Editing Hypoglycemia (section)

==Treatment==
After hypoglycemia in a person is identified, rapid treatment is necessary and can be life-saving.<ref name="NIH2008" /> The main goal of treatment is to raise blood glucose back to normal levels, which is done through various ways of administering glucose, depending on the severity of the hypoglycemia, what is on-hand to treat, and who is administering the treatment.<ref name="NIH2008" /><ref name="Jameson_2018" /> A general rule used by the [[American Diabetes Association]] is the "15-15 Rule," which suggests consuming or administering 15 grams of a [[carbohydrate]], followed by a 15-minute wait and re-measurement of blood glucose level to assess if blood glucose has returned to normal levels.<ref name=":2" />

=== Self-treatment ===
If an individual recognizes the symptoms of hypoglycemia coming on, blood sugar should promptly be measured, and a sugary food or drink should be consumed.<ref name="NIH2008" /> The person must be [[Consciousness|conscious]] and able to swallow.<ref name="NIH2008" /><ref name="Jameson_2018" /> The goal is to consume 10–20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70&nbsp;mg/dL (3.9&nbsp;mmol/L).<ref name="Jameson_2018" /><ref name="Cry2009" />

Examples of products to consume are:
* Glucose tabs or gel (refer to instructions on packet)<ref name="NIH2008" /><ref name="Cry2009" />
* Juice containing sugar like apple, grape, or cranberry juice, {{cups|1/2|US}}<ref name="NIH2008" /><ref name="Cry2009" />
* Soda or a soft-drink, {{cups|1/2|US}} (not diet soda)<ref name="Cry2009" />
* Candy<ref name="Cry2009" />
* Table sugar or honey, {{tbspUS|1}}<ref name="NIH2008" />

Improvement in blood sugar levels and symptoms are expected to occur in 15–20 minutes, at which point blood sugar should be measured again.<ref name="Jameson_2018" /><ref name="Cry2009" /> If the repeat blood sugar level is not above 70&nbsp;mg/dL (3.9&nbsp;mmol/L), consume another 10–20 grams of a carbohydrate and remeasure blood sugar levels after 15–20 minutes.<ref name="Jameson_2018" /><ref name="Cry2009" /> Repeat until blood glucose levels have returned to normal levels.<ref name="Jameson_2018" /><ref name="Cry2009" /> The greatest improvements in blood glucose will be seen if the carbohydrate is chewed or drunk, and then swallowed.<ref name=":5">{{Cite journal |vauthors=De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djärv T |date=April 2019 |title=First aid glucose administration routes for symptomatic hypoglycaemia |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=4 |pages=CD013283 |doi=10.1002/14651858.cd013283.pub2 |pmc=6459163 |pmid=30973639}}</ref> This results in the greatest ''[[bioavailability]]'' of glucose, meaning the greatest amount of glucose enters the body producing the best possible improvements in blood glucose levels.<ref name=":5" /> A 2019 systematic review suggests, based on very limited evidence, that [[oral administration]] of glucose leads to a bigger improvement in blood glucose levels when compared to [[buccal administration]].<ref name=":13">{{Cite journal |vauthors=De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djärv T |date=April 2019 |title=First aid glucose administration routes for symptomatic hypoglycaemia |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=4 |pages=CD013283 |doi=10.1002/14651858.CD013283.pub2 |pmc=6459163 |pmid=30973639 |collaboration=Cochrane Metabolic and Endocrine Disorders Group}}</ref> This same review reported that, based on limited evidence, no difference was found in plasma glucose when administering combined oral and buccal glucose (via dextrose gel) compared to only oral administration.<ref name=":13" /> The second best way to consume a carbohydrate it to allow it to dissolve under the tongue, also referred to as ''[[sublingual administration]].''<ref name=":5" /> For example, a hard candy can be dissolved under the tongue, however the best improvements in blood glucose will occur if the hard candy is chewed and crushed, then swallowed.<ref name=":5" />

After correcting blood glucose levels, people may consume a full meal within one hour to replenish glycogen stores.<ref name="Cry2009" />

==== Education ====
Family, friends, and co-workers of a person with diabetes may provide life-saving treatment in the case of a hypoglycemic episode.<ref name="NIH2008" /> It is important for these people to receive training on how to recognize hypoglycemia, what foods to help the hypoglycemic eat, how to administer injectable or intra-nasal [[glucagon]], and how to use a [[glucose meter]].<ref name="NIH2008" />

[[File:GlucaGen.jpg|thumb|A glucagon kit used to treat severe hypoglycemia|421x421px]]

=== Treatment by family, friends, or co-workers ===
Family, friends, and co-workers of those with hypoglycemia are often first to identify hypoglycemic episodes, and may offer help.<ref name="Jameson_2018" /> Upon recognizing the signs and symptoms of hypoglycemia in a diabetic, a blood sugar level should first be measured using a [[glucose meter]].<ref name="NIH2008" /> If blood glucose is below 70&nbsp;mg/dL (3.9&nbsp;mmol/L), treatment will depend on whether the person is conscious and can swallow safely.<ref name="Jameson_2018" /><ref name="Cry2009" /> If the person is conscious and able to swallow, the family, friend, or co-worker can help the hypoglycemic consume 10–20 grams of a [[carbohydrate]] to raise blood glucose levels to a minimum of 70&nbsp;mg/dL (3.9&nbsp;mmol/L).<ref name="Cry2009" /> Improvement in blood sugar level and symptoms is expected to occur in 15–20 minutes, at which point blood sugar is measured again.<ref name="Jameson_2018" /><ref name="Cry2009" /> If the repeat blood sugar level is not above 70&nbsp;mg/dL (3.9&nbsp;mmol/L), the hypoglycemic should consume another 10–20 grams of a carbohydrate and with remeasurement of blood sugar levels after 15–20 minutes.<ref name="Jameson_2018" /><ref name="Cry2009" /> Repeat until blood glucose levels have returned to normal levels, or call emergency services for further assistance.<ref name="Cry2009" />

If the person is unconscious, a [[Glucagon (medication)|glucagon]] kit may be used to treat severe hypoglycemia, which delivers glucagon either by injection into a muscle or through nasal inhalation.<ref name="Cry2009" /><ref name="Jameson_2018" /><ref name=":10" /> In the United States, glucacon kits are available by prescription for diabetic patients to carry in case of an episode of severe hypoglycemia.<ref>{{Cite web |title=Severe Low Blood Sugar (Hypoglycemia) Treatment {{!}} Lilly GLUCAGON |url=https://www.lillyglucagon.com/ |url-status=live |archive-url=https://web.archive.org/web/20220124005627/https://www.lillyglucagon.com/ |archive-date=24 January 2022 |access-date=24 January 2022 |website=www.lillyglucagon.com}}</ref><ref>{{Cite web |title=Glucacon Emergency Kit |url=https://glucagonemergencykit.com/ |url-status=live |archive-url=https://web.archive.org/web/20220124033904/https://glucagonemergencykit.com/ |archive-date=24 January 2022 |access-date=24 January 2022 |website=Glucagon Emergency Kit |language=en-US}}</ref> Emergency services should be called for further assistance.<ref name="Cry2009" />

=== Treatment by medical professionals ===
In a healthcare setting, treatment depends on the severity of symptoms and [[Intravenous therapy|intravenous]] access.<ref name=":6">{{Cite journal |vauthors=Pasala S, Dendy JA, Chockalingam V, Meadows RY |date=2013 |title=An inpatient hypoglycemia committee: development, successful implementation, and impact on patient safety |journal=The Ochsner Journal |volume=13 |issue=3 |pages=407–412 |pmc=3776519 |pmid=24052773}}</ref> If a patient is conscious and able to swallow safely, food or drink may be administered, as well as glucose tabs or gel.<ref name=":6" /> In those with [[Intravenous therapy|intravenous]] access, 25 grams of 50% dextrose is commonly administered.<ref name=":6" /> When there is no intravenous access, [[Intramuscular injection|intramuscular]] or [[Nasal administration|intra-nasal]] glucagon may be administered.<ref name=":6" />

=== Other treatments ===
While the treatment of hypoglycemia is typically managed with carbohydrate consumption, glucagon injection, or [[dextrose]] administration, there are some other treatments available.<ref name="Jameson_2018" /> Medications like [[diazoxide]] and [[octreotide]] decrease insulin levels, increasing blood glucose levels.<ref name="Jameson_2018" /> [[Dasiglucagon]] was approved for medical use in the United States in March 2021, to treat severe hypoglycemia.<ref name="Zegalogue FDA label">{{Cite web |title=HIGHLIGHTS OF PRESCRIBING INFORMATION. These highlights do not include all the information needed to use ZEGALOGUE® safely and effectively. See full prescribing information for ZEGALOGUE. ZEGALOGUE (dasiglucagon) injection, for subcutaneous use. |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/214231s000lbl.pdf |url-status=live |archive-url=https://web.archive.org/web/20210515201935/https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/214231s000lbl.pdf |archive-date=15 May 2021 |access-date=10 November 2021 |website=Accessdate.fsa.gov}}</ref> Dasiglucagon (brand name Zegalogue) is unique because it is glucagon in a prefilled syringe or auto-injector pen, as opposed to traditional glucagon kits that require mixing powdered glucagon with a liquid.<ref name="Zegalogue FDA label" />

Due to its original formulation containing large amounts of glucose, the soft drink [[Lucozade]] was recommended by diabetes charities in the [[United Kingdom]] as an immediate treatment for hypoglycemia; however, as the drink was reformulated to replace much of its glucose content with [[artificial sweeteners]], this is no longer recommended.<ref>{{Cite web |title=Diabetic patients should be warned about changes to Lucozade glucose content |url=https://www.nursinginpractice.com/article/diabetic-patients-should-be-warned-about-changes-lucozade-glucose-content |url-status=dead |archive-url=https://web.archive.org/web/20190228070127/https://www.nursinginpractice.com/article/diabetic-patients-should-be-warned-about-changes-lucozade-glucose-content |archive-date=28 February 2019 |access-date=27 February 2019 |website=[[Nursing in Practice]] |vauthors=Harrold A}}</ref>