glucose remains <70 mg/dL (3.9 mmol/L), repeat the 15-20 gram glucose dose 1, 2, 3
Wait at least 10-15 minutes before calling EMS if the patient remains conscious and stable 1
Once blood glucose normalizes (>70 mg/dL), provide a meal or snack with starchy or protein-rich foods to prevent recurrence, especially if the next meal is more than one hour away 1, 2
Treatment for Unconscious or Severely Impaired Patients
Immediate Actions
Call EMS immediately 1
Administer glucagon 1 mg intramuscularly or subcutaneously for adults and children >25 kg (or ≥6 years with unknown weight) 1, 4
For children <25 kg or <6 years with unknown weight, administer glucagon 0.5 mg 4
Alternative IV Treatment (if access available)
Administer 20-40 mL of 50% dextrose solution intravenously 1
If blood glucose remains <54 mg/dL (3.0 mmol/L), give an additional 60 mL of 50% dextrose IV 1
Glucagon Administration Details
Newer ready-to-use glucagon formulations (intranasal, auto-injector) are preferred due to ease of administration without reconstitution 3, 5
If no response after 15 minutes, administer a second dose of glucagon using a new kit while waiting for emergency assistance 4
Once the patient can swallow, immediately provide oral carbohydrates to restore liver glycogen and prevent recurrence 4
Critical Pitfalls to Avoid
Never use sliding-scale insulin alone in any setting - this increases hypoglycemia risk 1
Do not add protein to treat acute hypoglycemia - it may increase insulin secretion and does not prevent subsequent hypoglycemia 1, 3
Avoid adding fat to carbohydrate treatment - it slows and prolongs the glycemic response 1, 3
Do not delay treatment waiting for blood glucose confirmation if testing is unavailable 2
Post-Treatment Management
Investigate the cause of hypoglycemia and adjust medications 1, 2
For patients with hypoglycemia unawareness or recurrent severe episodes, raise glycemic targets for at least several weeks to partially reverse unawareness 1, 2
Prescribe glucagon emergency kits for all patients at significant risk of severe hypoglycemia and train caregivers in administration 1
Ensure patients carry glucose tablets or glucose-containing foods at all times 3