Hypoglycemia — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Can the patient take oral intake?
   Glucose <3.9 mmol/L — can the patient take oral intake? (Treat at glucose <3.9 mmol/L (70 mg/dL); <3.0 mmol/L (54) is severe; <3.0 or altered consciousness/needing assistance = level 3 severe. First assess mental status and swallowing.)
   • Alert, can swallow → Alert → rule of 15
   • Unable to take oral / comatose / seizing → Cannot take oral → IV glucose
2. [End] Alert → rule of 15
   Rule of 15: 15 g of fast-acting carbohydrate orally (glucose tablets/juice/sugary drink), recheck in 15 min; if still <3.9 repeat, and once ≥3.9 and stable have a meal with complex carbohydrate. Find and correct the trigger (insulin/sulfonylurea excess, missed meal, renal impairment, alcohol).
3. [End] Cannot take oral → IV glucose
   IV glucose: 25 g (50% dextrose 50 mL) or 10% dextrose 100–250 mL, recheck and repeat to >3.9; no IV access → glucagon 1 mg IM/SC (less effective with alcohol use, liver disease, or sulfonylurea-induced). Then maintenance dextrose infusion and monitoring. (Note: Sulfonylurea-induced hypoglycemia is prolonged — admit, octreotide if needed; after recovery give a meal with complex carbohydrate to prevent recurrence; find and treat the cause.)

Source guidelines & references

• American Diabetes Association (ADA) Standards of Care · hypoglycemia grading and management

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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