How is hypoglycemia treated?
The acute management of hypoglycemia involves the rapid delivery of a source of easily absorbed sugar. Regular soft drinks, juice, lifesaver candies, table sugar, and the like are good options. In general, 15 grams of glucose is the dose that is given, followed by an assessment of symptoms and a blood glucose check if possible. If after 10 minutes there is no improvement, another 10-15 grams should be given. This can be repeated up to three times. At that point, the patient should be considered as not responding to the therapy and an ambulance should be called.
The equivalency of 10-15 grams of glucose (approximate servings) are:
- Four lifesavers
- 4 teaspoons of sugar
- 1/2 can of regular soda or juice
Many people like the idea of treating hypoglycemia with dietary treats such as cake, cookies, and brownies. However, sugar in the form of complex carbohydrates or sugar combined with fat and protein are much too slowly absorbed to be useful in the acute treatment of hypoglycemia.
Once the acute episode has been treated, a healthy, long-acting carbohydrate to maintain blood sugars in the appropriate range should be consumed. Half a sandwich is a reasonable option.
If the hypoglycemic episode has progressed to the point at which the patient cannot or will not take anything by mouth, more drastic measures will be needed. In many cases, a family member or roommate can be trained in the use of glucagon. Glucagon is a hormone that causes a rapid release of glucose stores from the liver. It is an injection given intramuscularly to an individual who cannot take glucose by mouth. A response is usually seen in minutes and lasts for about 90 minutes. Again, a long-acting source of glucose should thereafter be consumed to maintain blood sugar levels in the safe range. If glucagon is not available and the patient is not able to take anything by mouth, emergency services (for example 911) should be called immediately. An intravenous route of glucose administration should be established as soon as possible.
With a history of recurrent hypoglycemic episodes, the first step in treatment is to assess whether the hypoglycemia is related to medications or insulin treatment. Patients with a consistent pattern of hypoglycemia may benefit from a medication dose adjustment. It is important that people with diabetes who experience hypoglycemia check blood glucose values multiple times a day to help define whether there is a pattern related to meals or medications. Some people who experience recurrent hypoglycemia will benefit from changes in their dietary patterns; for example, eating multiple small meals and frequent small snacks throughout the day rather than three larger meals.