Hypoglycaemia is defined as blood glucose <4.0 mmol/L

If there are symptoms of hypoglycaemia but blood glucose >4.0 mmol/L → treat with carbohydrate snack or normal meal (if due).

1st line: oral fast-acting carbohydrate (e.g. glucose tablet, glucose 40% gel, pure fruit juice)

• Glucose gel is preferred in those who are not capable and not cooperative (e.g. confused, disoriented, aggressive)
• Avoid chocolate and biscuits as they have a lower sugar content, and their high fat content may delay stomach emptying
• Repeat up to 3 times (15 min apart)
• Once blood glucose >4 mmol/L → provide a  long-acting carbohydrateExamples include: - 2 biscuits - 1 slice of bread - 200-300 mL of normal milk - Normal carbohydrate-containing meal (if due)

2nd line (no response to 3 treatment cycles): IM glucagon or IV glucose infusion

1st line: IV glucose infusion (100 mL of 20% dextrose or 200 mL of 10% dextrose over 15 min)

• If no IV access, use glucagon IM
• Re-check glucose level after 10 min, and repeat treatment if necessary
• Once blood glucose >4 mmol/L → provide a  long-acting carbohydrateExamples include: - 2 biscuits - 1 slice of bread - 200-300 mL of normal milk - Normal carbohydrate-containing meal (if due)

Do NOT omit subsequent insulin doses. The insulin regimen should be reviewed.

NICE BNF Treatment summaries. Hypoglycaemia
JBDS 01 The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus