How Hypoglycemia (Low Blood Sugar) Is Treated

Hypoglycemia (low blood sugar) treatments will depend on the severity of symptoms and how low the blood sugar level has fallen. Mild hypoglycemia symptoms can be treated with high-sugar foods or beverages or with over-the-counter (OTC) glucose tablets or gels.

For moderate to severe hypoglycemia due to diabetes, a prescription medication containing the hormone glucagon can be delivered by injection or nasal inhalation. Hypoglycemic emergencies, in which blood sugar levels cannot be restored even with appropriate treatment, require 911 medical assistance.

Mild Hypoglycemia

Mild hypoglycemia can usually be treated with fast-acting carbs that are quickly absorbed in the gut and released into the bloodstream within five to 15 minutes. These are simple carbohydrates that don't need to be broken down much during digestion.

If you have diabetes, ingest 15 grams of fast-acting carbs if:

• You develop symptoms of hypoglycemia, such as shakiness, anxiety, headaches, sweating, heart palpitations, blurred vision, light-headedness, mental confusion, numbness, or tingling
• Your blood sugar drops below 70 mg/dL—even if you have no symptoms

Pure glucose is the preferred treatment for hypoglycemia, but any form of carbohydrate that contains glucose will raise blood glucose. The sugar content of food is a better indication of quick response than carbohydrate content.

You should not overtreat hypoglycemia by eating too many carbs, as doing so can trigger hyperglycemia (high blood sugar). Hyperglycemia could require diabetes medications to bring your blood sugar back under control.

A good strategy is to follow the "15-15 Rule," which means eating 15 grams of fast-acting carbs, waiting 15 minutes, checking your blood sugar, and then repeating this process until your blood sugar returns to at least 70 mg/dL.

Once your blood sugar has normalized, eat a small snack containing carbs and protein, such as an egg and crackers or a turkey sandwich.

Over-the-Counter Treatment

If you develop hypoglycemia and are nowhere near food, or if you find keeping food down during the event is difficult, over-the-counter glucose tablets or gels offer a handy solution. Not only do these products have a long shelf life, but they can also be safely stored in an office desk, purse, or pocket.

Moreover, because they don't have to be broken down by the body, they deliver results quickly. It usually takes just a few minutes for hypoglycemia symptoms to begin to subside.

Most glucose tablets are available in 4-gram (g) tablets. Typically, three or four tablets are necessary to return blood sugar to normal. Glucose gel formulations are packaged in single-serve 15-gram tubes.

Your healthcare provider may recommend glucose tablets or gels rather than fast-acting carbs if you have frequent hypoglycemic episodes. Glucose tablets or gels also may be preferred if you take certain types of diabetes medications.

Moderate to Severe Hypoglycemia

If your hypoglycemia symptoms are more severe and glucose tablets or fast-acting carbs don't help, your healthcare provider may recommend prescription medications that spur the body to produce its own glucose—especially if your diabetes is poorly controlled.

This would involve either the injection or nasal inhalation of glucagon, a hormone produced by the pancreas that triggers the release of stored glucose (glycogen) from the liver, fat cells, and muscles.

Glucagon Injections

Glucagon injections are made with a synthetic form of glucagon and are used in an emergency. Because they are injectable, they can be administered to a person who is unconscious or unable to consume carbs by mouth.

• GlucaGen, approved in 1998, comes in a kit with a vial of glucagon powder and a separate syringe pre-filled with sterile water to mix with the powder to create a 1-mg injection. It can be given to adults, children 6 and over, or children under 6 who weigh at least 55 pounds (25 kilograms). A lower dose (0.5-mg injection) can be given to children under 55 pounds or those under 6 whose weight isn't known.
• Gvoke, approved in 1960, comes in a pre-filled syringe with either 0.5 mg or 1 mg of glucagon solution. It can also be delivered with a HypoPen, a pre-mixed auto-injector, and is approved by the Food and Drug Administration (FDA) for adults and children 2 and over.
• Zegalogue was approved in 2021 to treat severe hypoglycemia in adults and children 6 and older with diabetes.

If you are experiencing symptoms of severe hypoglycemia and can't give yourself carbohydrates, you may be given a glucagon shot intramuscularly (into a large muscle), which should normalize your blood sugar levels within 10 to 15 minutes.

If you are fully conscious and able to self-administer carbohydrates, take 15 to 20 grams of glucose, then follow the 15-15 rule. If your symptoms still do not improve, follow the guidelines in "When to Call 911" below.

Glucagon injection side effects tend to be mild and may include:

• Headache
• Stomach upset
• Nausea
• Vomiting
• Injection site pain

Baqsimi (Glucagon Nasal Powder)

In July 2019, the FDA approved Baqsimi, an intranasal formulation of glucagon, for the treatment of severe hypoglycemia. Baqsimi is dispensed into a nostril via a pre-filled nasal applicator. Each dose delivers 3 mg of glucagon in powder form.

Baqsimi is used under the same circumstances as injected glucagon and with similar effectiveness.

Side effects tend to be mild and may include:

• Headache
• Nasal congestion
• Cough
• Runny nose
• Watery eyes
• Nausea
• Vomiting
• Itchy nose, throat, or eyes

When to Call 911

If someone you know falls unconscious due to a hypoglycemic event, act quickly if you are unable to provide emergency treatment yourself (such as giving a shot).

Call 911 immediately if the person is unresponsive, their blood sugar stays persistently and extremely low (below 50 mg/dL), and/or they have symptoms despite treatment, such as:

• Confusion
• Dizziness
• Nausea or vomiting
• Shortness of breath
• Tremors or chills
• Extreme anxiety
• Irritability and changes in behavior
• Profuse sweating
• Pale, clammy skin
• Rapid heartbeat
• Extreme fatigue or sleepiness
• Loss of consciousness
• Seizures

As you await emergency services, the 911 staff can provide you with step-by-step instructions for how to deliver a glucagon injection if an emergency kit is available.

In emergency situations, glucagon may be delivered intravenously (into a vein) to rapidly elevate blood sugar. Emergency medical personnel also commonly use intravenous dextrose, a form of sugar, until blood sugar levels are fully normalized. Once the individual is stabilized, oral glucose or sucrose is administered to help replenish glycogen stores.

Summary

Treatment for hypoglycemia will depend on the severity of symptoms and how low the blood sugar level has fallen. Mild hypoglycemia can be treated with fast-acting carbs or OTC glucose products. More severe hypoglycemia may need to be treated with glucagon injection or nasal powder, or intravenous treatment in the most severe cases.

If you don't have diabetes, your healthcare provider will need to identify and treat the underlying cause of hypoglycemia.