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

Immediate Treatment of Hypoglycemia

For conscious patients with hypoglycemia (blood glucose ≤70 mg/dL), immediately administer 15-20 grams of oral glucose, preferably as glucose tablets or solution, and recheck blood glucose in 15 minutes. 1

Recognition and Threshold for Treatment

• Treat any blood glucose ≤70 mg/dL promptly, even if the patient is asymptomatic 1
• Consider treatment for levels between 60-80 mg/dL depending on clinical context 1
• Early symptoms include sweating, tremor, palpitations, hunger, dizziness, and anxiety (autonomic symptoms) 2, 3
• Neuroglycopenic symptoms include confusion, slurred speech, altered behavior, inability to concentrate, and if untreated, can progress to seizures, unconsciousness, and death 2, 3

Treatment Protocol for Conscious Patients

First-line treatment:

• Give 15-20 grams of glucose orally 1, 4
• Pure glucose (tablets or solution) is strongly preferred because the glycemic response correlates better with glucose content than total carbohydrate content 1, 4
• Glucose tablets and glucose solution are most effective; orange juice and glucose gel are significantly less effective and should be avoided 1, 5

Alternative carbohydrate sources if glucose unavailable:

• Any carbohydrate-containing food with glucose can be used 1, 4
• Sucrose tablets or solution are acceptable alternatives, showing similar efficacy to glucose in research studies 5
• Fruit juice is less effective and not recommended as first-line treatment 1, 5

Follow-up protocol:

• Expect initial response within 10-20 minutes 1, 4
• Recheck blood glucose exactly 15 minutes after carbohydrate ingestion 1, 4
• If hypoglycemia persists at 15 minutes, repeat treatment with another 15-20 grams of carbohydrate 1, 4
• Recheck blood glucose again 60 minutes after initial treatment 1

Special Dosing Considerations

• Patients on automated insulin delivery systems: Consider lower dose of 5-10 grams carbohydrate unless hypoglycemia occurs with exercise or after significant insulin overestimation 1
• Pediatric patients weighing <20 kg (44 lbs): Use 0.3 g/kg of rapid-acting carbohydrate 6

Treatment for Severe Hypoglycemia (Unconscious or Unable to Swallow)

When patient cannot take oral carbohydrates:

• Administer glucagon immediately—newer intranasal and ready-to-inject preparations are preferred over traditional injectable forms due to ease of administration 1, 7
• Adult dose and children ≥25 kg or ≥6 years: 1 mg glucagon subcutaneously or intramuscularly 8
• Pediatric patients <25 kg or <6 years: 0.5 mg glucagon subcutaneously or intramuscularly 8
• If no response within 15 minutes, administer a second dose using a new kit while waiting for emergency services 8

Critical safety measures:

• Turn unconscious patient on their side to prevent choking from vomiting when they awaken 2
• Call emergency services immediately after administering glucagon 2, 8
• Once patient awakens and can swallow, give fast-acting sugar (regular soft drink or fruit juice) followed by long-acting carbohydrate (crackers with cheese or meat sandwich) 2

Important Caveats and Pitfalls

• Do not add fat to carbohydrate treatment—it slows and prolongs the glycemic response 1
• Do not use protein to treat hypoglycemia—it may increase insulin secretion without raising blood glucose 1, 4
• Never delay treatment even for mild hypoglycemia, as it can rapidly progress to severe hypoglycemia 4
• Do not proceed with any medical procedures or evaluations (such as swallow studies) until blood glucose normalizes >70 mg/dL, as hypoglycemia causes altered mental status that can confound assessments 4
• Hypoglycemia symptoms can be mistaken for other conditions; always check blood glucose when in doubt 4

Prevention of Recurrence

• Once treated and stable, have patient consume a meal or snack to prevent recurrence 4, 2
• Ensure at-risk patients always carry glucose tablets or glucose-containing foods 1
• Avoid targeting overly tight glucose control; maintain blood glucose >70 mg/dL 1
• In very young children with recurrent severe hypoglycemia, accept higher glycemic targets to prevent permanent neuropsychological dysfunction 3