Treatment of Symptomatic Hypoglycemia in Conscious Adults
For a conscious adult with symptomatic hypoglycemia who can safely swallow, administer 15-20 grams of rapid-acting carbohydrate, with pure glucose being the preferred form. 1, 2
Recommended Carbohydrate Dose
Standard dose: 15-20 grams of carbohydrate should be given to most adults experiencing symptomatic hypoglycemia (blood glucose ≤70 mg/dL). 1, 2
Pure glucose is the preferred treatment, though any carbohydrate containing glucose will raise blood glucose levels. 1
For patients using automated insulin delivery systems, a lower dose of 5-10 grams of carbohydrate is recommended, except when hypoglycemia occurs with exercise or significant overestimation of a carbohydrate/meal bolus. 1
Practical Carbohydrate Options
The following provide approximately 15-20 grams of carbohydrate 1:
- Glucose tablets: 15-20 grams (most effective, with 87% achieving clinical relief within 15 minutes)
- 20-25 Skittles (84.7% relief rate)
- 200 mL unsweetened orange juice (70% relief rate)
- 15-20 jelly beans (73.3% relief rate)
- 5-10 Mentos mints (91.7% relief rate)
Critical Follow-Up Protocol
Recheck blood glucose after 15 minutes of carbohydrate ingestion. 1, 2
If hypoglycemia persists (glucose remains <70 mg/dL), repeat the 15-20 gram carbohydrate dose and seek medical care for ongoing hypoglycemia. 1
Continue monitoring until blood glucose stabilizes above 70 mg/dL. 2
Important Treatment Considerations
What to avoid:
Do not add fat to the carbohydrate treatment, as it slows and prolongs the acute glycemic response. 1
Do not use protein-rich foods (such as milk or peanut butter) to treat hypoglycemia, as dietary protein may increase insulin secretion and is ineffective for acute treatment. 1
Never give oral carbohydrates to unconscious patients or those unable to protect their airway, as this creates aspiration risk. 3, 4
Timing of response:
Blood glucose typically begins to rise within 10-20 minutes after carbohydrate ingestion, though glucose tablets show faster and more reliable response compared to dietary sugars. 1
The glycemic response correlates better with glucose content than total carbohydrate content of the food. 1
Prevention of Recurrent Hypoglycemia
After initial recovery, ongoing insulin activity or insulin secretagogues may lead to recurrent hypoglycemia unless additional food is ingested. 1
Patients should consume a meal or snack after treating hypoglycemia if more than one hour remains until the next scheduled meal. 4
Common Pitfalls
Glucose gel and fruit juice are less effective than glucose tablets or other forms of dietary sugar, showing slower resolution of symptoms in clinical studies. 1
Patients may overtreat hypoglycemia out of fear, leading to rebound hyperglycemia—emphasize the specific 15-20 gram dose. 5
Treatment instructions should be reviewed at every clinical visit, as adherence to proper hypoglycemia management is often suboptimal. 1