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6.1.4 Treatment of hypoglycaemia

Formulary choicesGlucose (oral)

Initially, glucose 15-20g is given by mouth usually in liquid form
See attached leaflet for further details on management of ‘hypos’

Glucagon 1mg vial (GlucaGen® HypoKit)Dose:
Subcutaneous, intramuscular or intravenous injection, adult and child (over 25kg) 1mg
Glucose intravenous infusion As per local trust policy

Prescribing Notes

Acute management:

  • Hypoglycaemia is defined as blood glucose of less than 4mmol/L (if not < 4mmol/L but the patient is symptomatic, give a small carbohydrate snack for symptom relief)
  • If the patient is conscious, capable and co-operative, give 15-20g quick acting carbohydrate of the patient’s choice where possible. Examples are given in the ‘hypo’ leaflet
  • If the patient is conscious but not capable and/or co-operative, give 2 tubes of oral glucose gel (squeezed into mouth between teeth and gums) OR glucagon 1mg IM
  • Once capillary blood glucose (CBG) is above 4mmol/L, give 20g of long acting carbohydrate, e.g. 2 digestive biscuits or a slice of bread or next meal if due. If IM glucagon has been used, give 40g of long acting carbohydrate in order to replenish glycogen stores
  • Adults with decreased level of consciousness due to hypoglycaemia who are unable to take oral treatment safely should be:
    • given intramuscular glucagon by a trained user (intravenous glucose may be used by professionals skilled in obtaining intravenous access)
    • monitored for response at 10 minutes, and then given intravenous glucose if the level of consciousness is not improving significantly
    • then be given oral carbohydrate when it is safe to administer it, and placed under continued observation by a third party who has been warned of the risk of relapse