Management of Severe Hypoglycemia

Initial Assessment and Treatment

• For conscious patients with severe hypoglycemia, immediately administer 15-20g of oral glucose, and monitor blood glucose every 15 minutes until levels rise above 3.9 mmol/L, as recommended by the American Diabetes Association 1, 2, 3
• Once blood glucose is >3.9 mmol/L, provide starchy or protein-rich foods if the next meal is more than an hour away, according to the American Diabetes Association 1

Treatment for Patients with Cognitive Impairment

• Administer glucagon 0.5-1.0 mg intramuscularly for patients with cognitive impairment or unable to swallow, as recommended by the American Heart Association 1, 3
• For children who are awake but unwilling to swallow glucose, consider applying a slurry of granulated sugar and water under the tongue, as suggested by the American Heart Association 3

Practical Considerations

• Ensure glucagon emergency kits are available for patients at risk of severe hypoglycemia, and train caregivers or family members on proper administration of glucagon, as recommended by the American Diabetes Association 4, 5
• Activate emergency medical services if the patient is unable to swallow, has a seizure, or shows no improvement within 10 minutes of treatment, according to the American Heart Association 2, 3

Prevention of Recurrence

• Once the patient recovers, investigate the cause of hypoglycemia and adjust medications as needed, and consider relaxing glycemic targets temporarily for patients with recurrent hypoglycemia, as recommended by the American Diabetes Association 1, 2
• Educate patients to carry emergency glucose sources and identification at all times, according to the American Diabetes Association 1