How Hypoglycemia Is Treated

The treatment of hypoglycemia (low blood sugar) depends on the severity of symptoms and the degree to which blood sugar levels have fallen. In mild cases, hypoglycemia can be treated with high-sugar foods or beverages or with over-the-counter glucose tablets or gels. For severe hypoglycemia due to diabetes, prescription drugs can be delivered, either by injection or nasal inhalation, that contain a hormone called glucagon.

what to know about hypoglycemia

Verywell / Laura Porter

Hypoglycemic emergencies, in which blood sugar levels cannot be restored even with appropriate treatment, require 911 medical assistance.

The American Diabetes Association defines hypoglycemia as a blood glucose level below 70milligrams per deciliter (mg/dL).

Home Remedies

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

If you have diabetes, ingest between 15 grams and 20 grams of fast-acting carbs if either of the following occurs:

  • You develop symptoms of hypoglycemia, such as shakiness, anxiety, headaches, sweating, heart palpitations, blurred vision, and light-headedness.
  • 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 glucose content of food is a better measure of quick response than the carbohydrate content of food. 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 abide by the "15-15 Rule," which involves 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.

Foods That Deliver 15 Grams of Fast-acting Carbs
Food Quantity
Banana One half
Corn syrup 1 tablespoon 
Fruit juices 1/2 to 3/4 cup or 4 to 6 ounces
Honey 1 tablespoon
LifeSavers Six to eight candies
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, or gumdrops Consult nutrition facts labels

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

Even if you don't have diabetes, you can still treat hypoglycemia with fast-acting carbs. However, it is important to see a doctor afterward, since frequent unexplained crashes may be an early sign of prediabetes.

Over-the-Counter Therapies

If you develop hypoglycemia and are nowhere near food, or if you find that 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 be safely stored in an office desk or glove compartment. Moreover, because they don't have to be broken down by the body, they deliver results quickly. It usually only takes a few minutes for hypoglycemia symptoms to begin subsiding.

Most glucose tablets are available in 4-milligram tablets and it typically takes three or four tablets to return blood sugar to normal. Glucose gel formulations are packaged in single-serve 15-gram tubes.

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

If you take an Alpha-glucosidase inhibitor like Precose (acarbose) or Gyset (miglitol), use glucose tablets or gels instead of fast-acting carbs. Medications in this class of drugs slow the absorption of glucose and may blunt the absorption of anything other than pure glucose. As always it is best to speak with your doctor about your individual management strategies.

Prescription Medications

If your hypoglycemia symptoms are severe and glucose tablets or fast-acting carbs are unable to provide relief, your doctor may recommend prescription medications that spur the body to produce its own glucose. This is especially true if your diabetes is poorly controlled.

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

There are injectable forms and intranasal form of glucagon approved by the U.S. Food and Drug Administration (FDA) for treating severe hypoglycemia.

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 even if the affected person falls unconscious.

  • GlucaGen, approved in 1998, comes in a kit with a vial of glucagon powder and a separate syringe prefilled with sterile water to mix with the powder to create a 1 milligram (mg) injection. It can be used in adults, children 6 and over, or children under 6 who weigh at least 55 pounds (25 kilograms).
  • Gvoke, approved in 2019, comes in a prefilled syringe with either 0.5 mg or 1 mg of glucagon solution. The product can also be delivered through HypoPen, a pre-mixed auto-injector. It can be taken by adults and children 2 and over.
  • Zegalogue was approved in 2021 to treat severe hypoglycemia in pediatric and adult patients with diabetes.

Now Approved: Generic Glucagon Injection

In December 2020 the FDA approved the first generic of glucagon for injection. The product is packaged in an emergency kit and is indicated for the treatment of severe hypoglycemia in patients with type 1 diabetes. Lower-cost, high-quality generic versions of drug products that are as safe and effective as their brand name counterparts representan important advancement for increasing patient access to affordable care.

A glucagon injection is given if you are experiencing symptoms of severe hypoglycemia, which means you are unable to administer carbohydrates and need the help of another person to do so. The shot is given intramuscularly (into a large muscle) and usually normalizes blood sugar within 10 to 15 minutes.

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

If you’re unsure whether you’re experiencing hypoglycemia, but still conscious, try to correct your blood sugar level with food and/or glucose first. A glucagon pen is meant to be used in cases when hypoglycemia is not responsive to treatment or when a person has lost consciousness.

Side effects tend to be mild and may include headache, stomach upset, nausea, vomiting, and 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. Basqimi is 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 include headache, nasal congestion, cough, runny nose, watery eyes, nausea, vomiting, and itchy nose, throat, or eyes.

Because Basqimi needs to be inhaled, it may not be the best option if you have a history of passing out or nearly passing out during a hypoglycemic crash. In such cases, glucagon injections may be preferred, because someone else can give you the shot.

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 whenever the individual is unresponsive, or if they have persistently extremely low blood sugar (below 50 mg/dL) and/or the following symptoms despite appropriate treatment:

  • 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 step-by-step instructions on how to deliver a glucagon injection if an emergency kit is available.

Never try to give an unconscious person food or drink, since this can cause choking, vomiting, and asphyxiation.

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.

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 carbs, and take your medications as prescribed to help keep your blood sugar within the 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 them checked out.

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Article Sources
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