Thresholds to treat (Neonate (<48 h–2 wk): treat if glucose <2.6 mmol/L (45 mg/dL) or symptomatic (PES 2015) · Older infant/child: treat if <3.3 mmol/L (60 mg/dL) or symptomatic; diabetes protocols often use <3.9 mmol/L (70 mg/dL) (ISPAD 2022, ADA) · Always treat symptomatic hypoglycemia regardless of numeric threshold)
First-line therapy
Oral glucose • p.o. • 300–300 mg/kg/dose • 1×/day
Max 20000 mg/dose · Duration: Once · 0.3 g/kg PO once — calculator uses mg/kg glucose (300 mg/kg); repeat q15 min PRN; max practical single dose ~20 g
• Oral glucose indications: **conscious**, able to swallow safely, and no risk of aspiration — preferred first-line for mild–moderate hypoglycemia in all ages when airway protected (ISPAD 2022, ISPED 2024, AAP).
• Dose: **0.3 g/kg** rapid-acting glucose (pure glucose tablets/gel preferred — absorbed ~2× faster than sucrose) — e.g. 9 g for 30 kg, 15 g for ≥50 kg; practical fixed doses: **6–12 mo** 5–10 g · **1–6 yr** 10–15 g · **≥6 yr** 15–20 g (ISPAD 2022, ISPED 2024).
• Diabetes (T1D) threshold: treat when glucose **<3.9 mmol/L (70 mg/dL)** on meter/CGM; with hybrid closed-loop/AID systems consider **0.1 g/kg** correction only if symptomatic or within 2–3 h of excess bolus (ISPED 2024).
• Recheck glucose **q15 min** — repeat 0.3 g/kg if still <3.9 mmol/L (70 mg/dL) or symptomatic; after correction give snack with protein (15 g carb + protein) if meal >45 min away (ISPAD 2022).
• Do NOT force liquids/powders into semi-conscious child — risk of aspiration; escalate to glucagon or IV glucose (ISPAD 2022, ERC 2021).
Max 20000 mg/dose · Duration: Once · 0.3 g/kg carbohydrate PO — honey, regular soft drink, or candy if pure glucose unavailable; prefer glucose for faster absorption (ISPAD 2022)
• Honey/juice/candy: pure glucose tablets or gel unavailable — use equivalent ~0.3 g/kg carbohydrate; sucrose acceptable but slower rise (ISPAD 2022).
• Mini-dose glucagon SC: T1D child with gastroenteritis, poor oral intake, glucose 3.3–4.4 mmol/L (60–80 mg/dL) and falling — prevents severe hypoglycemia; NOT for unconscious child (use full glucagon dose or IV glucose) (ISPAD 2022).
• Buccal glucose paste: resource-limited settings without IV access and child cannot safely swallow — place in recovery position; hospital setting should establish IV access (ISPAD 2022).
• If unable to swallow or deteriorating: escalate immediately to **severe variant** — IM/IN glucagon or IV D10W; do not delay (ERC 2021, ISPAD 2022).
• Neonates: oral feeding (breast/formula) or NG glucose may be used in mild asymptomatic transitional hypoglycemia per nursery protocol — symptomatic neonate requires IV D10W (PES 2015, WHO).
Enter weight on Kids to calculate doses
Clinical notes
• Hypoglycemia thresholds by age: **neonate** (<48 h–2 wk) treat if glucose **<2.6 mmol/L (45 mg/dL)** or symptomatic (PES 2015) · **older infant/child** treat if **<3.3 mmol/L (60 mg/dL)** or symptomatic; diabetes management often uses **<3.9 mmol/L (70 mg/dL)** (ISPAD 2022, ADA) · **symptomatic hypoglycemia always treat** regardless of level.
• Symptom recognition: autonomic (tremor, pallor, sweating, tachycardia, hunger, anxiety) and neuroglycopenic (behavior change, irritability, confusion, seizure, coma) — young children may show only behavioral change or pallor; neonates: jitteriness, poor feeding, hypotonia, apnea, seizures (ISPAD 2022, PES 2015, ERC 2021).
• Immediate algorithm (conscious): check glucose → **0.3 g/kg oral glucose** → recheck q15 min → repeat if still low → snack with protein → investigate cause when stable (ISPAD 2022, ISPED 2024).
• Oral vs IV indications: **oral** if conscious, cooperative, and can swallow without aspiration risk · **IV D10W** if unconscious, seizing, unable to swallow, or no response to oral therapy · **glucagon** if no IV access and glycogen stores adequate (ISPAD 2022, ERC 2021).
• Post-treatment monitoring: recheck glucose **q15–30 min** until consistently >3.9 mmol/L (70 mg/dL) (diabetes) or above age-specific target; investigate cause after stabilization — hyperinsulinism, adrenal insufficiency, GH deficiency, inborn errors, sepsis, toxin ingestion; **admit** if persistent/recurrent hypoglycemia, diagnostic uncertainty, neonate, altered consciousness, or need for continuous dextrose infusion (PES 2015, ISPAD 2022, WHO).
• ISPAD Clinical Practice Consensus Guidelines — Hypoglycemia in children and adolescents with diabetes (2022)
• Pediatric Endocrine Society — Evaluation and management of persistent hypoglycemia in neonates, infants, and children (2015)
