Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

Dale Clayton MHSc, MD, FRCPC Vincent Woo MD, FRCPC Jean-François Yale MD, CSPQ, FRCPC

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Key Messages

  • It is important to prevent, recognize and treat hypoglycemic episodes secondary to the use of insulin or insulin secretagogues.
  • The goals of treatment for hypoglycemia are to detect and treat a low blood glucose (BG) level promptly by using an intervention that provides the fastest rise in BG to a safe level, to eliminate the risk of injury and to relieve symptoms quickly.
  • It is important to avoid overtreatment, since this can result in rebound hyperglycemia and weight gain.

Highlights of Revisions

  • The chapter includes a new section on driving and hypoglycemia, and awareness of provincial driving regulations has been added to the recommendations.


  1. 1.Mild to moderate hypoglycemia should be treated by the oral ingestion of 15 g carbohydrate, preferably as glucose or sucrose tablets or solution. These are preferable to orange juice and glucose gels [Grade B, Level 2 (1) ]. Patients should retest BG in 15 minutes and re-treat with another 15 g carbohydrate if the BG level remains <4.0 mmol/L [Grade D, Consensus]. Note: This does not apply to children. See Type 1 Diabetes in Children and Adolescents, p. S153, and Type 2 Diabetes in Children and Adolescents, p. S163, for treatment options in children.
  2. 2.Severe hypoglycemia in a conscious person should be treated by oral ingestion of 20 g carbohydrate, preferably as glucose tablets or equivalent. BG should be retested in 15 minutes and then re-treated with another 15 g glucose if the BG level remains <4.0 mmol/L [Grade D, Consensus].
  3. 3.Severe hypoglycemia in an unconscious individual
    1. a.With no IV access: 1 mg glucagon should be given subcutaneously or intramuscularly. Caregivers or support persons should call for emergency services and the episode should be discussed with the diabetes healthcare team as soon as possible [Grade D, Consensus].
    2. b.With IV access: 10–25 g (20–50 cc of D50W) of glucose should be given intravenously over 1–3 minutes [Grade D, Consensus].
  4. 4.For individuals at risk of severe hypoglycemia, support persons should be taught how to administer glucagon by injection [Grade D, Consensus].
  5. 5.Once the hypoglycemia has been reversed, the person should have the usual meal or snack that is due at that time of the day to prevent repeated hypoglycemia. If a meal is >1 hour away, a snack (including 15 g carbohydrate and a protein source) should be consumed [Grade D, Consensus].
  6. 6.Patients receiving antihyperglycemic agents that may cause hypoglycemia should be counselled about strategies for prevention, recognition and treatment of hypoglycemia related to driving and be made aware of provincial driving regulations [Grade D, Consensus].

BG, blood glucose.


  1. Slama G, Traynard PY, Desplanque N, et al. The search for an optimized treatment of hypoglycemia: carbohydrates in tablets, solution, or gel for the correction of insulin reactions. Arch Intern Med 1990;150:589-93.


Reproduced with permission from Canadian Journal of Diabetes © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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