From the Guidelines
Acute hypoglycemia should be managed immediately with the administration of 15-20 grams of glucose, with the preferred treatment being glucose itself, although any form of carbohydrate that contains glucose may be used, as recommended by the most recent guidelines 1. The management of acute hypoglycemia involves several key steps, including:
- Administering 15-20 grams of glucose, with glucose being the preferred treatment, although any form of carbohydrate that contains glucose may be used 1
- Waiting 15 minutes and then rechecking blood glucose levels
- Repeating the treatment if blood glucose levels remain below 70 mg/dL (3.9 mmol/L) 1
- Providing a more substantial snack containing complex carbohydrates and protein after initial recovery to prevent recurrence For severe hypoglycemia with altered consciousness or inability to swallow safely, glucagon should be administered:
- 1 mg intramuscularly or subcutaneously for adults and children weighing over 25 kg
- 0.5 mg for children under 25 kg
- Newer intranasal glucagon (Baqsimi) provides 3 mg per dose regardless of weight 1 In healthcare settings, intravenous dextrose (25 grams of D50W for adults or D10W for children) can be given 1. It is essential to educate patients with diabetes on hypoglycemia recognition and management, and caregivers of those at risk should be trained in glucagon administration 1. Hypoglycemia occurs when blood glucose drops too low, typically due to excess insulin, missed meals, or increased physical activity, and the brain depends on glucose for energy, which explains the neurological symptoms that occur during hypoglycemic episodes 1.
From the FDA Drug Label
2 DOSAGE & ADMINISTRATION 2. 1 Important Administration Instructions for Using the Glucagon Emergency Kit for Low Blood Sugar to Treat Severe Hypoglycemia
Glucagon for Injection is for subcutaneous, intramuscular, or intravenous injection. Administer intravenously ONLY under medical supervision. Instruct patients and their caregivers on the signs and symptoms of severe hypoglycemia Because severe hypoglycemia requires the help of others to recover, instruct the patient to inform those around them about Glucagon for Injection and its Instructions for Use. Administer Glucagon for Injection as soon as possible when severe hypoglycemia is recognized Instruct the patient or caregiver to read the Instructions for Use at the time they receive a prescription for Glucagon for Injection Emphasize the following instructions to the patient or caregiver: Using the supplied prefilled syringe, carefully insert the needle through the rubber stopper of the vial containing Glucagon for Injection powder and inject all the liquid from the syringe into the vial. Shake the vial gently until the powder is completely dissolved and no particles remain in the fluid The reconstituted solution should be clear and colorless. Inspect visually for particulate matter and discoloration. If the resulting solution is cloudy or contains particulate matter do not use. The reconstituted solution is 1 mg per mL glucagon. Immediately after reconstitution, inject the solution subcutaneously or intramuscularly in the upper arm, thigh, or buttocks In addition, healthcare providers may administer intravenously. Call for emergency assistance immediately after administering the dose. When the patient has responded to the treatment and is able to swallow, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia. Discard any unused portion.
The management of acute hypoglycemia involves administering glucagon as soon as possible when severe hypoglycemia is recognized. The recommended dosage is:
- 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older.
- 0.5 mg (0.5 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously for pediatric patients weighing less than 25 kg or for pediatric patients with unknown weight less than 6 years of age. If there has been no response after 15 minutes, an additional dose of glucagon may be administered using a new kit while waiting for emergency assistance. After the patient has responded to the treatment and is able to swallow, oral carbohydrates should be given to restore the liver glycogen and prevent recurrence of hypoglycemia 2.
From the Research
Management of Acute Hypoglycemia
- Acute hypoglycemia is a serious problem in insulin-treated diabetic patients, and its management is crucial to prevent severe complications 3.
- Intravenous glucagon and dextrose are effective in treating hypoglycemic coma, but intravenous glucagon has a slower recovery time compared to intravenous dextrose 3.
- Octreotide therapy has been shown to be effective in treating refractory hypoglycemia, especially in cases where the cause is not well understood 4, 5.
- Intranasal glucagon is a new formulation that has been approved for the acute treatment of severe hypoglycemia in patients with diabetes, and it has been shown to be effective and easy to use 6, 7.
Treatment Options
- Intravenous dextrose is a common treatment for hypoglycemia, but it may not be effective in all cases, especially in patients with refractory hypoglycemia 4, 5.
- Glucagon, either intravenous or intranasal, is a recommended treatment for severe hypoglycemia, especially in patients who are disoriented or unconscious 3, 6, 7.
- Octreotide therapy may be considered in cases where hypoglycemia is refractory to conventional treatment 4, 5.
Special Considerations
- Patients with diabetes and kidney disease may be at higher risk of developing refractory hypoglycemia, and octreotide therapy may be an effective treatment option in these cases 5.
- Intranasal glucagon may be preferred by caregivers and noncaregivers due to its ease of use, but additional studies are needed to further clarify its bioavailability, efficacy, and tolerability 6.