Hypoglycemia Treatment Guidelines

Detailed Information

Hypoglycemia Prevention

Prevention of hypoglycemia is a critical part of diabetes management; however, when hypoglycemia occurs, current treatment guidelines should be followed.^1-3

Hypoglycemia Treatment

American Diabetes Association

Health care providers should ask individuals at risk for hypoglycemia about symptomatic and asymptomatic hypoglycemia at each visit.¹

In a conscious individual with a BG of <70 mg/dL (<3.9 mmol/L), 

• glucose (15 to 20 grams) is the preferred treatment but any form of carbohydrate containing glucose may be used 

• if SMBG continues to show hypoglycemia 15 minutes after glucose treatment, the glucose treatment should be repeated, and

• a meal or snack should be consumed once SMBG returns to normal to prevent hypoglycemia recurrence.¹

Glucagon should be prescribed and available to individuals with an increased risk of level 2 hypoglycemia, defined as a BG of <54 mg/dL (<3.0 mmol/L).¹

The use of glucagon is indicated for the treatment of severe hypoglycemia in people unwilling or unable to consume carbohydrates by mouth.¹

Family members, caregivers, coworkers, and school personnel should know

• where glucagon is located

• when to administer glucagon, and 

• how to administer glucagon.¹

A person's treatment regimen should be reevaluated when there is 

• hypoglycemia unawareness, or

• 1 or more events of level 3 hypoglycemia, defined as a severe event characterized by altered mental and/or physical status requiring assistance for recovery.¹

A insulin-treated person with hypoglycemia unawareness or a level 2 hypoglycemia event should increase their glycemic targets to

• avoid hypoglycemia for several weeks,

• reverse hypoglycemia unawareness, and

• reduce the risk of hypoglycemic events.¹

International Society for Pediatric and Adolescent Diabetes

In children, if the BG is <70 mg/dL (<3.9 mmol/L), 0.3 g/kg of carbohydrate in the form of glucose should be given.²

Hypoglycemia resolved in most children given 0.3 g/kg of rapidly acting carbohydrate and increased the median BG at

• 10 minutes by 18 to 23.4 mg/dL (1.0 to 1.3 mmol/L), and 

• 15 minutes by 36 to 37.8 mg/dL (2.0 to 2.1 mmol/L).²

No rebound hyperglycemia was observed at the following meal.²

The BG level should be rechecked after 10 to 15 minutes and if hypoglycemia continues, oral carbohydrate intake should be repeated.² 

Typically, a rapidly acting carbohydrate can be followed with a slower acting carbohydrate.² 

The amount of the carbohydrate needed will depend on

• the size of the child

• the type of insulin therapy

• the active insulin on board

• the timing and intensity of exercise, and 

• other factors.²

Insulin administration should typically be held if the BG level is <56 mg/L (2.0 mmol/L).² 

Urgent treatment of severe hypoglycemia can be treated with glucagon or IV glucose in the hospital setting.²

Caregivers need to understand that a child will be at a higher risk of other hypoglycemic events following a severe hypoglycemic event and changes in therapy may need to occur.²

References

The published references below are available by contacting 1-800-LillyRx (1-800-545-5979).

1. American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(suppl 1):S61–S70. https://doi.org/10.2337/dc19-SINT01

2. Abraham MB, Jones TW, Naranjo D, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatric Diabetes. 2018;19(suppl 27):178-192. https://doi.org/10.1111/pedi.12698

3. International Hypoglycaemia Study Group. Minimizing hypoglycemia in diabetes. Diabetes Care. 2015;38(8):1583-1591. http://dx.doi.org/10.2337/dc15-0279

Glossary

BG = blood glucose

IV = intravenous

SMBG = self-monitored blood glucose