Glucose Tablet Dosing for Hypoglycemia
For a conscious patient with hypoglycemia who can swallow, administer 15-20 grams of oral glucose, preferably as glucose tablets. 1, 2
Initial Treatment Protocol
Conscious Patients Who Can Swallow
Administer 15-20 grams of oral glucose immediately as the first-line treatment for hypoglycemia (blood glucose <70 mg/dL or 3.9 mmol/L). 1, 2
Glucose tablets are superior to other forms including glucose gel, dietary sugars (sucrose, fructose), orange juice, jellybeans, candy, and milk for symptom resolution at 15 minutes. 1, 3
Pure glucose tablets raise blood glucose more rapidly and effectively than other carbohydrate sources, with 10g raising glucose by approximately 40 mg/dL (2.2 mmol/L) over 30 minutes and 20g raising it by approximately 60 mg/dL (3.3 mmol/L) over 45 minutes. 2
Monitoring and Repeat Dosing
Check blood glucose 15 minutes after initial treatment. 1, 2
If blood glucose remains <70 mg/dL (3.9 mmol/L), repeat with another 15-20 grams of glucose. 1, 2
Once blood glucose normalizes (>70 mg/dL), provide a meal or snack containing complex carbohydrates and protein to prevent recurrence. 2, 4
Recheck blood glucose at 60 minutes as additional treatment may be necessary. 2
Alternative Carbohydrate Sources (When Glucose Tablets Unavailable)
If glucose tablets are not available, the following dietary sources contain approximately 15-20 grams of simple sugars: 1
- 1 tablespoon table sugar
- 6-8 oz apple or orange juice
- 6-8 oz regular (non-diet) soda
- 1 tablespoon honey
- 15-25 jellybeans or gummy bears
However, these alternatives are inferior to glucose tablets in terms of speed and effectiveness of blood glucose correction. 1, 3
Severe Hypoglycemia (Unconscious or Unable to Swallow)
Never attempt oral glucose in unconscious or seizing patients due to aspiration risk. 1, 5
Activate emergency medical services immediately for patients who cannot swallow, have seizures, or do not improve within 10 minutes of oral glucose. 1
Administer glucagon 0.5-1.0 mg intramuscularly or 20-40 mL of 50% glucose solution intravenously for severe hypoglycemia with cognitive impairment. 1, 5
Critical Clinical Pearls and Pitfalls
What Works
Glucose tablets demonstrate superior efficacy compared to glucose gel, with tablets producing higher blood glucose levels than buccally applied glucose products. 1
Treatment should not be delayed while waiting for confirmatory blood glucose measurement—if hypoglycemia is suspected, treat immediately. 2
Gastric emptying rates are twice as high during hypoglycemia, which facilitates rapid absorption of oral glucose. 2
What to Avoid
Do not use protein alone to treat hypoglycemia as it may increase insulin secretion without raising blood glucose quickly enough. 2
Avoid adding fat to treatment as it may slow and prolong the acute glycemic response. 2
Do not use glucose gel or orange juice as first-line therapy as they produce consistently lower glycemic responses at 10-15 minutes compared to tablets or solutions. 3
Do not forget the follow-up meal or snack after initial treatment to prevent recurrence. 2
Special Populations
Patients on Automated Insulin Delivery Systems
- A lower dose of 5-10 grams of carbohydrates may be appropriate unless hypoglycemia occurs with exercise. 2
Children Unable to Swallow
- For children who are awake but unwilling or unable to swallow glucose, applying a slurry of granulated sugar and water under the tongue may be reasonable. 1