Initial Treatment of Hypoglycemia
For conscious patients with hypoglycemia, immediately administer 15-20 grams of oral glucose, preferably as glucose tablets or solution, and recheck blood glucose in 15 minutes. 1
Immediate Treatment Protocol
First-Line Treatment for Conscious Patients
Administer 15-20 grams of glucose orally as the preferred initial treatment for symptomatic hypoglycemia (blood glucose ≤70 mg/dL). 2, 1
Glucose tablets or glucose solution are most effective because the glycemic response correlates better with glucose content than total carbohydrate content. 2, 1, 3
If glucose tablets are unavailable, alternative dietary sugars can be used including Skittles, Mentos, sugar cubes, jelly beans, or orange juice—though these are less optimal. 2
Avoid glucose gel and orange juice as first-line options when glucose tablets are available, as they are significantly less effective in quickly raising blood glucose and alleviating symptoms. 1, 3
Treatment Response Timeline
Expect initial symptom improvement within 10-20 minutes after carbohydrate ingestion. 2, 1
Recheck blood glucose 15 minutes after treatment—if hypoglycemia persists, repeat with another 15-20 grams of carbohydrate. 2, 1
Reassess blood glucose again at 60 minutes as additional treatment may be necessary despite initial improvement. 2, 1
Once blood glucose normalizes, provide a meal or snack to prevent recurrence of hypoglycemia. 2, 1
Special Considerations
Patients on Automated Insulin Delivery Systems
- Consider lower doses of 5-10 grams of carbohydrate for patients using automated insulin delivery systems, unless hypoglycemia occurs with exercise or after significant insulin overestimation. 1
What NOT to Add to Treatment
Do not add fat to carbohydrate treatment as it may retard and prolong the acute glycemic response without benefit. 2, 1
Do not add protein to treat hypoglycemia as it may increase insulin secretion without improving the glycemic response. 2, 1
Treatment for Severe Hypoglycemia (Unconscious/Unable to Swallow)
Glucagon Administration
Administer glucagon immediately for patients who cannot or will not consume oral carbohydrates due to altered mental status or unconsciousness. 1, 4
Dosing for adults and children ≥25 kg or ≥6 years: 1 mg (1 mL) subcutaneously, intramuscularly, or intravenously. 4
Dosing for children <25 kg or <6 years: 0.5 mg (0.5 mL) subcutaneously, intramuscularly, or intravenously. 4
If no response after 15 minutes, administer an additional dose using a new kit while waiting for emergency assistance. 4
Call for emergency assistance immediately after administering glucagon. 4
Once the patient responds and can swallow, give oral carbohydrates to restore liver glycogen and prevent recurrence. 4
Common Pitfalls to Avoid
Do not over-treat hypoglycemia with excessive amounts of sugar, as this leads to rebound hyperglycemia which, when repeated over time, may be as harmful as recurrent hypoglycemia episodes. 2
Do not delay treatment while searching for "perfect" glucose tablets—any glucose-containing carbohydrate is acceptable when glucose tablets are unavailable. 2
Do not assume symptoms will resolve without follow-up—the ongoing activity of insulin or insulin secretagogues may cause recurrent hypoglycemia even after initial correction. 2
Do not attempt oral feeding in severe hypoglycemia—use glucagon instead to avoid aspiration risk. 1