How Hypoglycemia Is Treated

In This Article

Hypoglycemia (low blood sugar) can develop unexpectedly but can be treated fairly easily with food, over-the-counter glucose tablets, or prescription medications. It is important to treat hypoglycemia promptly whether or not you have diabetes because repeat episodes can lead to potentially serious complications. Treatment involves getting your blood sugar levels back up as quickly as possible. If you can't and start to feel sleepy or have breathing problems, call 911.

Home Remedies

The treatment of hypoglycemia can vary based on the severity of symptoms and how frequently you experience hypoglycemic episodes. Mild to moderate cases can often be treated at home.

Fast-Acting Carbohydrates

If you have the early symptoms of hypoglycemia like shakiness, anxiety, irritability, headaches, sweating, heart palpitations, hunger, blurred vision, difficulty concentrating, and fatigue—or your blood sugar is 70 milligrams per deciliter (mg/dL) or below without symptoms—15 to 20 grams (g) of fast-acting carbohydrates can usually get your blood sugar up quickly.

Fast-acting carbs are simple sugar-based foods that are quickly absorbed in the bloodstream after you eat them. They absorb so quickly that they can change your blood glucose levels within five to 15 minutes.

Foods are typically the first-line defense against hypoglycemia. With that said, the overtreatment of hypoglycemia in people with diabetes needs to be avoided as it can start a cycle of highs and lows that makes it difficult to control blood sugar levels.

To avoid overtreating hypoglycemia, a good strategy is the "15-15 Rule" in which you eat 15 grams of fast-acting carbs, wait 15 minutes, check your blood sugar, and repeat until your blood sugar is at least 70 mg/dL.

Here are some foods that provide around 15 grams of fast-acting carbs:

  • Banana (half)
  • Corn syrup (1 tablespoon)
  • Fruit juice (1/2 to 3/4 cup or 4 to 6 ounces)
  • Honey (1 tablespoon)
  • LifeSavers (six to eight)
  • Orange juice (1/2 cup or 4 ounces)
  • Raisins (2 tablespoons)
  • Nonfat milk (1 cup or 8 ounces)
  • Soda with sugar (1/2 cup or 4 ounces)
  • Sugar (1 tablespoon or 5 small cubes)
  • Syrup (1 tablespoon)
  • Hard candies, jelly beans, and gumdrops (check the nutrition facts label to ascertain how many candies equal 15 g of carbohydrate)

Once your blood sugar has normalized, eat a small snack containing carbs and protein (like an egg or peanut butter sandwich).

If you don't have diabetes, you should still treat hypoglycemia with fast-acting carbs. Afterward, schedule a visit with your doctor as soon as possible to find out what is causing the acute drop in blood sugar.

Over-the-Counter (OTC) Therapies

There may be situations in which carbohydrate-rich foods or drinks are unsuitable, such as when you are nauseous and unable to keep food down. Hypoglycemia can also sometimes hit when you are nowhere near food and have forgotten to bring an emergency supply. In such cases, you may be well served to purchase over-the-counter (OTC) glucose tablets or gel that have a long shelf life and can be safely stored in your office desk or glove compartment.

Because glucose tablets and gels deliver the type of sugar that your body uses for energy, they tend to work faster than food, many of which need to be broken down and converted into glucose.

They are also easier to dose. In the event of a hypoglycemic event, a 15-gram dose of glucose would roughly translate to three or four tablets. Most glucose gel formulations are packaged in single-serve 15-gram tubes.

Your doctor may recommend glucose tablets or gels over fast-acting carbs based on the drugs you are taking or the frequency of hypoglycemic events.

Glucose gel or tablets should be used if you take Precose (acarbose) or Gyset (miglitol). Because the drugs (called alpha-glucosidase inhibitors) slow the absorption of glucose, rapid-acting glucose tends to work better than food or candies.



Prescriptions

If your symptoms become so severe that fast-acting carbs are unable to stave off unconsciousness, you will need prescription medications that can get your blood sugar right immediately. One option called glucagon is delivered by injection and the other called Baqsimi (intranasal glucagon powder) is inhaled into a nostril.

Glucagon

Glucagon is a hormone that is similar to insulin. Insulin works by turning glucose (sugar) into glycogen and storing it in muscles, liver, and fat cells for future use. Glucagon, on the other hand, increases blood sugar by converting glycogen back into glucose and releasing it into the bloodstream.

If you have poorly controlled diabetes, your doctor will likely give you a prescription for one or more glucagon kits to keep in case of an emergency. It is important that you train loved ones on the proper use of the kit in case you end up in a hypoglycemic emergency.

Typically, a glucagon injection will allow you to fully recover within one to six hours of treatment and avoid a trip to the emergency room.

Indications

A glucagon injection should be used when you're having symptoms of hypoglycemia and/or your blood sugar is 70 mg/dL or below and you're unable to swallow or are unconscious.

Even if you are not sure you are having a hypoglycemic emergency, use the injection anyway. If it is hypoglycemia, your blood sugar levels will normalize quickly. If hyperglycemia (high blood sugar) is involved, the shot won't be particularly harmful as you await emergency assistance.

Storage

Store your glucagon kit at room temperature. If you live in climates above 90°F, you can put it in the refrigerator or a cooler, but do not freeze it. Be sure to check the expiration date and replace your kits as needed. Mixed glucagon can be stored in the refrigerator for no more than 24 hours.

It's not a bad idea to keep your expired kits on hand so that you can teach others how to use them. They can practice mixing the solution and injecting a piece of fruit.

Instructions

Glucagon comes in a kit with a vial of powder and a syringe filled with liquid. These need to be mixed before injecting. Here is a summary of what to do:

  1. Inject the liquid in the syringe into the vial of powder and swirl it around gently until mixed.
  2. Insert the syringe needle into the vial and draw out all of the mixed solution, making sure there aren't any trapped air bubbles.
  3. Turn the affected person on their side if unconscious. The injection may cause vomiting, and you don't want your loved one to choke.
  4. For adults, inject all of the liquid into a major muscle such as the buttock, upper arm, or thigh. For a child, you may only need to inject half the solution into a muscle, after which you would wait 20 minutes and give the rest if needed.

The injection should take effect within minutes, and the person should regain full consciousness within 15 minutes. After 10 minutes, check the blood sugar. If it's still under 60 mg/dL and the person is still unconscious, inject a second dose. There is not a danger of glucagon overdose.

Once blood sugars normalize, the person would need to eat a snack containing protein and carbs as soon as possible (such as a peanut butter sandwich). Check the blood sugar over the next few hours, and report the incident to your primary health provider.

Baqsimi (Glucagon Nasal Powder)

In July 2019, the U.S. Food and Drug Administration (FDA) approved a Baqsimi, an intranasal formulation of glucagon used for the treatment of severe hypoglycemia. Rather than having to inject glucagon, Basqimi is simply inhaled into a nostril via a prefilled nasal applicator. Each dose delivers 3 grams 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 nausea, headache, nasal congestion, cough, runny nose, watery or red eyes, and itchy nose, throat, or eyes. Vomiting may also occur.

Storage

Baqsimi should be kept in its sealed container and shrink-wrapped packaging until needed. Baqsimi can be safely stored at temperatures no greater than 86º F (30º C). If needed, the medication can be stored in a refrigerator. Do not freeze.

Regularly check the expiration date, and replace Baqsimi immediately if expired so that you always have an emergency supply on hand. Be sure to let your family or caretaker know where you store Baqsimi so that they can locate it in an emergency.

Instructions

Baqsimi is easier to administer than glucagon injections but still requires training. Be sure to walk your family through the process so that they know what to do in an emergency. Here is a summary of what to do:

  1. Remove the Baqsimi nasal applicator from its sealed tube, taking care not to depress the plunger.
  2. Remove the shrink wrap from the applicator tip.
  3. Turn the affected person on their side if unconscious. In such instances, the upper nostril would receive the medication.
  4. Hold the applicator between your fingers like a syringe with your thumb on the plunger.
  5. Insert the nasal tip into one nostril until your fingers touch your nose.
  6. Compress the plunger firmly. The dose is complete when the green line on the bottom of the plunger disappears.
  7. If the person does not respond after 15 minutes, another dose may be given. 

Once the blood sugar is normalized, encourage the person to eat as soon as possible. When they can safely swallow, they should consume a fast-acting carbohydrate (such as juice) and eat a protein-and-carbohydrate snack (such as crackers with cheese or peanut butter). 

When to Call 911

If your loved one falls unconscious due to a hypoglycemic emergency, you need to act fast. If for any reason you are unable to provide emergency treatment—either because there is not any glucagon on hand or you haven't have been taught how to administer the drug—you need to call 911 immediately.

Call 911 if your loved one has persistently low blood sugar levels (below 70 mg/dL) and/or has the following symptoms despite appropriate treatment:

  • Confusion
  • Dizziness
  • Nausea or vomiting
  • Shortness of breath
  • Tremors or chills
  • Extreme anxiety
  • Irritabilibility 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 step-by-step instructions on how to stabilize your loved one and may even be able to walk you through the injection process.

Never give an unconscious person food or drink to normalize their blood sugar as this can cause choking, vomiting, and suffocation.

When paramedics arrive, they can administer a glucagon injection or deliver it intravenously (into a vein) to get your loved one's blood sugar back to normal. Your loved one will then be rushed to the emergency department and hospitalized if needed.

A Word From Verywell

Prevention is the best strategy to keep hypoglycemia at bay if you have diabetes. Proper diabetes management involves more than just monitoring your blood sugar. It demands that you recognize the early symptoms of hypoglycemia, control your intake of carbohydrates, and take your medications as prescribed to help keep your blood sugars within an optimal range.

If you don't have diabetes, your doctor will need to identify and treat the underlying cause of hypoglycemia. Until you are able to pinpoint the cause—whether it is diabetes-related or not—you may find yourself hard-pressed to prevent future episodes. Don't ignore the symptoms; see a doctor as soon as possible and have it checked out.

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Article Sources

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