What is the protocol for managing adult hypoglycemia (low blood sugar)?

From the Guidelines

The management of adult hypoglycemia should follow a stepwise approach, prioritizing the administration of 15-20g of fast-acting carbohydrates orally for conscious patients who can swallow safely, and glucagon or intravenous dextrose for unconscious patients or those unable to swallow safely, as recommended by the most recent guidelines 1. The approach to managing adult hypoglycemia involves several key steps, including:

• Assessing the patient's level of consciousness and ability to swallow
• Administering 15-20g of fast-acting carbohydrates orally, such as glucose tablets, fruit juice, or candy, for conscious patients who can swallow safely
• Rechecking blood glucose after 15 minutes and repeating treatment if necessary
• Providing a more substantial snack containing complex carbohydrates and protein to prevent recurrence once blood glucose normalizes
• Administering glucagon or intravenous dextrose for unconscious patients or those unable to swallow safely, with a dose of 1mg of glucagon intramuscularly or subcutaneously, or 25g (50ml) of 50% dextrose solution intravenously
• Considering continuous glucose monitoring for severe or recurrent hypoglycemia, and investigating the cause of hypoglycemia to adjust diabetes medication regimens and prevent future episodes, as suggested by recent studies 1. It is essential to prioritize the patient's safety and well-being, and to take a proactive approach to preventing and managing hypoglycemia, as it is a leading limiting factor in the glycemic management of type 1 and insulin-treated type 2 diabetes, and can have serious complications if not addressed promptly and effectively 1. Key considerations in the management of adult hypoglycemia include:
• The importance of prompt recognition and treatment of hypoglycemia to prevent serious complications
• The need for ongoing assessment and adjustment of diabetes medication regimens to prevent future episodes of hypoglycemia
• The importance of patient education and empowerment in recognizing and managing hypoglycemia, as well as in preventing future episodes
• The potential benefits of continuous glucose monitoring in preventing and managing severe or recurrent hypoglycemia, as supported by recent evidence 1.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION

1. 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.
2. 2 Dosage in Adults and Pediatric Patients for Using the Glucagon Emergency Kit for Low Blood Sugar to Treat Severe Hypoglycemia Adults and Pediatric Patients Weighing More Than 25 kg or for Pediatric Patients with Unknown Weight 6 Years and Older The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously If there has been no response after 15 minutes, an additional 1 mg dose (1 mL) of Glucagon for Injection may be administered using a new kit while waiting for emergency assistance.

The protocol for management of adult hypoglycemia involves:

• Administering 1 mg (1 mL) of Glucagon for Injection subcutaneously, intramuscularly, or intravenously as soon as possible when severe hypoglycemia is recognized.
• Calling for emergency assistance immediately after administering the dose.
• Giving oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia when the patient has responded to the treatment and is able to swallow.
• Administering an additional 1 mg dose (1 mL) of Glucagon for Injection using a new kit if there has been no response after 15 minutes, while waiting for emergency assistance 2.

From the Research

Management of Adult Hypoglycemia

• The management of adult hypoglycemia involves immediate treatment with carbohydrates, preferably glucose, with an optimal dose of 15-20 g 3.
• In cases of severe hypoglycemia, glucagon injection is recommended in non-professional settings, while intravenous administration of glucose is preferred in professional settings 3.
• Glucagon is an effective treatment for hypoglycemia, with a low failure rate, and can be administered via injection or intranasally 4.
• Octreotide therapy has been shown to be effective in treating recurrent refractory hypoglycemia due to sulfonylurea in patients with diabetes-related kidney failure 5.

Treatment Options

• Glucagon: can be administered via injection or intranasally, with similar effectiveness 4.
• Dextrose: can be administered orally or intravenously, with an optimal dose of 15-20 g 3.
• Octreotide: can be used to treat recurrent refractory hypoglycemia due to sulfonylurea in patients with diabetes-related kidney failure 5.

Prevention and Education

• Patient education on risk factors, warning signs, and treatment of hypoglycemia is crucial in preventing hypoglycemia 6, 7.
• Regular review and education between people with diabetes and their caregivers and healthcare professionals is essential in managing diabetes and preventing hypoglycemia 7.
• Awareness of the potential dangers of hypoglycemia is fundamental to the optimal management of diabetes 7.