Hypoglycemia

Treatment

Mild or moderate (grade 1 or 2)

Immediate oral rapidly absorbed simple carbohydrate
e.g.
- 5–15 g glucose or sucrose (tablets/sugar lumps)
- 100 ml sweet drink (glucose/sucrose drinks, cola, etc)
Wait 10–15 min ... if no response ...
Repeat oral intake as above
As symptoms improve or normoglycemia is restored, the next meal or oral complex carbohydrate should be ingested (e.g. fruit, bread, cereal, milk)

BG measurements are the only way to confirm hypoglycemia if the diagnosis is uncertain, for example in children who may mimic the symptoms of hypoglycemia in order to be allowed to eat sweet foods. BG measurements also confirm the return of BG towards normal after hypoglycemia

Severe (grade 3)

Treatment is urgent
Severe hypoglycemia with loss of consciousness ± convulsions (particularly if there is vomiting) is most safely and rapidly reversed by injection of
Glucagon
- 0.5 mg for age <12 years
- 1.0 mg for age 12+ years
- [or 0.1–0.2 mg/10 kg body weight]
  best given IM (or deep SC)
If glucagon is unavailable or recovery is inadequate ...
IV glucose should be administered slowly by trained personnel over several minutes to reverse the hypoglycaemia
e.g. glucose 10–30% at a dose of 200–500 mg/kg (glucose 10% is 100 mg/ml)
If the hypoglycemia is not associated with vomiting nor severe enough to remove the swallowing, spitting or gag reflexes, it is usually effective to give concentrated sugar as glucose gel/syrup/honey/jam carefully by mouth
[The evidence is not strong that massaging the outside of the cheek against the gum facilitates buccal absorption of glucose. It is likely that some of the sugar is swallowed and absorbed lower in the gastrointestinal tract]

In the recovery phase after severe hypoglycemia

Close observation and BG monitoring are essential because vomiting is common and recurrent hypoglycemia may occur

The child will then usually require

additional oral carbohydrate
and/or
IV infusion of glucose
e.g. glucose 10% 2–5 mg/kg per min (1.2–3.0 ml/kg per h)

Recommendations

An immediate source of glucose or sucrose must always be immediately available to young people with diabetes

Equipment for BG measurement must be available to all young people with diabetes for immediate confirmation and safe management of hypoglycemia

Children, adolescents, parents, schoolteachers and other care givers should receive education on the recognition and management of hypoglycemia

Glucagon should be readily accessible to all parents and care givers, especially when there is a high risk of severe hypoglycemia. Education on administration of glucagon is essential

Children and adolescents with diabetes should wear some form of identification or warning of their diabetes