Mild hypoglycemia is not necessarily a medical emergency unless the excessive use (overdose) of anti-diabetic agents or insulin has been implicated as a possible cause. This could rapidly progress into severe hypoglycemia. In most instances it can be managed in the home environment with readily available food ingredients. Even if medical attention is not required immediately in a case of mild hypoglycemia, the cause should be investigated and identified to prevent further episodes.
However, in cases of severe hypoglycemia, these measures are only useful temporarily and immediate medical attention is necessary.
Severe hypoglycemia is more likely to occur in diabetics – particularly insulin-dependent diabetes. The regular use of a blood glucose monitoring device is therefore essential and diabetics should not rely solely on their perception of low blood sugar levels. If left untreated, hypoglycemia can lead to death. This is not only a concern for older patients with diabetes. Sudden death due to hypoglycemia may occur in a young person with type 1 diabetes. This is not common but typically occurs during sleep possibly as a result of cardiac arrhythmias induced by hypoglycemia.
Treating Low Blood Sugar Levels
Treatment of Mild Hypoglycemia
The early warning signs as outlined in the Hypoglycemia Signs and Symptoms should be present and a blood glucose level below 70mg/dL (3.8mmol/L) in diabetics or 63 mg/dL (3.5 mmol/L) in non-diabetics is sufficient to warrant the implementation of the measures below.
- A fast-acting (simple) carbohydrate like glucose needs to be administered orally.
- 15 grams may be given in the form of a glucose solution, tablets, gel.
- A confectionery (sweet) may be helpful if no other measures are available. Table sugar, fruit juice and sodas may also be used.
- A snack containing long-acting starch (complex carbohydrate) should follow – example toast.
- Snacks should be avoided if hypoglycemia is suspected as a result of overdose, especially intentional, and immediate medical attention should be sought. Glucose can be administered orally in these instances.
It is acceptable to implement these measures without a blood glucose level assessment if a home monitor is unavailable. If a home glucose monitor is available, the blood glucose levels should be assessed every 15 minutes until the glucose levels return to an acceptable range and the signs and symptoms abate. A repeat dose of 15 grams of glucose may be necessary. Other signs and symptoms (neuroglycopenic) like confusion, inability to concentrate and poor coordination may take up to 60 minutes to resolve. If the blood glucose levels continue to drop despite the administration of glucose, this should be considered as severe hypoglycemia.
Treating Very Low Blood Sugar Levels
Emergency Treatment of Severe Hypoglycemia
Severe hypoglycemia is not solely dependent on the blood glucose levels as some patients are cautious about seeking emergency medical attention despite the presence of serious signs and symptoms. Difficulty speaking, drowsiness, impaired coordination and mental confusion is sufficient to determine a case of severe hypoglycemia, especially if a patient is unresponsive to glucose, and should be differentiated from alcohol or drug intoxication. Seizures, blackouts or a coma is a clear indication of severe hypoglycemia unless it is caused by other disorders. Ideally severe hypoglycemia should not be managed in the home environment but immediate measures are necessary until medical attention can be secured.
- Conscious patients who are able to swallow :
- 25 grams of glucose in solution, tablet or sweet form.
- Glucose gel or even honey can be rubbed on the inner lining of the mouth (cheek).
- Semiconscious or unconscious patients :
- These measures need to be conducted by a trained medical professional.
- Intravenous (IV) – 75ml of 20% dextrose or 25 to 50ml of 50% dextrose.
- Intramuscular (IM) – 1mg glucagon if no IV access.
- What is Low Blood Sugar (Glucose)? Hypoglycemia Range of Levels
- Causes of Low Blood Sugar Levels (Hypoglycemia)
- Hypoglycemia Signs and Symptoms (Blood Glucose), Whipple’s Triad