Hypoglycemia (Low Blood Sugar)
Treatment of symptomatic low blood glucose
⚠️ Key Point: Blood glucose testing is a vital sign in patients with altered level of consciousness!
Recognizing Hypoglycemia
Common Signs & Symptoms
- Confusion
- Sweating
- Anxiety
- Rapid heart rate
- Dizziness
- Abdominal pain
- Nausea/vomiting
- Seizures
NOTE: Many major medical problems may present with these symptoms. Low blood sugar is one potential explanation. Always refer to higher care.
Blood Glucose Levels
| Level | Definition | Action |
|---|---|---|
| <4.0 mmol/L | Hypoglycemia | Treat with glucose |
| <3.0 or "LO" | Severe hypoglycemia | Urgent treatment needed |
| 4.0-7.0 mmol/L | Normal | Monitor |
Treatment - Alert Patient (Able to Swallow)
For mild symptoms + history of diabetes:
- Give food and fluids OR
- One tube of Glucogel (or equivalent)
Activate advanced care if no improvement
Treatment - Altered LOC Patient
SFA, FR, EMR, and up
- Call for help
- Support ABCs
PCP, RPN, LPN, RN, and up (Blood Sugar <4.0)
- Activate EHS or higher level of care
- If BG <4.0 with moderate-severe symptoms:
- Start IV and give 100 cc of D10W
- May repeat x 1
- If no IV access: Give Glucagon 1 mg SC or IM (if available)
ACP, RN (EM/CC) (Blood Sugar "LO" or <3.0)
- Activate EHS or higher level of care
- Severe hypoglycemia:
- Start IV and push half to one amp of D50W
- May repeat x 1
- Wait up to 5 minutes, then recheck blood sugar
Quick Dosing Reference
| Medication | Dose | Route |
|---|---|---|
| Glucogel | 1 tube | Oral (if alert) |
| D10W | 100 cc | IV (PCP+) |
| D50W | ½ - 1 amp | IV push (ACP/RN) |
| Glucagon | 1 mg | SC or IM |
Monitoring & Disposition
- Repeat blood sugars every 5-10 minutes until within normal limits
- If not rising after 2 doses of sugar, activate 911
- Observation period: 3-4 hours of serial glucose checking usually required
- Patient must have clear, treatable cause identified before release
- See refusal of transport policy if patient declines further care
Implanted Glucose Monitors
If patient has implanted diabetic monitoring, check readings with a glucometer to ensure accuracy before treating.
Explore Causes (if known diabetic)
- Insulin use without eating
- Increased exercise
- Medication timing/dose changes
- Illness
⚠️ Safety: Dispose of sharps in sharps container. Ensure patient does not ambulate without support.
Source: Odyssey Medical Consulting
Version: 2023-06-21