Treatment for Hypoglycemia (POC Glucose 58 mg/dL)
Administer 15-20 grams of oral glucose immediately if the patient is conscious and able to swallow. 1, 2
Immediate Treatment Protocol
For Conscious Patients Who Can Swallow
Give 15-20 grams of fast-acting carbohydrate, preferably pure glucose (glucose tablets or gel), as this is the most effective treatment for raising blood glucose levels 3, 1, 2
Pure glucose is superior to other carbohydrate sources because it raises blood glucose more rapidly and effectively than equivalent amounts of juice, milk, or other carbohydrates 3, 1
Recheck blood glucose after 15 minutes—if hypoglycemia persists (glucose remains ≤70 mg/dL), repeat the 15-20 gram dose 1, 4, 2
Continue monitoring and retreating every 15 minutes until blood glucose exceeds 70 mg/dL 4
Once blood glucose normalizes, provide a meal or snack containing complex carbohydrates and protein to prevent recurrence of hypoglycemia 1, 2
Alternative Routes if Oral Glucose Unavailable
If glucose tablets are not immediately available, use any carbohydrate containing glucose (though less effective than pure glucose) 3
For patients using automated insulin delivery systems, a smaller dose of 5-10 grams may be appropriate unless hypoglycemia is exercise-related 1, 2
Avoid buccal-only administration as it is less effective than oral (swallowed) glucose 3, 5
For Severe Hypoglycemia (Altered Mental Status/Unable to Swallow)
Parenteral Treatment Options
Administer glucagon intramuscularly or subcutaneously: 1 mg for adults and children >25 kg (or age ≥6 years); 0.5 mg for children <25 kg (or age <6 years) 3, 6
Alternative: IV dextrose 10-20 grams of 50% dextrose solution (20-40 mL), administered slowly 4, 7
Recheck blood glucose after 15 minutes; if no response, repeat the dose while awaiting emergency assistance 6
Call for emergency assistance immediately after administering parenteral treatment 6
Once the patient can swallow, provide oral carbohydrates to restore liver glycogen and prevent recurrence 6
Critical Pitfalls to Avoid
Do not use foods high in protein without adequate glucose content (like peanut butter alone), as these may increase insulin secretion without adequately raising glucose levels 1, 2
Do not delay treatment to obtain blood glucose documentation in severe cases, though attempt to document if possible 3, 4
Do not fail to recheck blood glucose after initial treatment—many patients require repeat dosing 1, 2
Avoid overcorrection that causes iatrogenic hyperglycemia 4
Post-Treatment Monitoring
Target blood glucose >70 mg/dL after treatment 4
Continue monitoring every 15 minutes until stable 4
Assess for underlying causes: medication timing/dosing errors, missed meals, increased physical activity, or alcohol consumption 2, 8
Ensure patient carries fast-acting glucose sources at all times to prevent future severe episodes 4, 2