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

Immediate Treatment for Hypoglycemia

For a conscious patient with low blood sugar, immediately administer 15-20 grams of oral glucose (preferably glucose tablets), then recheck blood glucose every 15 minutes and repeat treatment if levels remain below 70 mg/dL. 1, 2

Recognition and Thresholds

• Hypoglycemia is defined as blood glucose <70 mg/dL (3.9 mmol/L), which requires immediate treatment regardless of symptom severity 1
• Level 2 hypoglycemia (<54 mg/dL) represents the threshold where neuroglycopenic symptoms begin and demands urgent action 1
• Level 3 hypoglycemia involves altered mental or physical status requiring third-party assistance for treatment 1, 2
• Symptoms include shakiness, sweating, confusion, irritability, drowsiness, and in severe cases, unconsciousness or seizures 1, 3

Treatment Protocol for Conscious Patients

The "15-15 Rule" is the standard approach:

• Administer 15-20 grams of fast-acting carbohydrate, with pure glucose (glucose tablets) being the preferred option 1, 2, 3
• Recheck blood glucose after 15 minutes 1, 2, 3
• Repeat the 15-20 gram dose if glucose remains <70 mg/dL 1, 2, 3
• Once glucose normalizes, provide a meal or snack with complex carbohydrates and protein to prevent recurrence 3

Important Treatment Considerations

• Avoid carbohydrate sources high in protein for acute treatment, as protein may increase insulin response without raising glucose in type 2 diabetes 1
• Added fat may delay and prolong the glycemic response, making it less ideal for immediate treatment 1
• Ongoing insulin activity or insulin secretagogues may cause recurrent hypoglycemia unless additional food is consumed after recovery 1

Treatment for Severe Hypoglycemia (Unconscious or Unable to Swallow)

For patients who cannot take oral glucose, glucagon is the treatment of choice:

• Administer glucagon via intramuscular, subcutaneous, or intravenous injection 1, 4, 5
• Dosing for adults and children ≥25 kg or ≥6 years: 1 mg (1 mL) 5
• Dosing for children <25 kg or <6 years: 0.5 mg (0.5 mL) 5
• If no response after 15 minutes, repeat the dose using a new kit while waiting for emergency assistance 5
• Call emergency services immediately after administering glucagon 5
• Non-healthcare professionals can safely administer glucagon after proper instruction 1

Available Glucagon Formulations

• Traditional injectable glucagon requiring reconstitution 1
• Intranasal glucagon 1
• Ready-to-use glucagon solution for subcutaneous injection 1
• Ensure glucagon products are not expired 1

Post-Treatment Management

• Once the patient can swallow, provide oral carbohydrates to restore liver glycogen and prevent recurrence 5
• Do not leave patients unsupervised until blood glucose returns to normal range 1
• Monitor for recurrent hypoglycemia, especially if long-acting insulin or insulin secretagogues are involved 1

Critical Pitfalls to Avoid

• Never delay treatment waiting for confirmation if hypoglycemia is suspected—any person with diabetes on medication who behaves oddly should be assumed hypoglycemic until proven otherwise 6
• Do not use sliding scale insulin alone in hospitalized patients, as this increases hypoglycemia risk 1
• Avoid treating with foods high in fat or protein alone, as these delay glucose absorption 1
• Do not assume symptom absence means no hypoglycemia—many episodes are asymptomatic, particularly in those with hypoglycemia unawareness 7

Prevention and Education

• Prescribe glucagon for all individuals at risk of level 2 or 3 hypoglycemia 3
• Instruct patients and caregivers on glucagon administration and ensure they know where it is stored 1
• Patients should carry fast-acting glucose at all times (glucose tablets or gel preferred) 3, 4
• After severe or recurrent episodes, implement a 2-3 week period of scrupulous hypoglycemia avoidance to restore counterregulatory responses and awareness 1, 7
• Educate on high-risk situations: fasting, delayed meals, alcohol consumption, intense exercise, and sleep 1, 4