• If blood glucose is <70 mg/dL (3.9 mmol/L):
  1. Take 15 g fast-acting carbohydrate
  2. Recheck glucose in 15 minutes
  3. If still <70, repeat 15 g and recheck in 15 minutes
  4. Once corrected, eat a snack/meal with carb + protein if next meal is >1 hour away

Fast-acting carb equivalents (about 15 g)

• 3-4 glucose tablets (depending on brand)
• 1 tube glucose gel
• 4 oz (120 mL) fruit juice
• 4 oz regular (non-diet) soda
• 1 tbsp sugar or honey

Severe hypoglycemia

• If confused, unconscious, seizing, or unable to swallow:
  • Do not give oral food/drink
  • Give glucagon (nasal or injection) if available
  • Call emergency services

Common “correction points” to remember

• Treat at <70 mg/dL
• Recheck every 15 min
• Avoid overtreating (which causes rebound hyperglycemia)
• Identify cause: missed meal, excess insulin, exercise, alcohol, renal impairment, etc.

1. Confirm low glucose
   • Treat if <70 mg/dL (3.9 mmol/L) or if classic symptoms with no immediate test available.
2. If patient is awake and can swallow (mild/moderate)
   • Give 15 to 20 g fast-acting carbohydrate (glucose tablets/gel, juice, regular soda, sugar/honey).
   • Recheck glucose in 15 minutes.
   • If still <70 mg/dL, repeat.
   • Once corrected, give a longer-acting carb snack or meal to prevent recurrence.
3. If severe hypoglycemia (needs help, altered, unconscious, seizure)
   • No oral intake.
   • If no IV access: give glucagon
     • 1 mg IM/SC or 3 mg intranasal.
   • If IV access available: give IV dextrose 10 to 25 g
     • e.g., 20 to 50 mL D50W over 1 to 3 min.
   • Call/emergency support and observe closely.
4. After recovery
   • Recheck glucose repeatedly for recurrence.
   • Identify trigger: excess insulin/sulfonylurea, missed meal, exercise, alcohol, renal dysfunction.
   • Adjust treatment plan to prevent repeat episodes.

• Hypoglycemia in Adults (p.24): Level 3 treatment doses for glucagon and IV dextrose.
• Diabetes Management in Wilderness Athletes (p.11): glucose repletion principles and severe hypoglycemia definition.