Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Guidelines for Nurses on How to Manage Hypoglycemia

Mild and Moderate Lows (<4.0 mmol/L)

  • Individual is able to self-test and treat low blood glucose
  • Test blood glucose level
  • Treat with 15g of fast acting carbohydrate such as:
    • 5 dextrose tables (3 g each)*, or
    • 3 glucose tablets (5 g each)*, or
    • 3/4 cup (175 ml) regluar pop, or
    • 3/4 cup juice, or
    • 3 teaspoons sugar or honey, or
    • 6 lifesavers
  • Pre-planning for hypoglycemia should occur if individual is NPO or unable to swallow; an order for IV Dextrose or IM Glucagon should be obtained (An order should be obtained in advance for all clients treated with insulin)
  • Repeat blood glucose test again in 15 minutes.  Treat again with another 15 g fast-acting carbohydrate if blood glucose remains less than 4.0 mmol/L.  Retest in 15 minutes.  Continue to retreat and retest until blood glucose is above 4.0 mmol/L
  • If the next meal is more than 60 minutes away, have a snack of 15 g of starch and include protein source.  For example: 1/2 cheese sandwich
  • Explore possible causes of hypoglycemia

*Treatment required for hypoglycemia if on Glucobay

Severe Lows (<2.8 mmol/L or unable to swallow)

  • Individual is not able to treat self and requires assistance with treatment of hypoglycemia
  • Test blood glucose level
  • If conscious and able to swallow treat with 20 g fast-acting carbohydrate:
    • 7 dextrose tablets (3 g each)*, or
    • 4 glucose tablets (5 g each)*, or
    • 1 cup (250 ml) of regular pop, or
    • 1 cup juice, or
    • 4 teaspoons of sugar or honey, or
    • 8 lifesavers
  • If unconscious, NPO or unable to swallow give 1 mg Glucagon injection IM (if ordered) or IV dextrose 20 to 50 ml D50W (if ordered) and/or call 911 prn
  • Inform your diabetes team of the event
  • Repeat blood glucose test again in 15 minutes.  If blood glucose is less than 4.0 mmol/L, continue to retreat with 15 g fast-acting carbohydrate and retest every 15 minutes until blood glucose is above 4.0 mmol/L
  • If glucagon has been used, follow with carbohydrate as soon as the individual is able to swallow
  • If the next meal is more than 60 minutes away, provide a snack of 15 g of starch and a protein source, For example: 1/2 cheese sandwich.
  • Explore possible causes of hypoglycemia.

* Treatment required for hypoglycemia if on Glucobay