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

From the Guidelines

Hypoglycemia should be treated immediately with 15-20 grams of fast-acting carbohydrates, such as oral glucose or glucose-containing foods, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

Treatment Approach

The treatment approach for hypoglycemia involves administering fast-acting carbohydrates to rapidly restore blood glucose levels. According to the guidelines, administration of 20 g oral glucose or the equivalent in glucose-containing foods can rapidly restore blood glucose levels 1.

• Key considerations for treatment include:
  • Oral glucose is available in different forms and can be given through different routes in the first aid setting.
  • Glucose products that are swallowed (e.g., tablets or gels) result in higher blood glucose levels than buccally applied glucose (spray or gel) 1.
  • For people with hypoglycemia who are unable to swallow, intravenous dextrose can be lifesaving 1.

Severe Hypoglycemia

For severe hypoglycemia where the person is unconscious or unable to swallow safely, bystanders should administer glucagon, as recommended by the 2023 American Diabetes Association standards of care 2.

• Glucagon is available as an injection (GlucaGen, Gvoke), nasal spray (Baqsimi), or auto-injector (Zegalogue), with dosing based on age and weight (typically 1 mg for adults).
• After glucagon administration, turn the person on their side and seek emergency medical help.

Ongoing Management

Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if impaired or declining cognition is found 2.

• Insulin-treated patients with hypoglycemia unawareness, one level 3 hypoglycemic event, or a pattern of unexplained level 2 hypoglycemia should be advised to raise their glycemic targets to strictly avoid hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce risk of future episodes 2.

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

Glucagon for Injection is for subcutaneous, intramuscular, or intravenous injection. Administer intravenously ONLY under medical supervision. Instruct patients and their caregivers on the signs and symptoms of severe hypoglycemia Because severe hypoglycemia requires the help of others to recover, instruct the patient to inform those around them about Glucagon for Injection and its Instructions for Use. Administer Glucagon for Injection as soon as possible when severe hypoglycemia is recognized Instruct the patient or caregiver to read the Instructions for Use at the time they receive a prescription for Glucagon for Injection Emphasize the following instructions to the patient or caregiver: Using the supplied prefilled syringe, carefully insert the needle through the rubber stopper of the vial containing Glucagon for Injection powder and inject all the liquid from the syringe into the vial. Shake the vial gently until the powder is completely dissolved and no particles remain in the fluid The reconstituted solution should be clear and colorless. Inspect visually for particulate matter and discoloration. If the resulting solution is cloudy or contains particulate matter do not use. 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 In addition, healthcare providers may administer intravenously. Call for emergency assistance immediately after administering the dose. 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. Discard any unused portion.

The recommended treatment for severe hypoglycemia is:

• 1 mg (1 mL) of Glucagon for Injection injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older.
• 0.5 mg (0.5 mL) of Glucagon for Injection injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously for pediatric patients weighing less than 25 kg or for pediatric patients with unknown weight less than 6 years of age. If there has been no response after 15 minutes, an additional dose of Glucagon for Injection may be administered using a new kit while waiting for emergency assistance 3.

From the Research

Treatment of Hypoglycemia

• The treatment of mild-to-moderate hypoglycemia in patients with type 1 diabetes is recommended to be 15-20g of carbohydrates, with the treatment to be repeated if hypoglycemia persists after 15 minutes 4, 5.
• However, a study found that 16g of carbohydrates may be insufficient to treat a large proportion of hypoglycemia episodes in type 1 diabetes patients treated with continuous subcutaneous insulin infusion (CSII) 4.
• Factors affecting treatment effectiveness include the glycemia level at the time of treatment and the proportion of total daily insulin from basal doses 4.
• Severe hypoglycemia can be treated with glucagon injection in non-professional settings, or intravenous administration of glucose in professional settings 6, 5.
• Patient education on the risk factors, warning signs, and treatment of hypoglycemia is crucial in preventing hypoglycemia and improving glycemic control 7.
• The symptomatic responses to hypoglycemia may vary depending on the type of treatment, with sulphonylurea-treated patients experiencing symptoms at higher glucose concentrations than insulin-treated patients 8.