The treatment of hypoglycemia depends on your patient’s mental status, her ability to swallow, and the severity of her signs and symptoms. If possible, check your patient’s blood glucose level to verify that she has hypoglycemia before starting treatment. A sudden drop in the glucose level can trigger the adrenergic response and produce such signs as tremors and diaphoresis without producing hypoglycemia. However, if your patient has signs and symptoms of hypoglycemia but glucose monitoring isn’t readily available, don’t delay treatment. You’re better off treating a normal or high blood glucose level than risking not treating a low level.If your patient has hypoglycemia and can swallow, give her 15 grams of a rapidly absorbed carbohydrate, such as orange juice, to alleviate symptoms and prevent the blood glucose level from falling further. If symptoms persist after 15 minutes, give her another 15 grams of the rapidly absorbed carbohydrate.
As your patient’s symptoms subside and her blood glucose level rises above 70 mg/dl, prevent hypoglycemia from recurring by giving her a snack of complex carbohydrates and protein if she’s not scheduled to eat a meal within the hour. A typical snack is six peanut butter crackers or a slice of bread with 1 ounce of meat or cheese. Instruct the patient not to exercise or engage in other strenuous activity for about 1 hour.
If your patient isn’t allowed to eat or drink, gently rub 15 grams of glucose gel (or an equivalent dose) between her cheek and gum. Recheck her blood glucose level after 15 minutes. Repeat this treatment if signs and symptoms of hyperglycemia persist.
If your patient loses consciousness or her symptoms worsen, t
he physician may prescribe an I.V bolus of 25 to 50 grams of 50% dextrose solution. If she doesn’t have an I.V. line in place, the physician may prescribe a subcutaneous or intramuscular glucagon injection, in a dosage of 0.5 mg for a child or 1 mg for an adult. Check her blood glucose level in 10 to 15 minutes. If she doesn’t respond to the first glucagon injection, she’ll need a second one.
When your patient responds, give her 15 grams of a rapidly absorbed carbohydrate, such as a non diet soft drink, followed by a snack, as described above. Because glucagon therapy commonly causes nausea and vomiting, use caution when giving your patient food. To prevent her from aspirating vomit, turn her on her left side until the nausea subsides.
If your patient’s hypoglycemia results from an excessive dose of an oral antidiabetic drug, she may require hospitalization. The physician may prescribe an initial I.V. bolus of 50% dextrose solution, followed by a continuous infusion of a dextrose solution, such as 10% dextrose in water. Check your patient’s blood glucose level at least every 15 minutes until it returns to normal. Then recheck it every 1 to 2 hours. If the glucose level doesn’t respond to dextrose alone, the physician may prescribe glucagon.
Treating Hypoglycemia with Carbohydrates
Each of the foods listed below supplies 15 grams of carbohydrate, the amount needed to treat hypoglycemia.
- 1/2 cup of fruit juice
- 1/2 cup of nondiet soda
- five hard candies
- 1 cup of skim milk
- three 5-gram glucose tablets
- one application of glucose gel, as marked on container
Overtreatment
Overtreating hypoglycemia with excess carbohydrates is fairly common. When patients treat themselves at home, they sometimes eat until their symptoms subside instead of eating the recommended amount of a rapidly absorbed carbohydrate and waiting 15 minutes for symptoms to resolve. Other patients overtreat themselves out of fear of losing control or going into a coma-especially if they’ve experienced moderate or severe symptoms before.
If you’re treating your patient with I.V. dextrose, wait 5 to 10 minutes to see if symptoms improve. Remember, overtreating hypoglycemia can lead to rebounding hyperglycemia. Giving the patient extra regular insulin to treat rebounding hyperglycemia can then cause her blood glucose level to fall sharply.