Managing diabetes can require patients to check their glucose (blood sugar) frequently with a glucose meter. Patients should ask their physician how often they need to test. A physician can also recommend a target blood glucose range. Glucose monitoring can tell people when their glucose is low and when they need to treat it.

It is important to note that the treatment of hypoglycemia associated with diabetes is complex, and all recommendations for treatment must be made by the physician providing diabetic care. Examples of various protocols for treating hypoglycemia in diabetic patients are given below. 

Glucose should be tested according to the physician-recommended schedule and whenever a patient suspects levels may be low. When hypoglycemia is confirmed, the patient should treat it immediately. If patients suspect low glucose but are unable to test, they should take steps to raise their glucose levels rather than wait until they can test later for confirmation.

It is highly recommended, for example, for people with diabetes who suspect hypoglycemia to check their glucose level before engaging in an activity that requires a high level of concentration. People should not drive if they suspect their glucose is low. The effects of low glucose on the autonomic nervous system and brain can increase a person’s risk of motor vehicle accidents. Patients with hypoglycemia unawareness (a condition in which the normal symptoms associated with low glucose are not felt or noticed) are instructed to always check their glucose before getting behind the wheel.

Likewise, it is advised that people immediately pull over into a safe location and test their glucose level when they begin to suspect low blood glucose. If their glucose reading is low, treatment to raise the blood sugar using the methods recommended by their physician is instituted, with a retest of their glucose level 15 minutes later. Individuals should not drive until their glucose levels are safe. A physician can recommend the glucose level that is safe for driving and how often a person should stop for glucose tests during long car trips.

Steps to raise glucose levels include:

• Consuming some form of carbohydrate-rich food. People with diabetes are advised to carry something containing sugar with them at all times. Hypoglycemia can be treated with 10 to 15 grams of carbohydrates. The American Diabetes Association (ADA) recommends an adult consume one of the following foods that contain the correct amount of carbohydrates:
  
  
• 3 glucose tablets
• ½ cup (118 milliliters [ml]) of fruit juice
• 5 to 6 pieces of hard candy
• Half a can of nondiet soda
• 10 gumdrops
• 2 teaspoons or large lumps of sugar
• 2 tablespoons of raisins
• 6 jellybeans
• 1 tablespoon of honey or corn syrup
• A 0.68-ounce (19-gram) tube of cake-decorating gel
• 1 cup (237 ml) of skim milk
• One dose of glucose gel  
  
  
Candy bars, ice cream, baked goods and other sugary foods with high fat content are generally not recommended unless they are the only option available. The fat in these foods slows the absorption of the sugar.

One protocol for treating hypoglycemia states that once the hypoglycemia has been treated, the patient should wait 15 to 20 minutes and test again. If the glucose level is still low or the symptoms have not gone away, the person with diabetes should repeat the treatment and test again in 15 to 20 minutes. It is important to wait 15 to 20 minutes before repeating treatment in order to avoid overtreatment. Symptoms can linger even after levels have returned to normal range. Automatically eating more can cause too much glucose, resulting in hyperglycemia later in the day.

Experts also recommend that patients whose blood glucose begins to return to their normal range, but whose next meal is more than 30 minutes away, eat a snack. It is generally advised that the snack contain carbohydrates and protein, such as crackers with cheese or peanut butter.

• Glucagon injection. It is important to treat low glucose quickly, because without treatment a person can faint. When a person cannot swallow or is unconscious, an immediate injection of glucagon is often the recommendation. Normally produced by the pancreas, glucagon is a hormone that raises glucose. An injectable form is available by prescription.
  
  People with diabetes are advised to establish a sick-day plan with their physician including emergency plans to use glucagon should they ever need it. Such preparation includes training of people who may need to administer the medication, such as family, friends, teachers and coworkers. If glucagon is not available, emergency services will need to be alerted. Treatment of severe hypoglycemia in a hospital typically includes intravenous administration of glucose.

Experts advise that people with diabetes who have lost consciousness because of low glucose should:

• Have emergency help called
• Be injected with glucagon
• Not be injected with insulin
• Not be given food or fluids by mouth
• Not have hands placed in their mouth

People with diabetes who take insulin are also advised to wear a medical identification bracelet or necklace at all times. Patients can also carry a medical identification card in their wallet to alert family, friends, teachers, coworkers and emergency personnel.

A physician may prescribe certain other medications to treat hypoglycemia. For example, diazoxide (Proglycem) can treat hypoglycemia that is due to overproduction of insulin. Diazoxide can interact with many other medications including antihypertensives, heart medications and antidepressants. Medical conditions that may affect its use include vascular, liver and kidney diseases.

Hypoglycemia may lead a physician to adjust an individual’s diabetes care plan, which could include exercise, diet or insulin schedule. For instance, patients may be advised to exercise in the morning rather than the evening and to perform glucose monitoring before, during and after exercise. Some antidiabetic agents, such as biguanides (metformin), are less likely to cause hypoglycemia than others such as sulfonylureas and meglitinides.

A registered dietitian may suggest approaches such as eating several small meals throughout the day and favoring fiber-rich complex carbohydrates over sugars and starches that may induce glucose to spike and fall.

Some treatments can help prevent hypoglycemia over the long term. Insulin pumps often improve glucose control for patients who require insulin therapy. The U.S. Food and Drug Administration in 2006 approved a device that combines an insulin pump with a continuous glucose monitor.

Some insulin-dependent patients may be candidates for a pancreas transplant or islet cell transplant. In its second annual report, the Collaborative Islet Transplant Registry indicated in 2005 that dangerous bouts of low glucose were rare in islet cell recipients. Interested individuals are advised to ask their physician if such treatments could be an option for them.

Assistance animals may be an option for some patients with hypoglycemia unawareness or hard-to-resolve hypoglycemia. Several organizations train dogs to sense irregular levels of glucose and alert their owner or other people. However, demand for these dogs is reported to far outstrip the supply.

Researchers are developing a noninvasive device to predict the onset of hypoglycemia. It consists of a chest-belt transmitter unit and a hand-held receiver.

In addition, researchers are working on drug treatments. Experimental medications block an enzyme called PARP-1 that may be involved in brain damage caused by hypoglycemia. Theoretically, however, such drugs might impede repair of DNA. 

Recent research on rats suggests that pyruvate, a byproduct of glucose metabolism, may prevent hypoglycemic brain damage. According to the scientists involved, pyruvate holds promise in treating humans, apparently without the potential disadvantage of the PARP-1 inhibitors. They hope to conduct clinical trials after further research on animals.