Baqsimi™ (glucagon) nasal powder

3mg

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Hypoglycemia Treatment Guidelines

The American Diabetes Association and International Society for Pediatric and Adolescent Diabetes have published treatment guidance on hypoglycemia.

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

Date of Last Review: January 25, 2019

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