- Mild to Moderate hypoglycemia: (60-70 mg/dL)
Adult or Pediatric Patient / Adult Treatment / Pediatric treatment
IV Access available
Unable to eat/swallow, NPO,
or unconscious / Administer D50% IV:
- 12.5 gm (25 ml) for BG 61-69 mg/dL
- Assess for adequate airway, breathing, and circulation
- Place in lateral recumbent position, if possible to decrease aspiration risk.
- Place in seizure precautions.
No IV Access available
Unable to eat/swallow, NPO,
Or unconscious / •Administer 1 mg glucagon , intramuscularly or SC
- Assess for adequate airway, breathing and circulation
- Place in lateral recumbent position, if possible.
- Place in seizure precautions
- Establish IV access
- Administer 0.5 mg glucagon, intramuscularly or SC
- Assess for adequate airway, breathing and circulation
- Place in lateral recumbent position, if possible
- Establish IV access
Able to take orally or NG tube /
- Give 15 gms of carbohydrate (choose one of ‘fast fifteen’ below). Not necessary to add additional sugar:
-4 oz (120 ml) regular soda
-8 oz (240 ml) nonfat milk
-15 gm glucose gel-squeeze entire package of gel inside cheek. /
- Give 15 gms of carbohydrate:
- 3-4 glucose tablets
Feeding tube in place without IV access /
- Administer 50 ml D50%, push slowly through feeding tube.
- Squirt the solution into a container and draw up with the feeding tube syringe to inject into the feeding tube (adult).
- Establish IV access.
For all patients listed above with mild or moderate hypoglycemia:
- Recheck glucose within 15 minutes of initial treatment.
- If BG is still 70 mg/dL, repeat initial treatment above that applies
- If BG is 70 mg/dL and patient asymptomatic, notify physician and follow with one of these snacks:
-8 oz of nonfat milk or
-4 oz juice and 6 saltine crackers or 4 graham cracker square
- Check patient’s blood pressure, pulse, respirations, and neurological status
- Check patient every 30 minutes for signs and symptoms of repeated hypoglycemia until a meal /snack has been eaten.
- Notify physician of treatment initiation and obtain further orders.
- Severe hypoglycemia: (blood glucose < 60 mg/dL)
Adult/Pediatric Patient / Adult Treatment / Pediatric treatment
IV Access available
Unable to eat/swallow, NPO,
or unconscious / Administer D50% IV:
- 25 gm (50ml) slowly over 5-10 min
- IV push slowly over 5-10 minutes.
- < 1 month—Call pediatrician for specific orders.
- 1 month to 12 years: Give 10% Dextrose at 5 ml/kg/dose.
- >12 years: follow adult treatment
No IV Access available
Unable to eat/swallow, NPO,
Or unconscious / 55lbs (25 kg):
- 1 mg glucagon IM or SC
- Obtain IV access
- 0.02-0.03 mg/kg/dose glucagon IM or SC
- 0.5 mg glucagon IM or SC
Alert and taking orally / •Give 30 gm simple sugar: i.e. 1 cup juice (apple juice for renal patients).
• Do not add extra sugar to juice.
OR
•Give two tubes of 15 gm glucose gel. Squeeze entire tube of gel inside cheek.
•For patients on Precose(acarbose) or Glyset(miglitol) use only glucose gel. /
- Give 30 gm carbohydrate:
OR
-4 glucose tablets + ½ cup juice
Once patient is conscious and able to swallow / •Give 1 cup low fat milk
OR
•½ cup juice and 6 saltines crackers
OR
•Give ½ cup juice and 4 graham cracker squares / •1 cup low fat milk
OR
- ½ cup juice and 3 graham crackers (or 6 saltines) and 1 oz cheese or peanut butter
For all patients with for severe hypoglycemia:
• Recheck blood glucose 15 minutes after initial treatment. If blood sugar is still < 60 mg/dL repeat initial treatment.
- If BG is 70 mg/dL and patient asymptomatic, notify physician and follow with one of these snacks:
-8 oz of nonfat milk or
-4 oz juice and 6 saltine crackers or 4 graham cracker square
- Check patient’s blood pressure, pulse, respirations, and neurological status
- Check patient every 30 minutes for signs and symptoms of repeated hypoglycemia until a meal /snack has been eaten.
- Notify physician of treatment initiation and obtain further orders.
- Glucagon may cause nausea/vomiting. Turn patient on their side after giving the injection to prevent aspiration from possible emesis.