Level 1 of 6Core
Hypoglycaemia: recognition and emergency correction
The core to-do list — diagnose and manage, at a glance
Diagnose— recognise it
- Check a capillary glucose in everyone with altered consciousness, seizure, focal weakness, confusion, apparent intoxication, collapse or hypothermia — and any unwell person with diabetes. Check it even when a stroke or drunkenness looks obvious.
- Treat anything below 4.0 mmol/L (72 mg/dL) — remember, “4 is the floor”.
- Warning (autonomic) signs: sweating, trembling, pounding heart, hunger, anxiety, pallor.
- Brain-starvation (neuroglycopenic) signs: confusion, slurred speech, drowsiness, odd behaviour, focal weakness, seizure, coma.
- Ask which glucose-lowering drug and when — sulphonylureas and long-acting insulins keep working for many hours.Doctor / Nurse
Manage now— do this, in order
- Airway first in the unconscious patient: recovery position, suction, oxygen to keep SpO2 ≥ 94%.
- Alert & swallowing safely: 15–20 g fast oral glucose (5–7 glucose tablets, or 150–200 mL juice / non-diet soft drink). Recheck at 10–15 min; repeat if still < 4.0.
- Drowsy or confused, airway safe: two tubes of 40% glucose gel between teeth and gums — never poured into the throat.
- Unconscious, fitting or nil by mouth: 20% glucose 75 mL IV (= 15 g) over 15 min (or 10% glucose 150 mL). Recheck 10 min after; repeat if < 4.0.Doctor / Nurse
- No IV access: glucagon 1 mg IM (0.5 mg if child < 25 kg). Follow with IV glucose once access is obtained.
- Malnourished or alcohol-dependent: thiamine 100 mg IV/IM with or just after the glucose — never delay the glucose to find it.Doctor / Nurse
- Once > 4.0 and awake: give 20 g long-acting carbohydrate (bread, biscuits, or the next meal) — the step most often forgotten.
- Never force oral glucose or gel into a drowsy or fitting patient — aspiration kills.
IV glucose — pick by what you stock
| Preparation | Dose | Over | |---|---|---| | 20% glucose | 75 mL IV (= 15 g) | 15 min — first line | | 10% glucose | 150 mL IV (= 15 g) | 15 min — small veins | | 50% glucose | 50 mL IV (= 25 g) | slow, large vein, then flush — never in a child |
Refer / escalate
Escalate or transfer if the patient is not fully awake about 10 minutes after a documented glucose > 4.0 mmol/L (there is a second diagnosis), or the agent is a sulphonylurea / long-acting insulin / deliberate overdose, or there is coma, seizure, focal deficit, hypothermia, recurrence, or any affected child.
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