Synopsis
Recognise and treat low glucose promptly while finding the cause, preventing recurrence and preserving essential background diabetes therapy safely.
- Think ‘four is the floor’: a capillary reading below 4.0 mmol/L requires action in an adult inpatient even when symptoms are subtle or absent.
- Choose treatment by consciousness and swallow safety, not by the number alone; oral carbohydrate is unsafe in a drowsy, fitting or uncooperative patient.
- For a conscious cooperative adult, JBDS uses 15–20 g rapid-acting carbohydrate followed by a glucose recheck after 10–15 minutes and repeat treatment if still low.
Key red flags
Sweating, tremor, hunger, palpitations, tingling or anxiety may precede cognitive impairment and provide a window for self-treatment when swallowing remains safe.
Investigation priorities
Identify a reversible cause of acute behavioural, neurological or autonomic symptoms at the bedside.
Management branches
Glucose is below 4.0 mmol/L and the adult is alert, cooperative and able to swallow safely.
- Give 15–20 g rapid-acting carbohydrate using a stocked option compatible with swallowing ability and any fluid or renal restriction, following the local JBDS-aligned chart.
- Recheck capillary glucose after 10–15 minutes; if it remains below 4.0 mmol/L, repeat the rapid treatment and reassess, using the escalation route if three cycles fail.
Key medicines
Rapid-acting oral carbohydrateGive 15–20 g of rapid-acting carbohydrate to a conscious cooperative adult, then recheck glucose after 10–15 minutes and repeat if it remains below 4.0 mmol/L, using the current local JBDS-aligned options.
Intravenous glucose for severe hypoglycaemiaJBDS lists 100 mL of 20% glucose over 15 minutes or 200 mL of 10% glucose over 15 minutes for an adult when intravenous treatment is required; prescribe the stocked concentration on the live local chart.