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 Initial Assessment
- Hypoglycemia is defined as blood glucose ≤70 mg/dL and requires prompt treatment 1
- Document blood glucose before treatment when possible, but never delay treatment while waiting for confirmation 1
- Symptoms include autonomic signs (sweating, tremor, palpitations, pallor) and neuroglycopenic symptoms (confusion, altered mental status, inability to concentrate, seizures) 1, 2
Treatment Protocol for Conscious Patients
First-Line Treatment
- Administer 15-20 grams of glucose orally 1, 3
- Pure glucose (tablets or solution) is the preferred treatment because glycemic response correlates better with glucose content than total carbohydrate content 1, 3
- Any carbohydrate-containing food with glucose can be used if glucose tablets are unavailable 1, 4
Treatment Response Timeline
- Expect initial response within 10-20 minutes after carbohydrate ingestion 1, 3
- Recheck blood glucose 15 minutes after treatment 1, 3
- If hypoglycemia persists, repeat with another 15-20 grams of carbohydrate 1, 3
- Evaluate blood glucose again 60 minutes after initial treatment 1
Special Dosing Considerations
- For patients using automated insulin delivery systems, a lower dose of 5-10 grams may be appropriate unless hypoglycemia occurs with exercise or after significant insulin overestimation 1
Treatment for Severe Hypoglycemia (Unconscious or Unable to Swallow)
Glucagon Administration
- For patients unable or unwilling to consume oral carbohydrates, glucagon is indicated 1
- Newer intranasal and ready-to-inject glucagon preparations are preferred due to ease of administration 1
Dosing by Weight and Age
- Adults and children weighing >25 kg or ≥6 years: 1 mg (1 mL) subcutaneously or intramuscularly 1, 5
- Children weighing <25 kg or <6 years: 0.5 mg (0.5 mL) subcutaneously or intramuscularly 1, 5
- Inject into upper arm, thigh, or buttocks 5, 4
Post-Glucagon Management
- Call for emergency assistance immediately after administering glucagon 5
- Turn the unconscious patient on their side to prevent choking if vomiting occurs 4
- If no response within 15 minutes, administer another dose using a new kit while waiting for emergency services 5
- When the patient awakens and can swallow, give oral carbohydrates immediately 5, 4
Post-Treatment Follow-Up
- Once conscious and able to swallow, provide both fast-acting sugar (regular soft drink or fruit juice) and long-acting carbohydrates (crackers with cheese or meat sandwich) to restore liver glycogen and prevent recurrence 1, 4
- Wait 30-60 minutes after treatment to ensure stable blood glucose before any other procedures 3
- Any episode of severe hypoglycemia or recurrent mild-to-moderate episodes requires reevaluation of the diabetes management plan 1
Critical Pitfalls to Avoid
- Do not use protein to treat hypoglycemia as it may increase insulin secretion without raising blood glucose 1, 3
- Avoid adding fat to carbohydrate treatment as it may slow and prolong the acute glycemic response 1
- Orange juice and glucose gel are less effective in quickly alleviating symptoms compared to glucose tablets or solution 1, 6
- Never proceed with other evaluations or procedures during active hypoglycemia, as altered mental status can affect assessment validity and patient safety 3
Prevention and Education
- Ensure patients at risk have immediate access to glucose tablets or glucose-containing foods at all times 1
- Caregivers and family members must be instructed on glucagon administration, including where it is kept and when and how to administer it 1
- Patients should understand high-risk situations: fasting for procedures, delayed or skipped meals, intense exercise, alcohol consumption, sleep, and declining renal function 1
- Avoid targeting overly tight glucose control; aim to keep blood glucose >70 mg/dL 1