Hypoglycaemia

Hypoglycaemia = BM <4.0 mmol/L. Mild: symptomatic but conscious and cooperative. Severe: unconscious, seizure, or unable to take oral treatment. Key steps: confirm on bedside glucose, treat immediately, find the cause, prevent recurrence…

Hypoglycaemia Management Protocol (JBDS/Trust)

The pathway

1 · Confirm & assess

BM <4.0: confirm with lab glucose if clinical doubt
Assess consciousness (GCS), symptoms (sweating, tremor, confusion, aggression)
Check Hypo Box on ward
Is the patient conscious and able to swallow?

2 · Conscious patient — oral treatment

Fast-acting carbohydrates (15–20g): 5–7 GlucoGel sachets, or Lucozade 100ml, or 4–5 glucose tablets
Recheck BM after 15 minutes
Repeat up to 3 times if still <4
Once >4: follow with long-acting carbohydrate (biscuits/toast)
DO NOT give oral glucose to unconscious patient

3 · Unconscious or unable to swallow

Glucagon 1mg IM (not if alcoholic or chronic liver disease — glycogen stores depleted)
OR IV 10% glucose 150ml over 15 minutes (preferred)
Recheck BM at 15 minutes
Establish IV access early
Repeat glucose infusion if needed

4 · IV glucose protocol

If BM remains <4 after glucagon: 10% glucose 100ml IV over 15 min
Avoid 50% dextrose — causes vein damage and rebound
If no IV access: buccal Hypostop gel under tongue
If still no response → ITU

5 · Post-treatment — find the cause

Review medication: insulin dose/timing, sulphonylureas (glibenclamide, gliclazide — risk of prolonged hypo)
Missed meal? Exercise?
Renal impairment increasing drug levels?
Alcohol?
Adrenal insufficiency?
Insulinoma (recurrent unexplained hypos)

6 · Sulphonylurea precaution

Sulphonylurea-induced hypoglycaemia requires hospital observation for minimum 24 hours due to risk of recurrence
IV glucose infusion may be needed
Seek endocrine advice about withholding the drug
DO NOT discharge same day

Drugs

Drug	Dose	Route	Notes
GlucoGel / Lucozade	15–20g glucose	Oral	First-line in conscious patient. Recheck BM in 15 minutes.
Glucagon	1mg	IM	If unconscious and no IV access. Takes 10–15 min to work. Avoid in liver disease/alcohol excess.
10% Glucose	150ml over 15 min	IV	Preferred IV treatment. Avoid 50% dextrose — concentrated and sclerotic.
Dextrose 10%	100ml/hr maintenance	IV infusion	Continue after correction if still at risk. Recheck BM at 10 minutes, then 30-minutely until stable.

When to escalate

No IV access + unconscious → Glucagon IM then call for help urgently,BM not rising after two IV glucose treatments → ITU,Sulphonylurea-induced hypo → minimum 24h admission,Recurrent unexplained hypoglycaemia → endocrinology (? insulinoma),Hypoglycaemia in patient without diabetes → urgent investigation (cortisol, insulin, C-peptide)

Reference: JBDS Inpatient Care Group — Management of Hypoglycaemia in Adults 2023

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