6.1.4 Treatment of hypoglycaemia


Choice	Drug	Dosage
Formulary choices	Glucose (oral)	Dose: Initially, glucose 15-20g is given by mouth usually in liquid form See attached leaflet for further details on management of ‘hypos’
		Or
		Glucagon 1mg vial (GlucaGen® HypoKit)	Dose: Subcutaneous, intramuscular or intravenous injection, adult and child (over 25kg) 1mg
		Or
		Glucose intravenous infusion	As per local trust policy

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