Guidelines for the management of hypoglycaemia in adults

CLINICAL GUIDELINE FOR THE CARE OF PEOPLE WITH 

DIABETES THE MANAGEMENT OF HYPOGLYCAEMIA IN 

ADULTS 

1. Aim/Purpose of this Guideline 

This guideline is for the management of Hypoglycaemia in Adults with Diabetes. 

It has been benchmarked against national guidance, to provide detailed guidance 

on the clinical management of hypoglycaemia in line with best practice 

guidelines. This guideline applies to all healthcare professionals involved in the 

treatment of hypoglycaemia 

2. The Guidance 

Hypoglycaemia 

Hypoglycaemia (which literally means low sugar in the blood) occurs when the blood 

glucose falls below 4 mmol/l 

Symptoms of Hypoglycaemia 

may include one or more of the following 

Sweating 

Hunger 

Pallor 

Headache 

Odd behaviour, confusion, aggression 

Weakness 

Drowsiness 

All episodes of hypoglycaemia i.e. glucose < 4mmol/l should be treated even if symptoms 

are not present 

References 

 

 

 

 

 

G. Williams, J Pickup 2009 :The Handbook of Diabetes 3 rd Edition. 

The Oxford Centre for Diabetes, 2002 Endocrinology and Metabolism. 

Diabetes UK 2010 (Online) 

Resuscitation Council(UK) 2010 (Online) 

NHS Diabetes 2010 : The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitis 

Clinical Guideline For The Care Of People With Diabetes The Management Of Hypoglycaemia In Adults 

Page 1 of 8

Initial Management of Hypoglycaemia 

(For patients who are enterally fed whilst nil by mouth see page 3) 

Is the peripheral blood glucose < 4 mmol/l 

Yes 

If the peripheral blood glucose < 2.8 mmol/l a 

venous sample must be obtained as per policy 

Clinical guideline for use of Nova Stat Strip blood 

glucose meter 

(Do not wait for the result before treating the hypo) 

No 

Hypoglycaemia management is not 

appropriate. 

BUT consider other reasons for 

symptoms and review soon as blood 

glucose may be dropping rapidly 

Is the patient conscious and able to swallow? 

Yes No 

1. Inform medical staff 

2. Give 15 - 20 grams of fast acting carbohydrate 

15-20 grams is 

150-200 mls of pure fruit juice 

90-120 mls of Lucozade original 

150-200 mls of Coca Cola original 

30-40 mls (to be diluted) of Ribena original 

4 - 5 Glucotabs 

3 - 4 heaped teaspoons of sugar dissolved in 

a non milky drink 

Or 

3. If the patient is Nil By Mouth 

1½ - 2 tubes of Glucose oral gel squeezed into the 

side of the mouth. (not swallowed).Rubbing the cheek 

can aid absorption. 

4. Repeat peripheral blood glucose in 10 minutes. 

N.B. follow this process twice only then seek medical 

review for Intravenous glucose / IM Glucagon 


2. Intravenous injection of 50 mls of 10% glucose 

(must be prescribed) 

3. Further intravenous injection 50mls of 10% 

glucose every minute until the glucose is > 4 mmol/l 

(must be prescribed) (give up to 150 mls in total) 

Or 

4. 1 mg of glucagon s.c, or i.m. (must be prescribed) 

* 

Then 

5. Repeat peripheral blood glucose in 10 minutes. 

 

 

Glucagon may be ineffective in episodes of 

hypo precipitated by the ingestion of alcohol 

N.B. follow this process twice only then seek 

medical review 

Is the peripheral blood glucose< 4mmol/l 

Yes 

If the patient is conscious and not nil by mouth 

1. Follow up with long acting carbohydrate i.e. 2 plain biscuits or 1 slice of toast or 200-300 mls of milk (Double 

the amount if Glucagon used) 

Or 

2. A meal with carbohydrate if the next meal is due. 

If the patient remains unconscious or is nil by mouth obtain medical review 

Guidance Notes 

Do not withhold insulin / medication. Once the hypoglycaemia has been treated as per the above 

guidelines, administer usual insulin / medication to prevent rebound hyperglycaemia. 

Intravenous Insulin Infusion is not a treatment for hypoglycaemia 

Note that hypo due to overdose of oral hypoglycaemics/insulin/ may be prolonged and may require 

prolonged dextrose infusion 

Continue regular blood glucose monitoring for at least 24 -48 hours. Long term management - medical 

review of insulin / medication / cause of repeated episodes of hypoglycaemia. 

For further advice refer to Diabetes In-Patient Specialist Nurse bleep 2205 / #3104 or the Endocrine team 

No 



Initial Management of Hypoglycaemia 

Adult inpatients with Diabetes who are being ENTERALLY fed whilst nil by mouth 

Is the peripheral blood glucose < 4 mmol/l 

Yes 

No 

If the peripheral blood glucose < 2.8 mmol/l a 

venous sample must be obtained as per policy 

Clinical guideline for use of Nova Stat Strip 

blood glucose meter 

(Do not wait for the result before treating the 

hypo) 

Hypoglycaemia management is not 

appropriate. 

BUT consider other reasons for symptoms 

and review soon as blood glucose may be 

dropping rapidly 


2. Give 15 - 20 grams of fast acting carbohydrate via the enteral feeding tube (by gravity– use a 

purple syringe as per NPSA). 

 

 

 

15-20 grams is 

45-60 mls Juice style Supplement Drink (ProvidExtra Juice Drink, Ensure Plus Juice or 

Fortijuice) 

30-40 mls of Ribena original (do not dilute) 

3-4 heaped teaspoons of sugar dissolved in sterile water 

 

flush with 50mls of sterile water 

Then 

N.B. follow this process twice only then seek medical review for Intravenous glucose / IM Glucagon 

Repeat peripheral blood glucose in 10 mins 

Is the peripheral blood glucose< 4mmol/l 

Yes No 

 

 

1. Follow up with long acting carbohydrate via enteral feeding tube: 

Restart Enteral feed 

or 

give 100 mls of Milky Supplement drink 

(Fresubin Energy Drink, Ensure Plus Milk Shake Style, Fortisip) 

CC/BH 

Guidance Notes 

Do not use Oral Glucose Gel due to risk of aspiration 

Avoid using fizzy drinks or fruit juice as these can damage the tube 

Do not withhold insulin / medication. Once the hypoglycaemia has been treated as per the above guidelines, 

administer usual insulin / medication to prevent rebound hyperglycaemia. 

Continue regular blood glucose monitoring for at least 24 -48 hours. Long term management - medical review 

of insulin / medication / cause of repeated episodes of hypoglycaemia. 

Intravenous Insulin Infusion is not a treatment for hypoglycaemia 

Note that prolonged hypo may require prolonged dextrose infusion 

For further advice refer to Diabetes Dietitian bleep 2955 / #4569 / #2409 



3. Monitoring compliance and effectiveness 

Element to be 

monitored 

Lead 

Tool 

Frequency 

Reporting 

arrangements 

Acting on 

recommendations 

and Lead(s) 

Compliance 

Specialist Adult In-Patient Diabetes Team 

Patient Documentation 

Adult diabetes In-patients who are reviewed by the specialist 

diabetes team who have required management of Hypoglycaemia 

Non compliance will be reported to the ward /area manager. 

Repeated non compliance will be reported via Datix 

Ward / Area managers will undertake subsequent 

recommendations and action planning for any or all deficiencies 

and recommendations within reasonable timeframes for their areas 

The Specialist Adult In-Patient Diabetes Team will undertake any 

trust wide recommendations and action planning for any or all 

deficiencies and recommendations within reasonable timeframes 

Change in 

practice and 

lessons to be 

shared 

Lesson learned or changes to practice will be shared with all the 

relevant stakeholders 

4. Equality and Diversity 

4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service 

Equality and Diversity statement. 

4.2. Equality Impact Assessment 

The Initial Equality Impact Assessment Screening Form is at Appendix 2. 



Appendix 1. Governance Information 

Document Title 

Date Issued/Approved: 19 Jul 12 

Clinical Guideline For The Care Of People 

With Diabetes The Management Of 

Hypoglycaemia In Adults 

Date Valid From: 19 Jul 12 

Date for Review: 1 July 2015 

Directorate / Department responsible 

(author/owner): 

Amanda Veall Clinical Nurse Specialist 

Diabetes 

Contact details: 01872 253104 

Brief summary of contents 

Treatment for hypoglycaemia in adults with 

diabetes 

Suggested Keywords: 

Target Audience 

Executive Director responsible for 

Policy: 

Diabetes 

RCHT PCT CFT 

 

Medical Director 

Date revised: April 2012 

This document replaces (exact title of 

previous version): 

Approval route (names of 

committees)/consultation: 

Divisional Manager confirming 

approval processes 

Guidelines For The Management Of 

Hypoglycaemia In Adults 

Diabetes In-Patient Specialist Nurses, 

Specialist Diabetes Dietitian, Consultant 

Endocrinologists 

Rowena Green 

Name and Post Title of additional 

signatories 

Signature of Executive Director giving 

approval 

Publication Location (refer to Policy 

on Policies – Approvals and 

Ratification): 

Document Library Folder/Sub Folder 

Not Required 

{Original Copy Signed} 

Internet & Intranet Intranet Only 

Clinical/ Endocrine And Diabetes 

Links to key external standards NSF Diabetes Standards 7 and 8 

Related Documents: 

NHS Diabetes: The Hospital Management 



Training Need Identified? 

of Hypoglycaemia in Adults with Diabetes 

Mellitus March 2010 

Yes / Learning and Development have been 

informed via email 15/05/2012 

Version Control Table 

Date 

March 

2010 

30 April 

2012 

Version 

No 

V1.0 Initial Issue 

V2.0 

Summary of Changes 

Amendment to quantities of CHO and 

enterally fed patients in accordance with 

national guideline 

Changes Made by 

(Name and Job Title) 

Amanda Veall 

Clinical Nurse 

Specialist Diabetes 

Amanda Veall 

Clinical Nurse 

Specialist Diabetes 

All or part of this document can be released under the Freedom of Information 

Act 2000 

This document is to be retained for 10 years from the date of expiry. 

This document is only valid on the day of printing 

Controlled Document 

This document has been created following the Royal Cornwall Hospitals NHS Trust 

Policy on Document Production. It should not be altered in any way without the 

express permission of the author or their Line Manager. 



Appendix 2.Initial Equality Impact Assessment Screening Form 

Name of service, strategy, policy or project (hereafter referred to as policy) to be 

assessed: Clinical Guideline For The Care Of People With Diabetes The Management 

Of Hypoglycaemia In Adults 

Directorate and service area: Diabetes 

Is this a new or existing Procedure? 

Existing 

Telephone: 01872 253104 

Name of individual completing 

assessment: Amanda Veall 

1. Policy Aim* To provide detailed guidance on the clinical management of 

hypoglycaemia in line with best practice guidelines. 

2. Policy Objectives* To provide a consistent approach to the management 

of hypoglycaemia at RCHT sites. 

3. Policy – intended 

Outcomes* 

4. How will you measure 

the outcome? 

5. Who is intended to 

benefit from the Policy? 

 

 

 

To maintain patient safety and improve outcomes for 

patients experiencing hypoglycaemia whilst inpatients 

at RCHT sites 

Consistent management of hypoglycaemia at RCHT 

sites. 

Prompt and safe management of hypoglycaemic 

episodes and follow up care. 

Audit 

Datix Reporting 

Review of nursing/ medical documentation as required 

All patients with diabetes who experience hypoglycaemia in 

hospital at RCHT sites. 

6a. Is consultation 

required with the 

workforce, equality 

groups, local interest 

groups etc. around this 

policy? 

b. If yes, have these 

groups been consulted? 

c. Please list any groups 

who have been consulted 

about this procedure. 

Yes 

Yes 

Diabetes Inpatient Specialist Nurses 

Consultant Endocrinologists 

Diabetes Dietician 

*Please see Glossary 

7. The Impact 

Please complete the following table using ticks. You should refer to the EA guidance notes 

for areas of possible impact and also the Glossary if needed. 

Where you think that the policy could have a positive impact on any of the equality 

group(s) like promoting equality and equal opportunities or improving relations 

within equality groups, tick the ‘Positive impact’ box. 

Where you think that the policy could have a negative impact on any of the equality 

group(s) i.e. it could disadvantage them, tick the ‘Negative impact’ box. 



Where you think that the policy has no impact on any of the equality group(s) listed 

below i.e. it has no effect currently on equality groups, tick the ‘No impact’ box. 

Equality 

Group 

Age 

Positive 

Impact 

Negative 

Impact 

No 

Impact 

x 

Reasons for decision 

Disability 

x 

Religion or 

belief 

Gender 

x 

x 

Transgender 

x 

Pregnancy/ 

Maternity 

Race 

x 

x 

Sexual 

Orientation 

Marriage / Civil 

Partnership 

x 

x 

You will need to continue to a full Equality Impact Assessment if the following have 

been highlighted: 

A negative impact and 

No consultation (this excludes any policies which have been identified as not 

requiring consultation). 

8. If there is no evidence that the policy 

promotes equality, equal opportunities 

or improved relations - could it be 

adapted so that it does? How? 

Full statement of commitment to policy of 

equal opportunities is included in the policy 

Please sign and date this form. 

Keep one copy and send a copy to Matron, Equality, Diversity and Human Rights, 

c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Chyvean 

House, Penventinnie Lane, Truro, Cornwall, TR1 3LJ 

A summary of the results will be published on the Trust’s web site. 

Signed ________Amanda Veall________________________________ 

Date _____10-07-2012____________________________________

Guidelines for the management of hypoglycaemia in adults

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