A. Mild to Moderate hypoglycemia: (60-70 mg/dL)
Adult or Pediatric Patient Adult Treatment
Administer D50% IV:
IV Access available
Unable to eat/swallow, NPO,
or unconscious

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.
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
Give 15 gms of carbohydrate (choose
one of ‘fast fifteen’ below). Not
necessary to add additional sugar:
-4 oz (120 ml) juice
-4 oz (120 ml) regular soda
-8 oz (240 ml) nonfat milk
-15 gm glucose gel-squeeze entire
package of gel inside cheek.
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.

No IV Access available
Unable to eat/swallow, NPO,
Or unconscious

•


Able to take orally or NG
tube
Feeding tube in place
without IV access






Pediatric treatment
Same as severe





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
Give 15 gms of carbohydrate:
-4 oz (120 ml) juice
- 3-4 glucose tablets
Call physician for orders.
For all patients listed above with mild or moderate hypoglycemia:
 Recheck glucose within 15 minutes of initial treatment.


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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.
B. Severe hypoglycemia: (blood glucose < 60 mg/dL)
Adult/Pediatric Patient
Adult Treatment
IV Access available
Unable to eat/swallow, NPO,
or unconscious
Pediatric treatment

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.

No IV Access available
Unable to eat/swallow, NPO,
Or unconscious
> 55lbs (25 kg):

1 mg glucagon IM or SC

Obtain IV access
•
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
•
•
Once patient is conscious
and able to swallow
•
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 1 cup low fat milk
OR
>12 years: follow adult
treatment
<55lbs (25kg):

0.02-0.03 mg/kg/dose
glucagon IM or SC
OR

0.5 mg glucagon IM or SC

Give 30 gm carbohydrate:
-1 cup juice
OR
- 4 glucose tablets + ½ cup
juice
•
1 cup low fat milk

½ cup juice and 3 graham
crackers (or 6 saltines) and 1 oz
cheese or peanut butter
OR
•
½ cup juice and 6 saltines crackers
•
Give ½ cup juice and 4 graham cracker
squares
OR
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.