The patient is conscious, orientated and able to swallow, with a capillary blood glucose below 4.0 mmol/L. Oral treatment has already been attempted but has not resolved the hypoglycaemia.
The first-line approach — oral rapid-acting carbohydrate (glucose tablets, glucose liquid, fruit juice, or sugar dissolved in water) — did not achieve the target of a capillary blood glucose above 4.0 mmol/L when remeasured at 10–15 minutes. This failure triggers escalation to a more assertive intervention.
Medical assistance should be called immediately. Treatment moves away from the oral route and involves either an injectable agent or an intravenous glucose preparation. The choice between options, and any adjustment for underlying conditions, is determined by the full protocol. A long-acting carbohydrate snack is given once the patient has recovered.
Capillary blood glucose above 4.0 mmol/L when remeasured 10 minutes after treatment.
A. Adults who are conscious, orientated and able to swallow
In people who are conscious and able to swallow, 15-20g of rapid-acting carbohydrate is the treatment of choice (see algorithm A).
1mg of glucagon IM (only licensed for insulin induced hypoglycaemia, may be less effective when administered repeatedly, in people prescribed sulfonylurea therapy or people with a history of alcohol abuse or chronic liver disease)
100ml of 20% glucose (at 400ml/hour over 15 minutes) or 200ml of 10% glucose (at 800ml/hour over 15 minutes).
Consider smallest possible volume in renal and/or cardiac failure
People given glucagon require a larger portion of long-acting carbohydrate (40g) to replenish glycogen stores (double the suggested amounts below) although nausea associated with glucagon injections may be an issue.
Repeat capillary blood glucose measurement 10 minutes later. If it is still less than 4.0mmol/L, repeat step 5.