This protocol covers the acute management of moderate to severe hypoglycemia — confirmed blood glucose below 4.0 mmol/L — in adults who are unconscious, experiencing seizures, or presenting with severe aggression. Immediate medical assistance is the first step.
The patient is unconscious and/or having seizures and/or is very aggressive, with blood glucose below 4.0 mmol/L. The inability to cooperate or self-administer treatment defines this sub-population and determines the route of intervention.
Immediate medical assistance must be requested. The specific agent used to restore blood glucose — and how it is delivered — depends on what access is available at the bedside. The protocol specifies two distinct pathways based on this. Once blood glucose is corrected and the patient has recovered, a carbohydrate snack is given as a follow-up step. Full dosing, agent selection, and sequencing are in the complete protocol.
Capillary blood glucose above 4.0 mmol/L on remeasurement 10 minutes after treatment.
C. Adults who are unconscious and/or having seizures and/or are very aggressive
If IV access is available give 100ml of 20% glucose at 400ml/hour or 200ml of 10% glucose at 800ml/hour over 15 minutes.
The smallest possible volume should be administered in renal and/or cardiac failure.
If no IV access is available then give 1mg Glucagon IM.
Once blood glucose is above 4.0mmol/L and the person has recovered, give a long-acting carbohydrate snack (20g) of their choice where possible, taking into consideration any specific dietary requirements.
Repeat capillary blood glucose measurement 10 minutes later. If it is still less than 4.0mmol/L, repeat step 5 (or 6 if IV access remains unavailable).
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