The treatment of low blood sugar, or hypoglycaemia, focuses on quickly restoring glucose levels to normal, preventing future episodes, and addressing any underlying causes. Prompt intervention is crucial to avoid serious complications such as cognitive impairment, seizures, or even death.
Immediate Treatment
The first step in managing low blood sugar is the rapid administration of glucose. The goal is to raise blood sugar levels above the hypoglycaemic threshold (usually 4.0 mmol/L or 72 mg/dL) as quickly and safely as possible.
For mild to moderate hypoglycaemia (where the person is conscious and able to swallow), the standard treatment is the “15-15 Rule”:
- Consume 15 grams of fast-acting carbohydrates. Examples include:
- 3 to 4 glucose tablets
- 125 ml of fruit juice
- 1 tablespoon of honey or sugar
- 5–6 jelly sweets or glucose gels
- Wait 15 minutes, then recheck blood glucose levels.
- If blood sugar is still low, repeat the process.
Once glucose levels have stabilized, it’s important to eat longer-acting carbohydrates (such as a sandwich or whole-grain crackers) to maintain stable glucose levels and prevent a rebound hypoglycaemic episode.
Severe Hypoglycaemia
For severe hypoglycaemia — when the person is unconscious, having seizures, or unable to eat — emergency treatment is needed. The main options include:
- Glucagon injection: Glucagon is a hormone that prompts the liver to release stored glucose. It is available in injection kits or nasal spray form. Family members, caregivers, and co-workers of individuals at risk should be trained to use it.
- Intravenous dextrose: In hospital settings, a 25–50 mL of 50% dextrose solution (D50) is administered intravenously to rapidly elevate glucose levels. For children, a more diluted solution (e.g., D10) is used to minimize risks like vein damage.
Addressing Underlying Causes
The treatment approach may vary depending on the cause of hypoglycaemia. In people with diabetes, common triggers include:
- Excessive insulin or oral hypoglycaemic agents (e.g., sulphonylureas)
- Skipping or delaying meals
- Increased physical activity without adjusting insulin or food intake
- Alcohol consumption on an empty stomach
To prevent future episodes, adjustments to diabetes management may be necessary. These can include:
- Lowering insulin doses or changing insulin types
- Adjusting the timing of insulin injections
- Modifying oral medication regimens
- Ensuring regular carbohydrate intake throughout the day
- Using Continuous Glucose Monitoring (CGM) to detect drops early and adjust treatment accordingly
For those with hypoglycaemia unawareness (where the early warning signs are diminished or absent), CGM with alert functions and structured education programs, like the DAFNE course (Diabetes and Food Education in the UK), can be helpful in reducing the frequency and severity of episodes.
Treatment for Non-Diabetic Hypoglycaemia
In individuals without diabetes, hypoglycaemia treatment begins with identifying the underlying cause:
- Reactive hypoglycaemia (occurs a few hours after eating) may benefit from dietary changes, including:
- Eating smaller, more frequent meals
- Avoiding high-sugar foods
- Including protein and fiber with each meal to slow digestion
- Fasting hypoglycaemia (due to conditions like insulinoma or adrenal insufficiency) may require:
- Surgical removal of insulin-producing tumors
- Corticosteroid replacement therapy in cases of adrenal failure
- Medication-induced hypoglycaemia (e.g., due to sulphonylureas, quinine, or beta-blockers) involves:
- Discontinuing the offending medication
- Monitoring glucose levels during recovery
- Administering intravenous glucose and providing supportive care when necessary
Neonatal Hypoglycaemia
Neonatal hypoglycaemia, especially in premature infants or those born to diabetic mothers, requires careful management:
- Frequent feeding with breast milk or formula
- If oral feeding is insufficient, intravenous glucose infusions may be required.
- Continuous monitoring for the first 48 hours, as many cases occur during this period.
For persistent hypoglycaemia due to congenital hyperinsulinism, treatments may include diazoxide or octreotide. Surgical options may also be considered if medical management is unsuccessful.
Lifestyle Modifications
Long-term management of low blood sugar includes several lifestyle changes, such as:
- Avoiding alcohol on an empty stomach
- Ensuring consistent meal timing and not skipping meals
- Maintaining regular carbohydrate intake
- Adjusting exercise intensity and timing with proper nutrition
- Monitoring stress, illness, or hormonal changes that can affect glucose levels
People at risk of hypoglycaemia should always carry a source of fast-acting sugar, such as glucose tablets or sweets, and consider wearing a medical alert bracelet for emergency situations.
Advanced Treatment Options
Technological advancements have significantly improved hypoglycaemia management, particularly in diabetic patients. For example, hybrid closed-loop insulin pumps (artificial pancreas systems) use CGM data to automatically adjust insulin delivery in real-time, helping to prevent both high and low blood sugar.
In rare cases, autoimmune-related hypoglycaemia (e.g., insulin autoimmune syndrome) may require immunosuppressive treatments or other specialized interventions. These conditions are diagnosed through antibody testing and managed by endocrinologists specializing in rare metabolic disorders.
Conclusion
The treatment of low blood sugar must be immediate, targeted, and proactive. It includes not just acute management, but also long-term strategies to prevent future episodes and improve quality of life. Whether the cause is related to diabetes, medications, or hormonal imbalances, education, monitoring, and medical supervision are crucial for successful management. With the right treatment plan, most people with hypoglycaemia can avoid severe complications and maintain a healthy lifestyle.
