What is the treatment for hypoglycemia (low blood glucose)?

Treatment of Hypoglycemia (Low Blood Glucose)

For conscious patients with hypoglycemia (blood glucose ≤70 mg/dL), immediately administer 15-20g of glucose orally, preferably as glucose tablets or solution, and recheck blood glucose after 15 minutes—if hypoglycemia persists, repeat the treatment. 1, 2

Immediate Treatment Protocol

First-Line Treatment for Conscious Patients

• Administer 15-20g of pure glucose as the preferred treatment because the glycemic response correlates better with glucose content than with total carbohydrate content 1, 2
• Glucose tablets or glucose solution are the most effective options for rapidly correcting hypoglycemia 1
• 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 effective than pure glucose) 3
• Expect initial symptom improvement within 10-20 minutes after treatment 1, 2

Follow-Up Steps

• Recheck blood glucose exactly 15 minutes after carbohydrate ingestion 1, 2
• If hypoglycemia persists at 15 minutes, repeat treatment with another 15-20g of carbohydrate 1
• Evaluate blood glucose again 60 minutes after initial treatment to ensure sustained recovery 1
• After blood glucose normalizes, consume a meal or snack containing complex carbohydrates and protein to prevent recurrence 2, 4

Special Dosing Considerations

Patients on Automated Insulin Delivery Systems

• A lower dose of 5-10g carbohydrates may be appropriate for these patients 1, 2
• Use the full 15-20g dose if hypoglycemia occurs with exercise or after significant insulin overestimation 1, 5

Treatment Modifications Based on Food Composition

• Avoid using protein alone to treat hypoglycemia as it may increase insulin secretion without adequately raising glucose 1, 2
• Adding fat to carbohydrate treatment may slow and prolong the acute glycemic response, potentially delaying recovery 1
• Orange juice and glucose gel are less effective than glucose tablets or solution for quickly alleviating symptoms 1

Treatment of Severe Hypoglycemia (Unconscious or Unable to Swallow)

Glucagon Administration

• For patients unable or unwilling to consume oral carbohydrates, administer glucagon immediately 1, 6, 4
• Newer intranasal and ready-to-inject glucagon preparations are preferred due to ease of administration and faster correction 1, 5
• Dosing for adults and children weighing >25 kg or ≥6 years: 1 mg (1 mL) subcutaneously or intramuscularly 1
• Dosing for children weighing <25 kg or <6 years: 0.5 mg (0.5 mL) 1
• Alternative treatment: concentrated intravenous glucose (requires medical personnel) 6, 4

Post-Glucagon Management

• After apparent clinical recovery from severe hypoglycemia, continued observation and additional carbohydrate intake are necessary to avoid recurrence 6, 4
• This is critical because the underlying insulin excess may outlast the glucagon effect 4

Critical Pitfalls to Avoid

• Never delay treatment while waiting for blood glucose confirmation—treat based on symptoms if testing is not immediately available 2
• Do not use foods high in protein without adequate glucose content as this can worsen hypoglycemia 2
• Failing to recheck blood glucose after initial treatment leads to missed recurrent hypoglycemia 2
• Not carrying fast-acting glucose sources increases risk of severe hypoglycemia 2
• Avoid "over-shooting" blood glucose goals by giving excessive sugar, which when repeated over time may be as harmful as recurrent hypoglycemia 3

Prevention and Risk Mitigation

Patient Preparedness

• All patients at risk for hypoglycemia must have immediate access to glucose tablets or glucose-containing foods at all times 1, 2
• Patients should be taught to recognize hypoglycemia symptoms and always carry fast-acting carbohydrates 2
• All individuals treated with insulin should be prescribed glucagon 5

Caregiver Education

• Family members and caregivers of patients at high risk must be instructed on glucagon administration, including where it is kept and when and how to administer it 1, 5
• This is particularly important for young children with type 1 diabetes and elderly individuals who have reduced ability to recognize symptoms 2

High-Risk Situations Requiring Extra Vigilance

• Fasting for tests or procedures 1
• Delayed or skipped meals 1
• Intense exercise (especially within 1-2 hours of mealtime insulin) 3, 1
• Alcohol consumption (inhibits gluconeogenesis) 1, 2
• Sleep periods 1
• Declining renal function 1

Post-Event Management

• Any episode of severe hypoglycemia or recurrent episodes of mild to moderate hypoglycemia requires reevaluation of the diabetes management plan 1
• Document all hypoglycemic episodes and review patterns to adjust insulin dosing if needed 5
• For unexplained or recurrent severe hypoglycemia, consider admission to a medical unit for observation and stabilization 1
• Consider continuous glucose monitoring for patients with recurrent hypoglycemia 2
• Temporarily raise glycemic targets for patients with recurrent hypoglycemia or hypoglycemia unawareness 5