Treatment and Prevention

Symptoms of non-severe hypoglycaemia can be treated with 15 g fast-acting carbohydrate,4 such as a few small sweets or cup of juice, milk, or sweetened drink. Treatment is also advised in asymptomatic patients with blood glucose in the “alert range” of 3.5 to 3.9 mmol/L (63 to 70 mmol/L). If glucose levels remain low after 15 minutes, treatment should be repeated.1,2

In a conscious person, severe hypoglycaemia can be treated in a similar manner with 20 g fast-acting carbohydrates. If glucose remains low after 45 minutes, IV glucose can be considered if available.3 In an unconscious person, hypoglycaemia is treated with IV glucose or with glucagon.

Strategies to prevent hypoglycaemia include:

  • Patient education:7 informing patients and caregivers about hypoglycaemia risk factors
  • Diet and exercise:8 establishing a predictable eating plan that accounts for exercise; adjusting exercise that has previously led to hypoglycaemia
  • Glucose monitoring, possibly with continuous glucose monitoring (CGM) technology: looking for trends in glucose values and making adjustments (such as changes in medication dosing or regimen) if a pattern of lows is detected4-6

Hypoglycaemia prevention and glucose targets

The following guiding principle can help set glycaemic goals: “Aim for the lowest HbA1c not associated with frequent hypoglycaemia.” Relaxing glucose targets may be an appropriate prevention strategy for patients with advanced diabetes complications or limited life expectancy.8

References

  1. Deary IJ et al. Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factor analysis. Diabetologia 1993;36:771.
  2. Cryer PE. Management of hypoglycemia during treatment of diabetes mellitus. UpToDate review, last updated May 15, 2014.
  3. Canadian Diabetes Association 2013 clinical practice guidelines. Chapter 14: Hypoglycaemia. Can J Diabet 2013;A3.
  4. The hospital management of hypoglycaemia in adults with diabetes mellitus. NHS
[U.K.] guidelines 2010. Accessed at http://www.diabetologists-abcd.org.uk/jbds/JBDS_IP_Hypo_Adults.pdf
  • McIntyre HD et al. Dose Adjustment for Normal Eating: A Role for the Expert Patient? Med J Aust 2010; 192:637.
  • Eng C et al. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet 2014;384:2228.
  • UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007;50:1140.
  • Edelman SV, Blose JS. the impact of nocturnal hypoglycemia on clinical and cost-related issues in patients with type 1 and type 2 diabetes. Diabetes Educ 2014;40:269.