Algorithm
- Confirm hypoglycemia: capillary BG <3.9 mmol/L (70 mg/dL) or compatible symptoms.
- If conscious and able to swallow: 15–20 g fast-acting oral glucose; recheck in 15 min.
- If unconscious, seizing, or unable to swallow: IV access — dextrose 10% or 20% bolus.
- If no IV access: glucagon 1 mg IM/SC (or intranasal 3 mg if available).
- Recheck BG q10–15 min; repeat treatment until BG ≥4.0 mmol/L and symptoms resolve.
- When stable: complex carbohydrate snack + identify cause (insulin, sulfonylurea, fasting, sepsis).
- Admit if refractory, sulfonylurea-induced, or unknown cause with recurrent episodes.
Red flags
- • Seizure or coma
- • Failure to improve after glucose — reconsider diagnosis / aspiration risk
- • On insulin / sulfonylurea — prolonged observation may be needed
Medications by step
Step 1 — Conscious, can swallow
- Glucose (oral) · p.o.
15–20 g PO (glucose gel/tablets/juice)
Step 2 — IV treatment (preferred if access)
- Dextrose 20% (D20W) · i.v.
25–50 mL IV bolus; repeat PRN
- Dextrose 10% (D10W) · i.v.
100–200 mL IV bolus; repeat PRN
Step 3 — No IV access
- Glucagon · i.m./s.c.
1 mg IM/SC once; repeat ×1 in 15 min if needed
Step 4 — Maintenance / prevention of relapse
- Dextrose 5–10% infusion · i.v. infusion
IV infusion titrated to BG ≥4.0 mmol/L
References
Updated: Июль 2026