Oral Glucose Treatment for Hypoglycemia
For immediate correction of hypoglycemia in conscious patients who can swallow, administer 15-20 grams of oral glucose, preferably as pure glucose tablets rather than other carbohydrate sources. 1
Recommended Dose and Form
Pure glucose (15-20 grams) is the preferred treatment for hypoglycemia, as it produces a more rapid and predictable glycemic response than other carbohydrate sources 1
Glucose tablets are superior to dietary sugars, with higher symptom resolution rates at 15 minutes post-treatment 2
If glucose tablets are unavailable, any carbohydrate containing glucose may be used, though the response will be slower 1
Treatment Protocol and Timing
Check blood glucose before treatment if possible, then administer 15-20 grams of glucose immediately 1, 3
Expect initial response within 10-20 minutes, with blood glucose rising approximately 40 mg/dL with 10 grams of glucose or 60 mg/dL with 20 grams over 30-45 minutes 1
Recheck blood glucose at 15 minutes; if still below 70 mg/dL (3.9 mmol/L), repeat the 15-20 gram dose 1
Blood glucose should be evaluated again at 60 minutes, as additional treatment may be necessary since glucose levels often begin falling 60 minutes after ingestion 1
Once blood glucose normalizes, the patient should consume a meal or snack to prevent recurrence 1
Route of Administration Considerations
Oral/swallowed glucose is strongly recommended over buccal or sublingual routes for adults and children who are conscious and able to swallow 1
Buccal glucose administration results in lower plasma glucose concentrations at 20 minutes compared to swallowed glucose 1
If glucose tablets are not immediately available, glucose gel (combined oral and buccal administration) may be used as an alternative 1
Sublingual administration may be considered for uncooperative children, though evidence is limited 1
Critical Pitfalls to Avoid
Never administer oral glucose to unconscious patients or those unable to protect their airway—use intravenous dextrose (10% solution in 5-gram aliquots) or intramuscular glucagon (1 mg) instead 3
Avoid adding fat to the carbohydrate treatment, as it retards the acute glycemic response 1
Do not add protein to carbohydrate treatment, as it does not affect the glycemic response or prevent subsequent hypoglycemia in type 1 diabetes, and may increase insulin response in type 2 diabetes 1
Dietary sugars containing fructose (orange juice) or galactose (milk) are less effective than pure glucose because these sugars do not raise plasma glucose as effectively 1
Treatment Threshold
Treat when blood glucose is below 70 mg/dL (3.9 mmol/L), which is the clinically important threshold requiring action 1
Level 2 hypoglycemia (below 54 mg/dL or 3.0 mmol/L) requires immediate action as neuroglycopenic symptoms begin at this threshold 1
For patients with neurologic injury, consider treating at blood glucose below 100 mg/dL rather than the standard 70 mg/dL threshold 3
Post-Treatment Management
Provide starchy or protein-rich foods once symptoms resolve if more than 1 hour until the next meal 3
Any severe hypoglycemic episode (Level 3, requiring external assistance) mandates reevaluation of the diabetes management plan 1, 3
Investigate underlying causes including medication timing, reduced oral intake, or interruption of nutrition 3