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Copyright ©The Author(s) 2021.
World J Diabetes. Dec 15, 2021; 12(12): 2036-2049
Published online Dec 15, 2021. doi: 10.4239/wjd.v12.i12.2036
Table 1 Protocols for treating hypoglycemia
Steps
Procedure
Adults who are conscious, orientated, and able to swallow
1If the patient is receiving insulin (pump or IV infusion), stop it immediately
2Give 15-20 g rapid-acting carbohydrate of the patient’s choice where possible. Examples include: 15-20 g chewable glucose tablets, 150-200 mL orange juice, or 3-4 heaped teaspoons of sugar dissolved in water
3Repeat capillary blood glucose measurement 10-15 min later. If it is still less than 70 mg/dL, repeat the previous step up to 3 times
4If the capillary blood glucose remains less than 70 mg/dL after 30-45 min or three cycles of treatment, consider IV 200 mL of 10% glucose over 15 min or administration of 1 mg of glucagon IM
5Once blood glucose is above 70 mg/dL and the patient has recovered, it is recommended to give a long-acting carbohydrate. Examples: one slice of bread, a 200-300 mL glass of milk, or two biscuits
Adults who are conscious but confused, unable to cooperate but able to swallow
1If the patient is receiving insulin (pump or IV infusion), stop it immediately
2If the patient is uncooperative but is able to swallow, give a 15g tube of glucose (e.g., Glucogel), squeezed into the mouth between the teeth and gums, or (if this is ineffective) glucagon 1mg IM
3Repeat capillary blood glucose levels after 10-15 min. If it is still less than 70 mg/dL, repeat the previous step up to three times (glucagon injection should only be given once)
4If the capillary blood glucose remains less than 70 mg/dL after 30-45 min (or three cycles of treatment), give IV 200 mL of 10% glucose over 15 min
5Once blood glucose is above 70 mg/dL and the patient has recovered, giving a long-acting carbohydrate is recommended (as detailed above)
Adults who are unconscious and/or having seizures
1An urgent medical assessment is required. The following things should be checked and treated accordingly: Airway (administration of oxygen as appropriate), breathing, circulation (pulse), state of consciousness, blood glucose concentration, and body temperature
2If the patient is receiving insulin (pump or IV infusion), stop it immediately
3Request immediate assistance from medical staff
4If IV access is available, give 100 mL of 20% glucose IV or 200 mL of 10% glucose over 15 min
5If no immediate IV access is available, give 1mg glucagon IM. If no IV access is available initially, continue trying to obtain IV access as IM glucagon is less likely to be successful if required for a second time. If there is a need for prolonged treatment, IV administration of glucose is the treatment of choice
6Capillary blood glucose test should be repeated after 10 min. If it is still less than 70 mg/dL repeat step 4 (or step 5 if IV access remains unavailable)
7Once the blood glucose is greater than 70 mg/dL and the patient has recovered, give a long-acting carbohydrate (as previously detailed)