Immediate Treatment of Hypoglycemia
For a conscious patient experiencing hypoglycemia symptoms, immediately administer 15-20 grams of oral glucose, preferably as glucose tablets or solution, and recheck blood glucose in 15 minutes. 1, 2
Recognition and Initial Assessment
Hypoglycemia is defined as blood glucose ≤70 mg/dL and requires prompt treatment. 2 Common symptoms include:
Autonomic/neurogenic symptoms:
Neuroglycopenic symptoms:
- Confusion, drowsiness, slurred speech 3
- Inability to concentrate, personality changes 3
- Seizures, unconsciousness, or coma in severe cases 1
Critical pitfall: Signs of severe hypoglycemia can be confused with intoxication or withdrawal—always check blood glucose immediately when these symptoms appear. 1
Treatment Protocol for Conscious Patients
Step 1: Immediate Carbohydrate Administration
Important: Pure glucose is preferred because glycemic response correlates better with glucose content than total carbohydrate content. 2 Orange juice and glucose gel are less effective than glucose tablets or solution. 2
Step 2: Monitor Response
- Recheck blood glucose after 15 minutes 1, 2
- Initial response should occur within 10-20 minutes 2
- If hypoglycemia persists: Repeat treatment with another 15-20 grams of carbohydrate 1, 2
Step 3: Follow-up Care
- Recheck blood glucose 60 minutes after initial treatment 2
- Once glucose normalizes (≥70 mg/dL), provide a meal or snack to prevent recurrence 1
- Give both fast-acting sugar (juice/soft drink) and long-acting carbohydrate (crackers with cheese or meat sandwich) 3
Special consideration for automated insulin delivery systems: A lower dose of 5-10 grams may be appropriate unless hypoglycemia occurs with exercise or after significant insulin overestimation. 2
Treatment for Severe Hypoglycemia (Unconscious/Unable to Swallow)
For patients unable or unwilling to consume oral carbohydrates, administer glucagon immediately. 1, 5
Glucagon Administration Protocol
Dosing:
- Adults and children ≥25 kg (or ≥6 years): 1 mg (1 mL) intramuscularly, subcutaneously, or intranasally 5, 6
- Children <25 kg (or <6 years): 0.5 mg (0.5 mL) intramuscularly or subcutaneously 5, 6
Administration steps:
- Newer intranasal and ready-to-inject formulations are preferred over traditional reconstitution kits due to ease of use and more rapid correction 5
- Inject into buttock, arm, or thigh 3
- Turn patient on their side to prevent choking if vomiting occurs 3
- Expected response within 5-15 minutes 5
If no response after 15 minutes: Administer a second dose using a new kit while waiting for emergency assistance. 6
Critical action: Call for emergency assistance immediately after administering glucagon. 6
Post-Glucagon Care
- Once patient awakens and can swallow, immediately give oral carbohydrates 3, 6
- Provide both fast-acting sugar and long-acting carbohydrate to restore liver glycogen and prevent recurrence 5, 3
- Common side effects: Nausea and vomiting are expected, particularly with higher doses 5
Important Clinical Caveats
What NOT to do:
- Do not use protein to treat hypoglycemia—it may increase insulin secretion 2
- Do not add fat to carbohydrate treatment—it slows and prolongs glycemic response 2
- Never delay treatment while waiting for blood glucose confirmation, though document glucose level when possible 2
High-risk situations requiring extra vigilance:
- Fasting for tests/procedures, delayed or skipped meals 2
- Intense exercise, alcohol consumption 2
- Sleep (nocturnal hypoglycemia) 4
- Declining renal function 2
Essential Patient/Caregiver Education
All patients at risk must:
- Carry glucose tablets or sugar source at all times 1, 2
- Have glucagon prescribed and readily available 1, 5
- Train family members, caregivers, and coworkers on glucagon administration 5
- Wear medical alert identification 1
Any episode of severe hypoglycemia or recurrent mild-to-moderate episodes requires immediate reevaluation of the diabetes management plan. 1, 2