3 Hypoglycemia

Recognize low blood glucose

Hypoglycemia means a blood glucose level below $\text{70 mg/dL}$ ($\text{3.9 mmol/L}$). Possible symptoms include shakiness, sweating, hunger, irritability, a fast heartbeat, dizziness, and confusion. Symptoms can vary; the key treatment decisions depend on whether the person is alert and can swallow safely.

Treat a mild low safely

For someone who is awake and can swallow safely, give about $\text{15 grams}$ of fast-acting carbohydrate, such as glucose tablets or gel, or juice. Recheck blood glucose after $\text{15 minutes}$.

If the level remains below $\text{70 mg/dL}$, repeat the fast-acting carbohydrate treatment and check again after $\text{15 minutes}$. Continue until glucose has recovered according to the person's care plan. Chocolate is not the best initial treatment because its fat can slow glucose absorption.

For example, a person who is awake, shaky, and sweaty with a reading of $\text{62 mg/dL}$ can swallow safely, so the initial response is fast-acting carbohydrate followed by a recheck. If a reading is still $\text{66 mg/dL}$ after taking glucose and the person remains shaky, repeat the treatment and recheck after $\text{15 minutes}$.

Respond when swallowing is unsafe

Confusion may make swallowing unsafe. If a person cannot follow instructions reliably or cannot swallow safely, do not give food, liquid, or gel by mouth. Use prescribed glucagon if available, call emergency services, and stay with the person.

A person who is confused and has a reading of $\text{49 mg/dL}$ should not be given glucose gel or a sugary drink by mouth. Do not leave the person alone to get food.

Help during a seizure or unconsciousness

A seizure or unresponsiveness is an emergency. Protect the person from nearby hazards, call 911, and give glucagon if it is available and the responder can administer it. Do not restrain the person or put anything in their mouth, including a spoon or juice. If the person is breathing but remains unconscious, place them on their side when it is safe to do so.

Follow up after a severe episode

After glucagon, give oral carbohydrate only when the person is awake and can swallow safely. Start with fast-acting carbohydrate, then provide a longer-lasting carbohydrate-containing snack or meal. Stay with the person and continue to obtain emergency medical help; severe hypoglycemia may need further evaluation and treatment.

Repeated or severe low blood glucose episodes should prompt a review of the diabetes treatment plan with a healthcare professional.

Understand episode severity

The need for help—not a particular glucose number—defines severe hypoglycemia. A person whose low glucose impairs their ability to treat themselves needs assistance, so assess alertness and safe swallowing as well as the glucose reading.