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6.1.4 Treatment of hypoglycaemia


Formulary choices

Glucose (oral)See information below
GlucaGen® HypoKit 1mg powder and solvent for solution for injection (glucagon)Dose:See BNF
Glucose intravenous infusion As per local trust policy

Prescribing Notes

Prevention and management of hypoglycaemia

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, able to swallow and co-operative, give 15-20g quick acting carbohydrate of the patient’s choice where possible. Examples are given in on the Diabetes UK website under ‘treating and managing a hypo’.
    • Note: glucose tablets and glucose juice shots (e.g. Lift glucose Juice shots®, Lift Glucose tablets®, Dextro energy®, Lucozade tablets®, Glucotabs® and Glucojuice®) should not be prescribed; patients should purchase these products. Refer to HSC Prescribing Stop List.
  • If the patient is conscious but not able to swallow and/or co-operate, give 2 tubes of oral glucose gel (squeezed into mouth between teeth and gums) OR glucagon 1mg IM (GlucaGen® Hypokit).
    • Note: Rapilose® 40% gel (3 x 25g) is the most cost-effective glucose gel to prescribe.
  • 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 (GlucaGen® Hypokit) 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